Review of Gastroesophageal Reflux Disease †MyAssignmenthelp.com

Question: Discuss about the Review of Gastroesophageal Reflux Disease. Answer: Introduction: Nursing care for chronic illnesses involves influence from multiple factors. In order to ensure safe and high quality care the nurse must ensure that the patient needs and the clinical needs are met. It can be ensured by the prioritisation of care and it is considered to be the integral part of the daily nursing practice (Harrison et al., 2017). The essay deals with Peter Mitchell presented with the uncontrolled diabetes and obesity. The aim of the essay is to manage the chronic illness integrating various principles. Applying the clinical reasoning cycle the main health issues of Peter will be identified, and two priorities of care will be discussed. According to Levett-Jones, clinical reasoning involves collection of cues, followed by information processing, understanding the health problems of the patient, implementing the interventions, evaluating the outcomes and reflecting on learning process (Barker, Linsley Trueman, 2016). The first step in clinical reasoning process is taking into consideration the patients situation and it involves listing of facts, objects or people (Dalton et al., 2015). Peter Michell, (52 years) is presented to medical ward with poorly controlled diabetes. He is troubled with sleep apnoea and obesity ventilation syndrome. For cues and information, the nurse must review the current information from the exiting handover, and asses for collecting new information (Barker, Linsley Trueman, 2016). On obtaining information from the clinical handover, it was found that patient has history of diabetes since 9 years; he has morbid obesity, hypertension, depression since three months, apnoea and Gastro oesophageal disease reflux disease. The patient is smoking since last 30 years. Social appears to be poor as he lives alone and his children rarely visit him. He is unable to cope up with his weight gain. His diabetes intervention, insulin led him to leave job. He is surviving only on governm ent benefits. He avoids socialization owing to his illness. He appears to be motivated to lose weight and is currently under medication. As per the previous assessment the Peter has HR 102 Bpm, BP 180/92mmHg, RR 23 Bpm, and Sp02 95%, Obesity, blood pressure, hypertension, and diabetes may be interrelated as per knowledge pathophysiology. The vital signs and symptoms demonstrated the risk of heart diseases (Koolhaas et al., 2017). Processing the collected information is important to identify the main heath issue of the patient. This part of the clinical reasoning involves analysing the data to understand the signs and symptoms of the patients and relate with the cues to identify the relationships (Barker, Linsley Trueman, 2016). It will help predict the necessary clinical outcomes in Peter. The patient has weight 145kgs and height 170cms, that can be calculated to have BMI around 50.2. A BMI of 30 or less than 30 is normal and above this range is considered obesity. The patient presenting ventilation syndrome and apnoea may be related to obesity. According to Castro-An et al. (2015) obesity disturbs the breathing process resulting low blood oxygen level and buildup of carbon di-oxide. It may have caused the ventilation syndrome. It affects sleeping process due to episodes of shallow breathing causing apnoea. People with excess weight have soft tissues in mouth and throat that may cause obstruction of airway d uring sleep. Smoking also causes apnoea through airway obstruction (Kent et al., 2015). It requires immediate intervention to prevent further deterioration. Patient history of hypertension is due to both obesity and diabetes. Hypertension is known as high blood pressure. The normal BP should be 120/80 and the patient has 180/92. Increase in fatty tissues in the body with weight gain increases vascular resistance and pressure on arteries. It causes the heart to pump more blood. Obesity is known as the major cause of type 2 diabetes. Obesity increases the insulin production to compensate the blood sugar level. It results in diabetes. Diabetes causes arthrosclerosis, thereby increasing blood pressure. It is the risk factor for stroke, and kidney damage (Koolhaas et al., 2017).The patient has high heart rate that is 102 bpm which is greater than the normal 100 bpm. The respiratory rate of the patient is 23 bpm which is greater than the normal 12-20 bpm. The increased respiratory and heart rate may be due to excess adipose tissues that restricts the movement of chest muscle and diaphragm. The increase in blood pressure, heart rate and respira tory rate, may lead to heart failure. It is also the risk factors for collapsibility of pharyngeal tract (Lycett et al., 2015). Depression in the Peter may be associated with illness and deterioration as well as social isolation. Stresses due to illness, smoking and social isolation are known to elevate depression (Snoek et al., 2015). Further, the gastro oesophageal disease reflux in patient is also associated with obesity. Lower oesophagealsphincterin obese people is displaced due to high intra-abdominal pressure. It results in increased gastro-oesophagealgradient. Obesity with diabetes further worsens this disease by damaging the nerves that is neuropathy. It may be improved by better glycemic control. Diaphoresis is also common to both obesity and diabetes (Punjabi et al., 2015). It can be concluded that obesity and diabetes are the major health issue of the patient. In order to establish the nursing goals, it is important to identify the patient problems by synthesising facts and inferences (Barker, Linsley Trueman, 2016). Based on the above analysis, the main issues identified are obesity due to excess weight and diabetes due to poorly controlled blood glucose level. However, obesity is the root of all the complications. The symptoms presented by Peter such as diaphoresis, shakiness and other deviation in vitals signs are all common to obesity and diabetes. These symptoms require immediate intervention as there is increasing risk of heart failure, liver, kidney damage. Weight gain increases obesity and diabetes, which increases the appetite and further weight gain. The symptoms of both the diseases are interrelated like a vicious cycle. Adequate nursing plan will help decrease the comorbidities and improve the quality of life. Taking action plan to reduce weight and glucose control will help Peter improve his social life and overcome depressio n. It will help him better participate in his activities of daily living. Based on the analysis two health priorities are identified to develop appropriate nursing actions. The two health issues in Peter are obesity due to excess weight gain, and uncontrolled diabetes. Reducing weight and controlling glucose level will eventually improve all the associated complications and are two priorities of care. Appropriate nursing action plan is developed to fulfil the two nursing priorities of care. Actions are based on the evidence and include both pharmacological and non-pharmacological interventions. The non-pharmacological interventions are lifestyle interventions. To fulfil the first priority, the patient may be administered with the orlistat as it effectively decreases the absorption of dietary fat by 30% (Yanovski Yanovski, 2014). It also improves sensitivity to insulin. The patient will be educated to lose weight and engage in exercises. The benefits and implications will be explained to ensure compliance to the treatment. It will be followed by collaboration with dietician to develop effective weight reduction and diet plan for Peter (Sharma Lau, 2013). The plan will include weight loss protocol with weekly target. The patient may be recommended to intake high protein diet and low fat food. It will help decrease cholesterol (Franz et al., 2015). Further, patient will be engaged in weight reduction by exercise program. It may be aerobics or brisk walking, to help manage the sugar level. Peter can participate for five days in a week for 30 minutes in swimming (Koolhaas et al., 2017). To fulfil the second priority, the nurse may administer the glucose lowering tablets such as metaformin. It is a glycosidase inhibitor. It is also helpful to reduce weight as well. Alongside insulin may be administered. The dosage may be adjusted to prevent hyperglycemia. In addition the patient may be administered with the anti-hypertensive medication to control high blood pressure such as metaprolol. It will prevent the risk of heart failure (Yang et al., 2018). The nurse may enhance self care in Peter by educating him about the self care. He may be trained to self monitor glucose. Educating patient about effect of smoking on diabetes, will motivate Peter to accept healthy behaviour (Lycett et al., 2015). He will be better able to manage the diabetes and obesity complications (Franz et al., 2015). Also he has depression, so he will be referred to psychiatrist. It will help Peter stop smoking, cope with weight loos interventions and overcome depression (Baumeister et al., 2014). After action plan, evaluating the efficacy of the clinical outcomes is important part of nursing care that helps achieve desired goals (Dalton Gee Levett-Jones, 2015). The patient may be monitored for any sign of ketoacidosis, as it may lead to death in untreated condition. Peters weight should be monitored regularly along with other vital signs. It includes his blood pressure, respiratory rate and oxygen saturation. Considering the medication, it may be effective to monitor hyperglycaemic condition. The patient will be monitored for diet plan adherence and exercise program to make modifications (American Diabetes Association, 2015). Reflection on the care process seems that it may be challenging for Peter to follow the dietary recommendations. I will support him through motivational therapy and involve in group discussions. It will improve social life and minimise stress (Baumeister, Hutter Bengel, 2014). In conclusion, the case study helped understand the clinical reasoning process. It allows nurses to design goal driven care plan for the chronic condition. Applying clinical reasoning cycle, the care plan for Peter is designed based on evidence. The essay helped gain valuable insights into prioritisation of care by analysing the health issues obesity and diabetes. The interventions were targeted to two priorities of care that are weight reduction and control glucose level. The interventions will help improve peters health related quality of life. References American Diabetes Association. (2015). 3. Initial evaluation and diabetes management planning.Diabetes Care,38(Supplement 1), S17-S19. Barker, J., Linsley, P., Trueman, I. (2016). Clinical judgement and decision making.Evidence-based Practice for Nurses and Healthcare Professionals, 45. Baumeister, H., Hutter, N., Bengel, J. (2014). Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review.Diabetic Medicine,31(7), 773-786. 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