1) What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?
Health risks associated with obesity that Mr.C has are:
– Elevated fasting blood glucose at 146/mg/dL (Mr. C. possibly might have diabetes)
– Elevated 172/96 with RR at 26. Mr. C. has hypertension and his RR shows that his body has to work harder to breathe; sleep apnea is another health risk.
– elevated total cholesterol is 250mg/dL (desirable value is below 200mg/dl).
– HDL is 30 mg/dL, which is low. Optimal value that protects ones heart is above 60 mg/dL.
– Elevated triglycerides at 312mg/dl and the desirable value should be below 200 mg/dl (Cholesterolmenu, 2017).
“Consensus guidelines suggest that the surgical treatment of obesity should be reserved for patients with a body-mass index (BMI) >40 kg/m(2) or with BMI >35 kg/m(2) and 1 or more significant comorbid conditions, when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity and mortality “ (Pentin, Nashelsky, 2005). Mr. C.’s Height: 68 inches (170 cm); Weight 134.5 kg; BMI is 46.9 (BMI calculator, 2017). Mr. C. is considered obese and meets criteria for beriatric surgery with BMI of 46.9 and at least one comobordity that puts him at risk for heart disease and stroke.
2) Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:
- Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
- Ranitidine (Zantac) 300 mg PO at bedtime.
- Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.
The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.
22:00 Mylanta and Zantac
22:30 (after snack) Carafate
3) Assess each of Mr. C.’s functional health patterns using the information given (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance).
What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.
Health perception – health management: Mr.C.is obese. He seeks information about bariatric surgery. He was always heavy but within last 2-3 years gained about 100lb. Potential problem within health perception and management for this individual is knowledge deficit. Mr. C.’s labs reveal high cholesterol, triglycerides. Mr C. knows he has high blood pressure but the only intervention is sodium restriction. Mr C. does not know how to manage his weight and needs to be aware about the risks he might be facing like heart disease, stroke. Even with surgery Mr C. still needs to know about what his daily nutrition should be.
nutritional – metabolic: Mr.C has imbalanced nutrition: more than body requirements. He consumes too much food and possibly not the healthy nutrients that his body needs (HDL is low). Sedentary lifestyle (working at a call center where he is sitting all day) is contributing to his obesity. Mr C. was diagnosed with peptic ulcer as well. According to a study by the National Institutes of Health [NIH], obesity can be a contributing factor to the development of gastric ulcers (2014).
Elimination: there is not enough data to examine this pattern.
activity-exercise: Mr.C’s job requires him to sit most of the day at the call center. Physical activity deficit is consequitive problem. Lack of exercise is contributing to Mr. C.’s obesity. Intervention with safe exercise plan is needed for Mr. C.
sleep-rest: Sleep pattern is disturbed due Mr. C.’s sleep apnea. This problem can cause him to be tired and weak during the day. Body that is depleted from oxygen can suffer other negative consequences such as heart problems.
self-perception – self-concept: Mr.C’s body image is disturbed due to his obesity. He knows that he is overweight and his self esteem is probably low. We can assume he is self aware and is looking for change since he is seeking information about surgery. He needs support, help and education
role-relationship: Mr. C. is single. Further assessment is needed for more information
Cholesterolmenu. (2017). A comprehensive Guide on Ideal Cholesterol Levels. Retrieved from: http://www.cholesterolmenu.com/cholesterol-levels-chart/
National Institutes of Health [NIH]. (2014). Measures of adiposity are associated with increased risk of peptic ulcer. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24681076