What health risks associated with obesity does Mr. C. have?

Nearly one third of the adult population of the United States is overweight or obese (Centers of Disease Control and Prevention, 2015). Obesity and diabetes are major health problems that are rapidly getting worse in the United States. In addition, obese people have an increased risk for the development of cardiovascular disease because obesity is often accompanied by elevated serum lipid levels. Obesity is also associated with hypertension. Obesity places an increased workload on the heart, which increases oxygen demand. According to the Centers of Disease Control and Prevention “the estimated cost of obesity in the United States was 147 billion in 2008 and the medical costs of people who are obese were $1,429 higher than those of normal weight” (Centers of Disease Control and Prevention, 2015). Obese people are also more likely to have delayed wound healing and wound infection because adipose tissue impedes blood circulation and its delivery of nutrients, antibodies, and enzymes required for wound healing. Obese clients also have difficulty breathing when sedated (Orlando Sentinel, 2012).

Is bariatric surgery an appropriate intervention? Why or why not?

 

According to the American Nurses Association “bariatric surgery provides dramatic improvement” to obese people that suffer from chronic diseases such as heart disease, hypertension, sleep apnea, degenerative joint disease, gastroesophageal reflux disease, asthma, and depression (American Nurses Association, 2009).

Bariatric surgery can be very effective when combined with a comprehensive treatment plan according to the American Society for Metabolic and Bariatric Surgery (American Society for Metabolic and Bariatric Surgery, 2015). The combined treatment can be an effective tool to provide a client with a long term weight-loss and help the client increase the quality of their health. Bariatric surgery has shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, hypertension, and heart disease it also helps in reducing the need to continue taking so many medications for these co-morbidities.

According to the US National Library of Medicine National Institutes of Health the following are some pros and cons of bariatric surgery (US National Library of Medicine National Institutes of Health, 2012):

 

Pros Cons
Initial and sustained weight loss Initial failure to lose weight
Resolution of obesity-related comorbidities Potential complication: preoperative, surgical, gastrointestinal, nutritional, and psychological
Improved mortality Initial costs
Reduction in obesity-related health risks Weight regain
Improved quality of life Permanency
Psychosocial benefit  

 

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered: (a) Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime; (b) Ranitidine (Zantac) 300 mg PO at bedtime; and (c) 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.

Carafate Mylanta Zantac
0600    
  1000  
1100    
  1500  
1700    
  2100  
2300   2300

Assess each of Mr. C.’s functional health patterns using the information given (Hint: Functional health patterns include:

Health-perception – health management – Based on the information provided in the case study Mr. C has always been heavy since he was a child but has gained 100 pounds in the last 2-3 years. With the limited information and the increase weight in the last 2-3 years I can only presume that Mr. C might live a sedentary lifestyle that might be related to lack of motivation or lack of education or readiness.

 

Nutritional – metabolic – Mr. C  is 5 feet 5 inches and weighs 295.9 pounds. According to Premier Health, Mr. C has a BMI of 47.6 and is considered morbidly obese (Premier Health, 2015). He also claims that he has gain 100 pounds in the last 2-3 years.  Based on the information he falls under Nutrition, Imbalanced, More Than Body Requirements as evidenced by reported higher baseline weight.

Elimination – Mr. C has a peptic ulcer and symptoms include passing of bloody stools or black tarry stools. Possible nursing diagnoses can be constipation/diarrhea related to effects of medications on bowel function.

Activity-exercise – Mr. C has an office job and based on his increased weight of 100 pounds in the last 2-3 years lives a sedentary lifestyle. The case study does not specify if Mr. C performs any type of exercise activities but we can assume that he is able to perform activities of daily living.

Sleep-rest – Mr. C is morbidly obese and suffers from sleep apnea due to his overweight.

Cognitive-perceptual – Mr. C appears alert and oriented and able to make his needs known.

Self-perception – self-concept – Mr. C claims that he has been heavy all his life and has gained 100 pounds in the last 2-3 pounds.  Mr. C is looking into bariatric surgery as a solution to his morbid weight.

Role-relationship – Based on the case study Mr. C is a single man not involved in a relationship.

Sexuality – reproductive – is a young man but the case study doesn’t offer any other information.

Coping – stress tolerance – Mr. C is able to identify that he has a problem with his weight. He is taking initiative by reducing salt intake to control his hypertension and he is looking into bariatric surgery to reduce his weight problem.

What actual or potential problems can you identify?  Describe at least five problems and provide the rationale for each.

 

1) Health maintenance ineffective related to sedentary lifestyle (Ackley & Ladwig, 2011).

2) Imbalanced nutrition more than body requirements related to lack of basic nutritional knowledge (Ackley & Ladwig, 2011).

3) Disturbed sleep pattern related to sleep apnea (Ackley & Ladwig, 2011).

4) Deficient knowledge related to his obesity, disturbed body image by verbalization of his weight gain (Ackley & Ladwig, 2011).

5) Ineffective coping related to lack of knowledge of weight gain resources (Ackley & Ladwig, 2011).

References

 

Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St. Louis: Mosby, Elsevier

American Nurses Association. (2009). Weight-loss surgery. Retrieved from

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TasbleofContents/Vol142009/No1Jan09/Weight-Loss-Surgery.html

American Society for Metabolic and Bariatric Surgery. (2015). Benefits of bariatric surgery. Retrieved from https://asmbs.org/patients/benefits-of-bariatric-surgery

Centers of Disease Control and Prevention. (2015). Adult Obesity Facts. Retrieved from

http://www.cdc.gov/obesity/data/adult.html

Orlando Sentinel. (2012). Obese patients create big problems for surgeons. Retrieved from

http://articles.orlandosentinel.com/2012-07-25/news/os-obese-patients-20120724_1_obese-patients-normal-weight-person-bmi

Premier Health. (2015). BMI calculator. Retrieved from

http://www.premierhealthspecialists.org/phspractice.aspx?id=64848

US National Liberty of Medicine National Institutes of  Health. (2012). Quick fix or long-term cure? Pros and cons of bariatric surgery. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/

            

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