The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
Mr. C., a 32-year-old single man, is seeking information at the outpatient center
regarding possible bariatric surgery for his obesity. He reports that he has always been
heavy, even as a small child, but he has gained about 100 pounds in the last 2-3 years.
Previous medical evaluations have not indicated any metabolic diseases, but he says he
has high blood pressure, which he tries to control with sodium restriction and sleep
apnea. He current works at a catalog telephone center.
Objective Data
�Height: 68 inches; Weight 134.5 kg
�BP: 172/96, HR 88, RR 26
�Fasting Blood Glucose: 146/mg/dL
�Total Cholesterol: 250mg/dL
�Triglycerides: 312 mg/dL
�HDL: 30 mg/dL
Critical Thinking Questions
1.What health risks associated with obesity does Mr. C. have? Is bariatric surgery an
appropriate intervention? Why or why not?
2.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.
1.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).
2.What actual or potential problems can you identify? Describe at least five problems
and provide the rationale for each.
Case Study
The case study is about a 32 year-old man seeking information regarding bariatric
surgery for his health condition. The patient states that he has always been obese since
childhood, but has recently gained 100 pounds. From the laboratory findings, the patient
could be suffering from diabetes because the level of fasting sugar (146 mg/dl) is way above
the normal level of 70-100 mg/dl. He is also at great danger of developing coronary heart
infection since his cholesterol level is high (250 mg/dL). His HDL is low than 40 mg/Dl
which is considered as a risk for heart disease. The normal triglycerides should be less than
CASE STUDY 2
150mg/dl; the patient has high triglycerides level. He is also at high risk of cancer,
osteoarthritis, and metabolic syndrome (Schuiling & Likis, 2013).
Bariatric surgery is an alternative that could be utilised by the patient as a medical
weight loss therapy. This is because patient loses up to 50% of their fat after this medical
weight loss treatment, which reduces their risks for developing complications associated with
cardiovascular diseases. In this case, the patient is most likely to have non-surgical weight
loss programs that were not successful. The patient is psychologically stable and have
supportive social environment. He must commit to lifestyle changing programs; diet,
supplementation as well as regular follow up. He must also understand that the procedures
are also associated with complications such as wound infection, bleeding, marginal ulcers,
gall stones, and anastomotic leak (Schuiling & Likis, 2013).
Administration schedule
DAY 9.pm 10. pm 6.am 10 am
The medicine
should be
taken every
day at these
stipulated
times
Mylanta 15mL PO 1
hour
AND
Sucralfate /
Ranitidine
(Zantac) 300
mg PO
Sucralfate /
Carafate 1 g
or 10ml
suspension
(500mg /
Mylanta
15mL PO 1
hour
CASE STUDY 3
Carafate 1 g or
10ml suspension
(500mg / 5mL)
5mL)
Functional Health patterns Assessment:
Nutrition pattern: The patient nutrition consists of unhealthy foods. These includes
fast foods and takes one large size of sweetened drinks.
Elimination pattern: The patient has normal regular bowels movement twice per day.
Urination frequency is irregular. He uses laxatives to ease regular constipation.
Activity/ Exercise pattern: He is physically inactive.
Sleep/ rest pattern: The patient suffers from sleep which makes him tire easily
Cognitive perceptual pattern: He seemed to be distressed by his weight. However, he
denies any history of neurological or cerebrovascular disorders or his in his family health
history
Self-perception: He has problem in expressing himself due to low self-esteem. He
suffered from discrimination.
Roles and relationship: He is friendly and respectful. He does not have a girlfriend
Cooping and stress management: He has learnt coping strategies to manage his obese
condition. The patient states that he struggles to manage hypertension
Sexuality and reproduction: He has no history of sexual abuse. He has normal sexual
functioning.
Values and beliefs: He is a Christian and attends church each Sunday. He believes
that people should be treated with love, care and respect
Actual and Potential Problems Identified
The problems identified from the family health assessment include (CDC, 2013);
CASE STUDY 4
a) Diabetes: The patient eating pattern and the laboratory finding indicates that the patient is
suffering from diabetes. More screening should be done to for early diagnosis of the disease.
b) Coronary artery disease which is supported by elevated cholesterol levels and poor
nutrition. The patient is also physically inactive, increasing the risk of these cardiovascular
disorders
c) Depression; Patient is likely to suffer from depression due to low self-esteem, lack of
coping strategies and increased discrimination.
d) Osteoporosis: the patient nutrition is lacks adequate minerals important for strengthening
of bones
e) Goitre: the patient uses little salt to manage hypertension, which could lead to deficiency
of sodium chloride.
References
CDC report (2013). Strategies to Prevent Obesity.
Schuiling, K.D. & Likis, F.E. (2013). Women’s gynecologic health. Burlington, MA: Jones
and Bartlett Learning.