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
What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?
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.
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.
Nursing
Obesity falls among the most common lifestyles diseases in the world today. Although there has been an association of obesity with genetics, most cases are related to wrong and unhealthy eating habits (Gustafson, 2010). One of the health risks that Mr. C. faces as a result of obesity is the development of heart diseases. Obesity leads to accumulation of cholesterol around the heart area. This makes it difficult for the blood vessels in the heart to carry out their functions properly. This leads to ailments such as high blood pressure and in very serious cases, a person may suffer cardiac arrest.
Bariatric surgery, commonly known as the surgery for weight loss is one of the most appropriate medical procedures for people with obesity. The aim of this medical process is to considerably bring to a small size the intestines thereby reducing the amount of food taken by an individual (Nonas, 2009). It is however done as last resort when the health of a person is on jeopardy all other avenues have proven futile.
The timings of the meal given are perfect but must be followed with strict adherence. It is, however, important for Mr. C. to have in between snacks between the first meal of the day and the second. Similarly, the period between the second and the third meal there ought to be snack. When the body is pushed to starvation, a person is likely to add weight instead of losing. This is because the energy that has been stored in form of fat is converted to provide energy to the starving body (Williams, 2011).
Due to the recently diagnosed condition peptic ulcer, the patient must ensure that they constantly have something to eat. It is thus advisable to eat often but in small bits. Use of magnesium hydroxide and aluminum hydroxide will come in hand to stabilize the ulcers. Mr. C. must however keep away from stressful conditions so as to contain the peptic ulcer condition.
References
Nonas, C. (2009). Managing obesity: a clinical guide. New York: Prentice Hall.
Gustafson S. (2010). Managing obesity and eating disorders. London: Sage.
Williams, G. (2011). Obesity: science to practice. New York: American Dietetic Association