NUR 490 Critical Care Nursing

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 sleep apnea and high blood pressure, which he tries to control with sodium restriction. 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:

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.

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 risks

Health risks associated with obesity that Mr. C. Have are:

Hypertension due to high blood pressure

Cholesterol and elevated triglycerides

Diabetes due to increased glucose levels

Cardiovascular diseases due to increasing weight (Shiao et al., 2013)

Intervention

Bariatric surgery may be beneficial for Mr. C as he is overweight and obese. With the help of surgery he can lose weight and decrease the risk of heart attack.  It will also reduce other comorbidities such as cholesterol, high blood pressure and risk of diabetes. Mortality rate was found to decrease by increasing bariatric surgery interventions. In addition to this intervention, Mr. C must undergo healthy lifestyle changes and it may be possible with the help of counselling sessions.  Counselling will help him get mentally ready for surgery and lose weight (Chang et al., 2014).  

Assessment of health function

Health management and health perception- Mr. C is ready for intervention that is bariatric surgery. It indicates that he perceives himself to be unhealthy and overweight as problematic health condition. He is taking the low sodium weight diet to manage high blood pressure

Nutritional-metabolic- despite weight gain Mr. C is consuming high calories every day as evident from the high glucose sugar, and saturated fat in his diet is evident from high cholesterol. He takes snacks late night which may the cause of increasing weight (Farzaei et al., 2015).

Elimination- the case study does not inform about the input and output problems of the patient. Healthy diet may eliminate the problems due to constipation or diarrhea.

Activity exercise- the patient’s lifestyle indicates a sedentary nature. It can be assumed that lack of physical activity may be the cause of weight gain  

Sleep rest- sleep apnoea deprives a person of sound sleep (Shiao et al., 2013)

Cognitive perceptual- the patient is cognitive alert of his illness, ready to learn and is seeking intervention

Self-perception and self concept- patient does not accept his illness as something wrong and is trying to cope up with it

Role –relationship- the patient’s family history is not given however, he may need family support to make healthy lifestyle changes

Coping stress tolerance- there is no data on coping mechanism.

Value belief- the patient values and beliefs are not mentioned

Potential problems

The actual and potential problems of Mr.C are (Leontiadis et al., 2013)-

Sleep apnoea- it is an independent risk factor for peptic ulcer and cessation breath exacerbates the condition of peptic ulcer

High blood pressure- obesity increases the arterial hypertension

Diabetes- type 2 diabetes is highly likely in patient and also has high glucose levels that increases risk can be known by hgbA1c 

Obesity- the patient has morbid obesity and is gaining weight with sedentary life style and dietary habits

Coronary artery disease- It is the potential problem associated with the diabetic condition and obesity patients. The course of this disease is concurrent with peptic ulcer  

References

Chang, S. H., Stoll, C. R., Song, J., Varela, J. E., Eagon, C. J., & Colditz, G. A. (2014). The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA surgery, 149(3), 275-287.

Farzaei, M. H., Abdollahi, M., & Rahimi, R. (2015). Role of dietary polyphenols in the management of peptic ulcer. World journal of gastroenterology: WJG, 21(21), 6499.

Leontiadis, G. I., Molloy-Bland, M., Moayyedi, P., & Howden, C. W. (2013). Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis. The American journal of gastroenterology, 108(3), 331-345.

Shiao, T. H., Liu, C. J., Luo, J. C., Su, K. C., Chen, Y. M., Chen, T. J., ... & Lee, Y. C. (2013). Sleep apnea and risk of peptic ulcer bleeding: a nationwide population-based study. The American journal of medicine, 126(3), 249-255.