Question

he 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 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.

Answer 1

Mr. C. health risks associated with obesity:

Based on the information it is clear that Mr. C have the risk of cardiovascular disorders like coronary artery disease (CAD), congestive heart failure (CHF), stroke. diabetes etc. Apart from Mr. C has high risk for hypertension. Besides, minor chances for cancer, gallbladder disease and gallstones, osteoarthritis gout etc.

Bariatric surgery appropriate intervention:

Yes, bariatric surgery is a more effective intervention for weight loss than non-surgical options. For example, in one large cohort study, weight loss was still apparent ten years after surgery, although patients receiving conventional treatment had gained body weight. Even it was evidenced most of the cases that after surgery, few numbers of peoples have metabolic syndrome and there was a higher remission of type 2 diabetes than in non-surgical groups. In another large cohort study, the incidence of 3 out of 6 comorbidities assessed 10 years after surgery was reduced body weight as compared with conventional therapy.

1. ANS: Functional health patterns include health-perception – health management

It’s focused on the person’s perceived level of health and well-being, and on practices for maintaining health. It also assessed the habits including smoking and alcohol or drug uses. It also occurs due to the following reasons – contamination, ineffective community therapeutic regimen management, ineffective family therapeutic regimen management and ineffective health maintenance etc.

Nutritional Metabolic Pattern

It’s reflects on the pattern of fluid and food consumption relative to metabolic need. Is evaluated the adequacy of local nutrient supplies. It also occurs due to imbalanced nutrition either more than body requirements or less than body requirements or has the risk for more than body requirements.

Elimination Pattern

It’s focused on excretory patterns (bowel, bladder, skin), Bowel incontinence, Constipation.

Activity and Exercise Pattern

It’s focused on the activities of daily living requiring energy expenditure, including self-care activities, exercise, and leisure activities.

Cognitive-Perceptual Pattern

It’s focused on the ability to comprehend and use information and on the sensory functions. Neurologic functions, Sensory experiences such as pain and altered sensory input.

Sleep Rest Pattern

It’s focused on the person’s sleep, rest, and relaxation practices. To identified dysfunctional sleep patterns, fatigue, and responses to sleep deprivation.

Self-Perception-Self-Concept Pattern

It’s focused on the person’s attitudes toward self, including identity, body image, and sense of self-worth.

Sexuality and Reproduction

It’s focused on the person’s satisfaction or dissatisfaction with sexuality patterns and reproductive functions.

Coping-Stress Tolerance Pattern

It’s focused on the person’s perception of stress and coping strategies Support systems, evaluated symptoms of stress, effectiveness of a person’s coping strategies.

2. ANS: Actual or potential problems related to fluid balance, tissue integrity, and host defenses may be identified as well as problems with the gastrointestinal system. Besides, Risk for actual other-directed violence, risk for actual self-directed violence. Excess fluid volume, Hyperthermia, Hypothermia, Imbalanced nutrition: more than body requirements, Imbalanced nutrition: less than body requirements, Imbalanced nutrition: risk for more than body requirements, Impaired dentition.

References:

Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–761.

Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–1209.

Muennig P, Lubetkin E, Jia H, Franks P. Gender and the burden of disease attributable to obesity. Am J Public Health. 2006;96(9):1662–1668.

American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016.

Retrived from: https://asmbs.org/app/uploads/2008/09/ASMBS-Nutritional-Guidelines-2016-Update.pdf

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