Mr. C., a 32-year-old single man, is seeking information at the outpatient cente

ID: 122233 • Letter: M

Question

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:

1. Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.

2. Ranitidine (Zantac) 300 mg PO at bedtime.

3. 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?

Explanation / Answer

Obesity is an abnormal accumulation of fat, it is one of the biggest health problems in the world. It travels with various other diseases, which combined kill millions of people per year.

Here Mr. C has health risks associated with obesity are :

Metabolic disorder is not factor for Mr. C to gain weight, maybe he has genetical impact/leptin resistance/certain food habits/sedentary life style caused sudden recent weight gain about 100pounds in last 2-3years.

Bariatric surgery should be a last priority after trying conventional therapies such as consuming fewer calories, increasing exercise, commercial weight-loss programs, etc. His BMI is 47.9 along with other comorbidities he has may leads to further health problems so, he has to loose weigh aggressively

Mr. C can undergo gastric bypass surgery if conventional therapies are not helping in loosing weight.

(Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat).

For his Peptic ulcer disease Mr. C Should follow the below drug administration chart.

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL

10AM(3hrs after breakfast)

4PM(3hrs after Lunch)

9PM(3hrs after Dinner)

10.30PM (At bed time)

Ranitidine (Zantac) 300 mg PO at bedtime. 10.30

10.30 PM(At bed time)

Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL)

6AM (1hr before Breakfast)

12PM (1hr before Lunch)

5pm (1hr before dinner)

10.30 PM (At bed time)

1. Following are the health patterns assesed in Mr.C based on the given info:-

Health-perception – health management,: Mr. C is aware of the consequences and risks of obesity. He know how to manage certain conditions with food restriction (Salt restricted diet for high blood pressure)

Nutritional – metabolic, elimination, : He has to understand that he needs to avoid fatty foods in his diet as he has high cholesterol levels which furthers leads to heart problems

Activity-exercise: His sedentary life style may be one of the cause for his recent abrupt weigh gain, Mr. C needs to work out daily along with diet modification.

Sleep-rest: obesity impaires his sleep, He has to wake up suddenly from sleep due to sleep apnea

2. The identified potential health problems due to obesity are :-

Obesity – Type2 Diabetes with Rationale: It may be that being overweight causes cells to change, making them resistant to the hormone insulin. Insulin carries sugar from blood to the cells, where it is used for energy. When a person is insulin resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar.

Obesity - High Blood Pressure with Rationale: Having a large body size may increase blood pressure because your heart needs to pump harder to supply blood to all your cells. Excess fat may also damage your kidneys, which help regulate blood pressure.

Obesity –Heart disease with Rationale: People who are overweight or obese often have health problems that may increase the risk for heart disease. Excess weight may cause changes to your heart that make it work harder to send blood to all the cells in your body.

Obesity - Sleep Apnea with Ratinale: A person who is overweight may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult or loud (because of snoring), or breathing may stop altogether for short periods of time. In addition, fat stored in the neck and throughout the body may produce substances that cause inflammation. Inflammation in the neck is a risk factor for sleep apnea.

Obesity – Osteoarthritis with Rationale: Extra weight may place extra pressure on joints and cartilage (the hard but slippery tissue that covers the ends of your bones at a joint), causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflamed joints may raise the risk for osteoarthritis.