The case scenario provided will be used to answer the discussion questions that
ID: 122652 • Letter: T
Question
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 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.
Explanation / Answer
Obesity is a serious, chronic disease that can have a negative effect on many systems in your body. Overweight and obesity may increase the risk of many health problems, including diabetes, heart disease, certain cancers, bone and joint disease.
Body Mass Index: The BMI is one way to tell whether you are at a normal weight, are overweight, or have obesity. It measures your weight in relation to your height and provides a score to help place you in a category:
Normal weight: BMI of 18.5 to 24.9
Overweight: BMI of 25 to 29.9
Obesity: BMI of 30 or higher
Mr. C Body Mass Index (BMI) is 45.2. This means Mr. C weight is within the obese range.
Mr. C current BMI is greater than the recommended range of 18.5 to 24.9.
To be within the right range for Mr. C height, Mr. C should weigh between 122 lbs / 55.3 kg and 164 lbs / 74.3 kg
Health risks associated with obesity in Mr. C: In addition to social and psychological problems, there is serious health risks associated with obesity. Conditions related to morbid obesity include:
High Cholesterol: Cholesterol is found in lipids in the bloodstream. Although it may be inherited, it's often caused by poor diet and lack of exercise.
High blood pressure: Like high cholesterol, high blood pressure can eventually lead to heart disease. Having a large body size may increase blood pressure because your heart needs to pump harder to supply blood to all your cells. .
Type 2 Diabetes: Obesity is the major cause of type 2 diabetes. This type of diabetes usually begins in adulthood.
Cancer: Obesity is thought to be a risk factor for certain cancers, such as uterine, ovarian, cervical, breast, colorectal and prostate cancer.
Breathing Disorders: Fatal breathing conditions such as asthma and sleep apnea are often caused or exacerbated by being overweight.
Gallbladder Disease: Increased cholesterol and body fat are key components in the development of gallbladder disease.
Bariatric surgery is one of the few effective treatments for morbid obesity. Mr. C. is having obesity but the weight is within the obese range, overall it appears that Mr. C would be a good candidate for a bariatric surgery consult but I would consider looking in further in to his health patterns. Mr C presents with numerous problems that could be reduced by the consideration of bariatric surgery. Bariatric surgery has been found to be effective in promoting weight loss and reducing the risk for many health problems. The surgery makes Mr. C stomach smaller and sometimes changes the small intestine. Surgeons use three types of bariatric operations most often: gastric band, gastric bypass, and gastric sleeve. Bariatric surgery can improve many health problems related to obesity, such as type 2 diabetes, high blood pressure, unhealthy cholesterol levels, and sleep apnea. Surgery also may lead to improved physical function and mood, and better quality of life.
Mr C actual and potential health problems:
Some health risks associated with Mr. C’s obesity are increased BP (hypertension), sleep apnea, elevated cholesterol, elevated triglycerides and possible start of diabetes (due to increase glucose levels). Mr. C needs to lose weight or he will be a diabetic and have cardiovascular disease. It is clear that with the glucose levels being what they are, he is already pre-diabetic already. Mr. C needs to lose weight to prevent him from becoming diabetic and to decrease his hypertension. Mr. C would benefit from have bariatric surgery, since his is already morbidly obese. If he were to lose weight, he could decrease his chance from becoming a diabetic and or having possible heart attack. There is a high reduction in mortality rates with bariatric surgery. There is a significant improvement in those diseases that are caused or worsened by obesity, including: blood pressure, diabetes, and heart disease, and stroke. There is still a need for Mr. C to undergo some counseling to help change his lifestyle.
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