Mandatory Discussion Question

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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

  1. Height: 68 inches; Weight 134.5 kg
  2. BP: 172/96, HR 88, RR 26
  3. Fasting Blood Glucose: 146/mg/dL
  4. Total Cholesterol: 250mg/dL
  5. Triglycerides: 312 mg/dL
  6. 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

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Mandatory Discussion Question

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Health risks associated with obesity include Diabetes, hypertension, sedentary lifestyle, high cholesterol and sleep apnea.  According to the American Society for metabolic surgery, Mr. C is a candidate for bariatric surgery.  Qualifying criteria includes BMI >40 or >100 lbs. overweight.  Mr. C has a BMI of 45.  Other qualifying factors include a BMI of >35 with comorbidities such as Diabetes Mellitus, Hypertension, sleep apnea, osteoarthritis, lipid abnormalities, gastrointestinal or heart disorders.  Along with a qualifying BMI, Mr. C has qualifying comorbidities.

 

Mylanta 1000, 1500, 2100

 

Zantac 2100

 

Sucralfate/Carafate 0600, 1100, 1700, 2100

 

 

 

Health management: Mr. C attempts to manage his HTN with a low sodium diet, being seen for bariatric surgery.  Seems to understand that he needs to take action in weight loss

 

Nutritional – metabolic: Attempts to follow a low sodium diet, eats 3 meals per day with an evening snack, fasting blood glucose 146, high cholesterol, 100# weight gain in 2-3 years

 

Elimination: no information provided

 

Activity-exercise: No report of physical activity, works at a call center where he probably sits during his shift

 

Sleep-rest: Reportedly has sleep apnea

 

Cognitive-perceptual: No apparent cognitive deficit, maintains job, alert and oriented according to his ability to request medical treatment

 

Self-perception – self-concept: Seemingly aware of need to take action regarding his health and weight loss.

 

Role-relationship: No information provided

 

Sexuality – reproductive: No information provided

 

Coping – stress tolerance: No specific information provided, but given his weight gain over the past 2-3 years I would say he has poor coping skills and stress may be a cause of weight gain.

 

Problems for Mr. C include:

 

Hypertension- Need further assessment and treatment

 

Sleep apnea- CPAP treatment to have more restful sleep at night

 

DM- Need further assessment and labs to diagnose and treat.  Possibly needs Metformin as uncontrolled diabetes can cause complications following surgical procedures

 

Sedentary lifestyle- Mr. C needs to understand that surgery alone will not fix his weight problem and he must also make lifestyle changes in order for it to be successful

 

High cholesterol- statin and consultation with dietician.

 

Diabetes alone can cause serious complications following surgery.  If you couple diabetes with the above mentioned problems Mr. C is at an increased risk for infection as well as major health concerns.  Some of the mentioned concerns are myocardial infarction, stroke, heel pressure sores, post-op wound infection and UTI.  Based on this evidence and Mr. C’s medical history, I would recommend that the problems are addressed prior to surgery to improve his outcome.

 

Tidy, D. C. (2016, February 12). Precautions with Patients with Diabetes Undergoing Surgery. Retrieved August 29, 2017, from https://patient.info/doctor/precautions-for-patients-with-diabetes-undergoing-surgery

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