Pathophysiology discussion response 5

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Please read the peers discussions and respond to them APA format with reference

Discussion 1

In reviewing the data provided, there are several health risks that
are associated with Mr. C’s obesity. His BMI is 46 which
indicates morbid obesity. Morbid obesity is defined as having a BMI
> than 30 (Copstead-Kirkhorn, & Banasik, 2014). Given his BMI
of 46 along with a FBS of 146, suggests that Mr. C has diabetes. He
admits to having HTN. He mentions that he tries to control his BP with
a low sodium diet, however his BP remains high at 172/96 which suggest
that he has uncontrolled HTN. His lipid panel is elevated, confirming
high cholesterol and he has been diagnosed with sleep apnea.

Mr. C’s risk factors are as follows:

Diabetes

HTN

Hyperlipidemia

Sleep Apnea

Morbid Obesity

Based on this information, Mr. C is a candidate for bariatric
surgery. He needs to take control of his health. Weight loss is a
start and the key to controlling his other risk factors. Agreeing to
have the surgery is the first step then there is a protocol that he
will have to follow. All patients referred for bariatric surgery must
undergo at least a year of specialist weight management services. The
guidelines are that all appropriate non-surgical measures have been
tried but the person has not achieved or maintained clinically
beneficial weight loss and only after a person had received intensive
treatment for weight loss (Schroeder, Garrison, & Johnson, 2011).
With bariatric surgery, Mr. C. may have better control of his
diabetes. “In a systematic review, metabolic surgery has been
shown to be superior to medical treatment for short-term remission of
type 2 diabetes and comorbidities” (Schroeder, Garrison, &
Johnson, 2011). It is important to remember that bariatric surgery is
not a weight loss technique, rather it is a tool that is used
congruently with medical guidance, psychological support and lifestyle
changes by Mr. C. to ensure positive outcomes.

Mr. C. has been diagnosed with peptic ulcer disease.

Another health issue of Mr. c. is his diagnosis of peptic ulcer
disease. There is no mention of when his PUD was diagnosed or whether
H.pylori was considered. “Most patients with PUD are treated
successfully with cure of H pylori infection and/or avoidance of
nonsteroidal anti-inflammatory drugs (NSAIDs), along with the
appropriate use of antisecretory therapy” (Anand & Katz,
2017). Mr. C’s current medication regime could be simplified by
adding a PPI, such as Protonix, continuing with Zantac and Carafate
and removing Mylanta (Mayo Clinic Staff, 2017).

Schedule:

7am- Carafate

8am- Breakfast and PPI such as Protonix

11am- Carafate

12pm- Lunch

5pm- Carafate

6pm- Dinner

10pm- snack

Bedtime -Zantac

Health perception and health management – Mr. C. is aware of
his obesity and seems motivated to ask bariatric surgery and take
control of his health. It is not clear whether he has attempted
lifestyle changes or weight loss programs in the past.

Nutritional / Metabolic Pattern – These patterns are evident
with Mr. C’s morbid obesity, uncontrolled HTN, undiagnosed
diabetes and PUD. The DM and HTN have not been addressed medically
since there are no medications prescribed that we know of. He would
benefit with a nutritional consult to assist with meal planning and
food choices.

Elimination- no information is given about his elimination patterns.

Activity / Exercise – Mr. C has a sedentary job at a catalog
phone center. Given his weight I can assume that he has limited
activity and exercise since there is no other information given.

Cognitive / Perceptual – Mr. C recognizes that his obesity is
a problem. He shows motivation to ask about a surgical intervention to
address this issue. He perceives his obesity as a medical concern and
is worried about his health from his statement about his weight always
having been a difficulty since childhood.

Sleep / Rest – He has documented sleep apnea, which
contributes to poor quality of sleep.

Self – Perception / Self Concept- He perceives that he has a weight
problem. This is supported by his statement that his weight has been a
problem since childhood. He probably has a low self-esteem, but this
needs further support.

Sexuality / Reproductive – no information given other than he
is single.

Coping / Stress – He admits to gaining 100 pounds in the last
2-3 years. This could support the possibility that Mr. C uses food as
a coping mechanism so these patterns need to be explored further.

Value / Belief – He is seeking information about a lifestyle
change and bariatric surgery, so this supports the fact that he values
his life. No information given about his beliefs.

What actual or potential problems can you identify? Describe at
least five problems and provide the rationale for each.

Altered nutritional/metabolic pattern -Morbid obesity – BMI
46, HTN- BP 172/96, Hyperlipidemia – elevated lipid panel,
Diabetes – FBS 146, PUD- cause unknown

Altered Sleep/ Rest -Diagnosed with sleep apnea. “Untreated,
sleep apnea can cause high blood pressure and other cardiovascular
disease, memory problems, weight gain” (American Sleep Apnea
Association, n.d.).

Altered Health Perception/ Health Management Pattern- Non-compliance
in weight management and low sodium diet, lack of follow-up in the
past with weight management and HTN

Altered Self-Perception / Self Concept – “I have always been
heavy, even as a child.”

Altered Coping/Stress Tolerance- Possible decompensation of coping
mechanisms as evidenced by 100lb. weight gain

Reference

Anand, B., & Katz, J. (2017). Peptic Ulcer Disease. Retrieved
from http://emedicine.medscape.com/article/181753-overv…

American Sleep Apnea Association. (n.d.). Sleep Apnea Information
for Individuals. Retrieved from https://www.sleepapnea.org/learn/sleep-apnea/

Copstead-Kirkhorn, L., Banasik, J. L. (2014). Pathophysiology, 5th
Edition. Chapter 42, p 846 [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-455…

Katz, D., & Haslam, D. (2015). Is bariatric surgery the right
approach to obesity? Retrieved from http://www.pharmaceutical-journal.com/opinion/comm…

Mayo Clinic Staff. (2017). Peptic ulcer. Retrieved from http://www.mayoclinic.org/diseases-conditions/pept…

National Heart Blood and Lung Institute. (n.d.). Calculate Your BMI
– Standard BMI Calculator. Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_…

Schroeder, R., Garrison, J. J., & Johnson, M. S. (2011).
Treatment of Adult Obesity with Bariatric Surgery. Retrieved from http://www.aafp.org/afp/2011/1001/p805.html

Discussion 2

What health risks associated with obesity does Mr. C. have?

In Mr. C’s case scenario, the fasting blood sugar which is
recorded at 146 mg/dL is higher than the normal levels of 70-100mg/dL
(Smeltzer et al., 2010). This figure is indicative of diabetes.
Likewise, blood pressure of 172/96 surpasses the normal range of
120/80 and thus indicative of hypertension. Also, the patient is at a
risk of cardiovascular disorders such as coronary artery disease
(CAD), stroke, congestive heart failure (CHF).

Is bariatric surgery an appropriate intervention? Why or why not?

Yes, I believe bariatric surgery is a more effective intervention
for weight loss compared to non-surgical options. In fact, when
combined with a comprehensive treatment plan, bariatric surgery may
often act as an effective tool to provide you with long term
weight-loss and help you increase your quality of health. Bariatric
surgery has been shown to help improve or resolve many obesity-related
conditions, such as type 2 diabetes, high blood pressure, heart
disease, and more. Frequently, individuals who improve their weight
find themselves taking less and less medications to treat their
obesity-related conditions (ASMBS, 2017).

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).

Functional health patterns include:

Nutritional- In evaluating this healthcare
pattern, obesity is identified as the major facing Mr. C healthcare
condition. The condition is due to poor dietary, sedentary lifestyle.
Nursing interventions are necessary to guide Mr. C to a proper
self-care that would allow her to change her lifestyle and eating habits.

Activity and Exercise Pattern. Given the
patient’s age, it’s clear that he is lacking physical and
regular exercises.Physical activity or exercise can improve Mr.
C’s health and reduce the risk of developing several diseases
like type 2 diabetes, obesity and cardiovascular disease. Recommending
physical activity and exercise can have immediate and long-term health
benefits by improving the patient’s quality of life. A minimum
of 30 minutes a day can allow Mr. C improved health benefits.

Sleep/Rest Pattern. The patient confirms that
he has high blood pressure and sleep apnea. Exercising to lose weight
could prevent the risk of blood pressure and improve his sleeping pattern.

Self-Perception-Self-Concept Pattern. This is
more concentrated on an individual’sreflections or attitudes
towards self, inclusive of self-image, and identity. Mr. C reports
that he has always been heavy, even as a small child suggesting that
he has accepted his condition. Research indicates that negative body
image may increase the risk of obesity. Though previous research
points to depression as a cause of obesity, researchers found no
correlation between depression and obesity when they introduced body
image into their research, suggesting body image may be a more
significant factor in obesity risk. Counselling would be appropriate
to help Mr. C cope with his condition (Villines Z., 2015).

What actual or potential problems can you identify? Describe
at least five problems and provide the rationale for each.

  1. Hypertension which is evidenced by a blood
    pressure of 172/96 mmHg is known to alter with tissue perfusion and
    destruction of microvasculature. The patient seems to lack exercises
    and is currently suffering from obesity. These are the top factors
    and reasons identified to cause hypertension. Lack of exercise, as
    well as having a sedentary lifestyle, raises the risk of
    hypertension.
  2. Diabetes on the other hand is associated with
    destruction of microvasculature and activity intolerance (Smeltzer
    et al., 2010). Research on diabetes reports that obesity is the key
    player in the development of type 2 diabetes. A normal result for
    fasting blood glucose ranges from 70 – 100 mg/dL. According to
    criteria set by the American Diabetes Association, a higher than
    normal fasting blood sugar between 100 to 125 mg/dL (5.6 to 6.9
    mmol/L) may indicate prediabetes. The patient’s Fasting Blood
    Glucose: 146/mg/Dl indicates increased risk of developing Type 2
    diabetes.
  3. Sleep apnea alters the breathing functions
    thus prompting activity intolerance and predisposes the patient to
    heart diseases.
  4. Peptic ulcers are associated with altered
    nutrition less than body requirement due to altered absorption
    (Smeltzer et al., 2010). The patient is also at risk of altered
    fluid balance secondly to fluid and electrolyte loss due to
    diabetes.
  5. Lack of awareness: the patient report being
    heavy since he was young. Given that he is currently 31years old, he
    seems to have lacked avenues which promotes wellness and awareness.
    If Mr. C., was exposed to an environment that support physical
    exercise and proper eating habits he could have overcome his obesity
    problem. Lack of awarenss and education is therefore a problem of
    concern in his case.

References

ASMBS (2017). Benefits of Bariatric Surgery. Retrieved from https://asmbs.org/patients/benefits-of-bariatric-surgery

Fujimoto, A., Hoteya, S., Iizuka, T., Ogawa, O., Mitani, T., Kuroki,
Y., … & Furuhata, T. (2013). Obesity and gastrointestinal
diseases. Gastroenterology research and practice, 2013.

Smeltzer, S. C., Bare, B.G., Hinkle, J. L., & Cheever, K. H.
(2010). Brunner& Suddarth Textbook of medical surgical
nursing (12th ed.)
. New York: Lippincott
Williams and Wilkins.

Villines Z., (2015). Negative Body Image Linked to Obesity Among
Adolescents. Retrieved from https://www.goodtherapy.org/blog/negative-body-ima…

Fujimoto, A., Hoteya, S., Iizuka, T., Ogawa, O., Mitani, T., Kuroki,
Y., … & Furuhata, T. (2013). Obesity and gastrointestinal
diseases. Gastroenterology research and practice, 2013.

Smeltzer, S. C., Bare, B.G., Hinkle, J. L., & Cheever, K. H.
(2010). Brunner& Suddarth Textbook of medical surgical
nursing (12th ed.)
. New York: Lippincott
Williams and Wilkins.

Villines Z., (2015). Negative Body Image Linked to Obesity Among
Adolescents. Retrieved from https://www.goodtherapy.org/blog/negative-body-ima…

Discussion 3

  1. What health risks associated with obesity does Mr. C. have? Is
    bariatric surgery an appropriate intervention? Why or why not?

Mr. C is a 32 year old man whom is 5’6” and 296.5lbs.
His BMI is 47.9 which puts him in the obese category.
(“Calculate Your BMI – Standard BMI Calculator”). Mr.
C’s blood pressure is high when checked at 172/96. Since he
states he is attempting dietary change to fix his blood pressure the
nurse should educate on sodium restriction and the patient should be
offered to start a antihypertensive medication to help reduce risk of
comorbidities due to hypertension. Before surgery Mr. C should have
his blood pressure managed and check his A1C to determine if he is a
diabetic before having any surgical intervention. Diabetes can affect
a persons healing ability and could determine if he is getting the
proper nutrients from his diet. This patient should also attempt diet
and exercise to get as much weight off as possible before trying surgery.

  • “Efforts to lose weight with diet and exercise have been
    unsuccessful
  • Your body mass index (BMI) is 40 or higher
  • Your BMI is 35 or more and you have a serious weight-related
    health problem, such as type 2 diabetes, high blood pressure or
    severe sleep apnea
  • You’re a teenager who’s gone through puberty, your BMI is 35
    or more, and you have serious obesity-related health problems, such
    as type 2 diabetes or severe sleep apnea” (“Gastric
    bypass surgery isn’t for everyone”, 2017, para 4)

Mr. C also has high cholesterol levels:

Total Cholesterol: 250mg/dL

Total blood cholesterol level:

  • High risk: 240 mg/dL and above
  • Borderline high
    risk: 200-239 mg/dL
  • Desirable: Less than 200 mg/dL”
    (“Understanding Your Cholesterol Test Results”)

Triglycerides: 312 mg/dL

“Normal levels: Less than 150 milligrams per deciliter

  • Borderline high:150 to 199
  • High: 200 to 499
  • Very high: 500 or more”
    (“How to Lower Your Triglycerides”)

HDL: 30 mg/dL

HDL

40mg/dL or higher
(“Cholesterol Levels: What You Need to Know”,
2018)

Due to these high numbers Mr. C should have a cardiology consult
before going to surgery to check the status of his heart due to his
high risk of having coronary artery disease. Mr. C should also have a
psychiatric consult before getting surgery to determine if he is
mentally stable enough to undergo surgery. New research is indicating
that there is a high suicide risk for patients after receiving
bariatric surgery. “For example, recent studies have identified
an increased risk of suicide in people who have had weight-loss
surgery. This risk is greatest in those who have attempted suicide in
the past. More research is needed to understand whether changes
related to the surgery itself play a role in increasing suicide
risk.” (“Gastric bypass surgery isn’t for everyone”,
2017, para 8)

Mr. C should also have his thyroid checked to be sure there is not
thyroid issue before surgery. Since Mr. C stated that he only
remembers being overweight it is important to determine that there is
not underlying causes to his weight problem.

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

0600 Carafate

0700 breakfast

1000 Mylanta

1100 Carafate

1200 lunch

1500 mylanta

1700 carafate

1800 dinner

2100 mylanta and Carafate

1000 bedtime snack and zantac

3.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.)

Health management: Mr. C is under the impression that he is managing
his hypertension by having a sodium reduced diet, however, his blood
pressure is indicating that his hypertension is not being managed. Mr.
C requires education on diet and exercise and should be offered
medication to help control his hypertension.

Health perception: Based off the information given it seems like Mr.
C is under the impression that he is an overall healthy man with his
weight being the only issue at hand. Mr. C needs a dietician to
educate on proper foods to eat due to his cholesterol levels all being
in high risk zone for heart disease.

Elimination/ sleep, rest/ sexuality/ and reproducing: from the
information given there is not indication that Mr. C has problems with
Elimination/ sleep, rest/ sexuality/ and reproducing. Although there
is no indication that Mr. C has problems the nurse should question Mr.
C to make sure that there are no issues before he gets surgery.

Coping: Mr. C should be assessed for mental health issues and learn
about his coping skills. It seems since Mr. C has been heavy since he
can remember he may be turning to food to cope. Getting psychiatric
support could enlighten Mr. C as to why he eats to much and give him
other means of coping during times of stress. This is very important
prior to Mr. C surgery so that he does not hurt himself after surgery
by consuming to much food.

Activity: Mr. C works at a telephone catalog center, it seems as if
he may not be getting proper exercise that he requires to keep his
body healthy. The nurse can suggest that during meal breaks that Mr. C
takes a walk around the office and then can exercise at home or at the
gym if he prefers.

4.What actual or potential problems can you identify? Describe at
least five problems and provide the rationale for each.

Actual

Imbalanced nutrition more then body requirements: Mr. C reports that
he only remembers being heavy even as a kid, it seems from the
information given that Mr. C is consuming more calories then his body
uses, especially with a job that he sits at a desk all day

Deficient knowledge: Mr. C is under the impression that he is
managing his blood pressure by reducing sodium in his diet, however,
the blood pressure taken during examination determines that he is not
managing his blood pressure well at all. The nurse should educate Mr.
C about the state of his blood pressure and educate on how to manage
with medication, diet changes, and exercise.

Potential

Risk for anxiety: Patients that undergo surgery are often filled
with anxiety wondering what is going to happen and afraid of the
outcomes of surgery. Mr. C should be educated what to expect before,
during, and after surgery. He should also be educated on potential
risk so he can make the decision if surgery is right for him.

Risk for infection: after any surgery patients are at risk for
infection of the surgical site. Mr. C should be educated before,
during, and after surgery for signs and symptoms of infection and that
he should call the doctor immediately. Signs and symptoms include:
chills, fever, redness, drainage, pain, and foul smell from site.

Risk for ineffective coping: Since Mr. C only remembers being heavy
he may be using food to cope with stress, after surgery this is not an
option since this could cause harm to Mr. C. Mr. C should see a
psychiatrist in order to find other coping methods, so he can adhere
to instructions from the doctor post-surgery.

Reference

Calculate Your BMI – Standard BMI Calculator. (n.d.). Retrieved June
28, 2018, from https://www.nhlbi.nih.gov/health/educational/lose_…

Cholesterol Levels: What You Need to Know. (2018, March 22).
Retrieved July 1, 2018, from https://medlineplus.gov/cholesterollevelswhatyoune…

Gastric bypass surgery isn’t for everyone. (2017, September 16).
Retrieved July 1, 2018, from https://www.mayoclinic.org/healthy-lifestyle/weigh…

How to Lower Your Triglycerides. (n.d.). Retrieved July 1, 2018,
from https://www.webmd.com/cholesterol-management/lower…

Understanding Your Cholesterol Test Results. (n.d.). Retrieved June
28, 2018, from https://www.webmd.com/cholesterol-management/chole…

Discussion 4

A person is considered obese when the BMI is 30 or higher. Mr.
C is 1.72 m tall and weighs 134.5 kg. His BMI is therefore 45. Mr. C
is morbidly obese.

There are many associated conditions that have been linked to
obesity. Among them are hypertension, high cholesterol, diabetes, some
cancers, heart disease and stroke, and sleep apnea. However, not every
obese person will have these conditions.

A BMI over 35kg together with other co-morbidities, such as
hypertension and sleep apnea, which Mr. C has, makes him an ideal
candidate for bariatric surgery. According to Sarpel (2014), most
overweight or obese people will only lose 10% of excess body weight,
and relapse is common. Therefore, for the morbidly obese patient, with
other co-morbidities, bariatric surgery is a good option. A
comprehensive nutritional assessment and psychological intervention
will be performed before a final decision since the patient needs
further nutritional education after the surgery.

Mr. C’s functional health patterns will be assessed before his
bariatric surgery to ensure he will benefit from the surgery.
Bariatric surgery results in rapid weight loss that can be
long-lasting. However, the procedure has also been associated with
morbidity. Patient selection and education are paramount for the
success of the surgery.

To start, Mr. C has demonstrated an interest in his health by
inquiring about possible bariatric surgery. He understands it will be
difficult to lose all the weight he needs just by dieting, given his
lack of exercise and sedentary life. He also recognizes he does not
sleep well due to his sleep apnea. The lack of good sleep could be a
contributing factor to his obesity, which is probably a cause for his
hypertension. Mr. C is a young single man and would like to change his
lifestyle habits and achieve a normal weight that could bring his
self-esteem back. He would need to see a psychologist that could help
him deal with his self-esteem, his goals, the cause for his overeating
since there is no history of any metabolic problems and assess his
stress trigger points.

There are some potential problems after bariatric surgery, depending
on the procedure done. There are two types of bariatric surgery:
restrictive (caloric intake is decreased by creating a reduction in
the stomach size) and malabsorptive (interrupting normal absorption of
ingested calories). If restrictive, the patient runs the chance of the
gastric remnant stretching to accommodate a larger volume of food,
hence gaining the weight back. If malabsorptive, the risk is of not
absorbing vitamins and minerals, since they do not stay in the bowel
long enough to be absorbed. People also have the “dumping
syndrome.” The most common surgery combines both restrictive and
malabsorptive properties. It creates a small gastric pouch that is
anastomosed to the down-stream small bowel. By doing this, the
opportunity for caloric absorption is reduced. Patients will need
lifelong nutritional supplementation since vitamins and minerals
absorption is reduced.

Due to all the diet and nutrient intake issues, there is a need for
a complete nutritional assessment and follow-up. The patient will have
to re-learn to eat small frequent meals to be able to get all the
calories needed.

Mr. C has also been diagnosed with peptic ulcer disease. Peptic
ulcers can be due to different causes: H Pylori infection, drugs
(e.g.NSAIDs), lifestyle factors, severe physiologic stress and
hypersecretory states (although this is uncommon), and genetic
factors. Our case study does not specify the cause for Mr. C’s
peptic ulcer. We do not know if his ulcer is gastric or duodenal. If
gastric, the symptoms would appear shortly after eating, and if
duodenal, 2-3 after a meal.

The following medications were prescribed for his ulcer: (1)
Mylanta 15 ml PO, one hour before bedtime, 3 hours after a meal, and
at bedtime, (2) Zantac 300 mg PO at bedtime and (3) Carafate 1gm one
hour before meals and at bedtime. According to Mr. C’s
meals and bedtime schedule, he should be taking the medications as
follow: (1) Mylanta – at 10 am, 3 pm, 9 pm, and 10 pm, (2)
Zantac – at 10 pm, and (3) Carafate – at 6 am, 11 am, 5 pm
and 10 pm.

After the surgery, the presence or absence of the peptic ulcers will
have to be reassessed as well as all the medications. Is the ulcer
still present, or was it removed during the gastric bypass (gastric
ulcer) or was the ulcer removed from the duodenum?

Some nursing diagnosis will be:

1. Knowledge deficit related to new dietary
guidelines as evidenced by smaller stomach with less space to hold
food. He acknowledged having been overweight since childhood.

2. High risk for malnutrition related to
bariatric surgery as evidenced by the reduced amount of time of
nutrients in the bowel and opportunity for caloric absorption. He will
need life-long nutrient supplementation.

3. Anxiety related to fear of the unknown as
evidenced by not knowing what it will be like after the surgery.

4. Potential for ineffective coping
mechanisms. Mr. C has been overweight since his childhood. He
will have to learn new coping mechanisms to handle stressors.

5. Knowledge deficit related to undiagnosed
diabetes. His fasting blood glucose of 146 is indicative of diabetes.

References

Sarpel,
U. (2014). Bariatric surgery. In Surgery an introductory
guide
(pp. 123-126). [Adobe Digital Edition]. https://doi.org/10.1007/978-1-4939-0903-2

Discussion 5

Mr. C. have high
cholesterol and fat (which indicates heart disease), high blood
sugar (which may indicate diabetes), hypertension, and sleep apnea
health risks associated with obesity. bariatric surgery may be an
option, but it is not the first choose because Mr. C is only
32-year-old, he can try eating low sugar, low fat, low salt diet and
exercise regularly to lose weight. If he follows the guideline to
lose weight, I believe he will improve his health condition.

The
administration schedule that will be most therapeutic and acceptable
to Mr. C as follow.

·
At 10 am, 3 pm, and
9 pm take Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO

·
At 10pm take
Ranitidine (Zantac) 300 mg PO at bedtime.

·
At 6am,11am, 5pm,
and 9pm take Sucralfate/Carafate 1 g or 10ml suspension (500mg /
5mL)

According to the
information given, Mr. C.’s functional health patterns are as
follow. Health perception: Mr. C. always sees himself as heavy, even
as a small child. Health management: He say he has sleep apnea and
high blood pressure. No medication for this condition. He tries to
control with salt to maintain health. he has three prescripted
medication for her peptic ulcer disease. nutritional –
metabolic pattern: Mr. C have three meal and one snack, it seems
over nutrition. He does not have metabolic problem. His height is 68
inches; Weight is 134.5 kg, and his BMI is 45. He is obese.
elimination, activity-exercise: this information could not find in
the data. Sleep-rest: he says he has sleep apnea. I believe this
problem may cause him without good sleep. Cognitive-perceptual: the
data has not showing any sensory deficits and any disease that
affects his mental functions. Mr. C express himself clearly and
logically. Self-perception and self-concept: he seems not satisfy
with his appearance by saying he has always been heavy, even as a
small child. No data can find about role-relationship and sexuality
– reproductive. Coping – stress tolerance: no clearly
mention in this case scenario. However, he is seeking the bariatric
surgery for his obesity, do not see he interest to change lifestyle.
So, he seems like to use outside source to solve the problem, more
than try inner effort.

The actual or
potential problems are identified as follow: (according to Ralph and
Taylor (2005), the nursing diagnosis as follow.)

1.
Ineffective
Breathing Pattern related to Inspiration and/or expiration that does
not provide adequate ventilation. (rationale: Mr. C says he has
sleep apnea, and his respiration rate is 26, and his is obesity (BMI
is 45.)

2.
Imbalanced Nutrition
related to more than body requirements (rationale: he eats three meals and
one snack a day. his BMI is 45. He is obese)

3.
Deficient knowledge
related to lack understand between nutritional needs, food intake,
and hypertension and diabetes (rationale: he eats three meals and one snack a
day. But he did not know hypertension and diabetes can be controlled
by diet and exercise)

4.
Deficient Knowledge
related to absence or deficiency of cognitive information related to
diabetes and hypertension topic. (rationale: Fasting Blood Glucose
is 146/mg/dL, BP is 172/96, Total Cholesterol is 250mg/dL and
Triglycerides is 312 mg/dL, and these need to bring his attention)

5.
Risk for infection
related to compromised host defenses due to diabetes and
hypertension. (rationale: Fasting Blood Glucose is 146/mg/dL, BP is
172/96, Total Cholesterol is 250mg/dL and Triglycerides is 312 mg/dL,)

Reference:

Ralph, S., and Taylor, C. (2005).
Nursing Diagnosis Reference Manual. (6 th ed.). New York,
U.S. A.: Lippincott William & Wilkins.

Discussion 6

It is obvious that Mr. C suffers from obesity, as evidence by his
height of 68 inches (5 feet, 8 inches) and his weight of 134.5 kg
(295.9 lbs.), giving Mr. C a calculation of a 45.0 Body Mass Index
(BMI). According to the National Heart, Lung and Blood Institute, a
BMI that is greater than 30 is considered obesity, (National Heart,
Lung and Blood Institute, n.d.). Health issues related to obesity
places Mr. C at risk Diabetes, Hypertension, High Cholesterol, Heart
Disease, Heart Attack, and Stroke.

Mr. C has a fasting blood glucose (FBG) of 146 mg/dL. A normal FBG
level is less than 100 mg/dL, a prediabetes is 100-125 mg/dL, and a
high is greater than 126 mg/dL, (Mayo Clinic, 2018). Mr. C’s
high FBG level indicates that he may be diabetic. Mr. C’s blood
pressure (BP) of 172/96 is considered to be abnormally high. According
to American Heart Association a BP of 140 of higher systolic and 90 or
higher diastolic is considered hypertension stage 2 which indicates
that Mr. C suffers from high blood pressure, (American Heart
Association, 2018). Mr. C has a total cholesterol lab value of 250
mg/dL. A total cholesterol level of 240mg/dL or higher is considered a
very high risk which places him not borderline high risk but high risk
for cholesterol, (Emedicine Health, 2018). High triglycerides and low
levels of HDL (the good cholesterol), places a person at risk for
heart diseases, heart attack, and stroke, (WebMD, 2018). A
triglyceride level between the ranges of 200-499 mg/dL is considered
high and an HDL of less than 40 mg/dL increases the risk of heart
disease, (Emedicine Health, 2018). Mr. C has both a high lab value of
triglycerides of 312 mg/dL and a low level of HDL of 30 mg/dL which
indicates he is at risk for heart issues.

Bariatric surgery is a major surgery to help people lose weight with
the guidelines that the candidate is obese and with a BMI of greater
than 40, with at least one health problem of diabetes or high blood
pressure that is related to weight gain and could be improved through
weight loss, or at least 100 pounds over your ideal weight, (Dr. Axe
Food is Medicine, n.d.). In Mr. C’s case he would be an
appropriate candidate for bariatric surgery intervention considering
he is diabetic, has hypertension, is obese and has a BMI of 45.0,
however before considering the surgery it is important Mr. C evaluates
his medical condition, health, and mental status as well a plan to
stay and remain healthy post-surgery. It is important he resumes a
healthy diet and exercise to maintain his weight and include any
vitamins and nutrients that can be affected due to the surgery. Like
any procedure/surgery, there are risk and in his case not maintaining
a healthy diet and weight can place him at risk for weight gain and
the same health issues.

Mr. C had been diagnosed with peptic ulcer disease which is referred
to an open sore, “ulcer” in the stomach or small intestine
caused by acid, H. pylori, or due to the use of NSAIDs, (American
College of Gastroenterology, 2018). Mr. C has been ordered Magnesium
hydroxide/ aluminum hydroxide aka Mylanta 15mL by mouth an hour before
bedtime and 3 hours after meal times, Ranitidine aka Zantac 300 mg by
mouth before bedtime, and Sucralfate/Carafate 1 g or 10 mL one hour
before meals and at bedtime. Mr. C eat breakfast at 7AM, Lunch
at noon, and dinner at 6PM with a snack at 10Pm, therefore an
appropriate therapeutic schedule for MR. C would be:

0600- Sucralfate/Carafate

0700- Breakfast

1000- Magnesium hydroxide/ aluminum hydroxide

1100- Sucralfate/Carafate

1200- Lunch

1500- Magnesium hydroxide/ aluminum hydroxide

1700- Sucralfate/Carafate

1800- Dinner

2100- Magnesium hydroxide/ aluminum hydroxide

2200- Snack

2100- Sucralfate/Carafate, Magnesium hydroxide/ aluminum hydroxide, Ranitidine

With the information given on MR. C’s case we can
assess/assume some of his functional health status that include the following:

Health Perception/Management- With the information given to assess
Mr. C’s functional health pattern it is obvious he is aware of
his health and would like to take control. He is obviously concern and
seeking information to better his health condition. This demonstrated
Mr. C is willing to take action.

Nutritional/Metabolic- Assessing Mr. C’s current condition of
obesity, diabetes, hypertension, and heart disease risk, it is obvious
that he has a history of a poor nutrient/healthy diet, however he does
try to control his high blood pressure with a low sodium restriction.

Activity/Exercise- although it does not state Mr. C’s exercise
activity, it does mention he currently works at a catalog telephone
center which indicates he sits and makes phone calls and possibly does
not get a lot of mobility activity in his job, therefore Mr. C could
be lacking in exercise.

Sleep/Rest- According to Mr. C, he states he has sleep apnea which
deprives him of sleep and rest.

Cognitive/Perceptual- It appears that Mr. C understands and follow
directions. His hearing and vision where not mentioned, however Mr. C
seems appropriately cognitively aware to make decisions regarding his
health condition.

Self-Perception/Self-Concept- Mr. C is obviously does not feel good
about his health because he reports always being heavy as a child, and
has gained about 100lbs in the past several years. He is also seeking
help which proves he is unhappy with his current health status and
condition. This could indicate he may be at risk for depression,
sadness, and anger about his body image, developed illnesses, eating
habits, and poor health.

Role Relationship- Mr. C does not mention any family or friends.
Which possibly indicates no support and at risk for loneliness.

Sexuality/Reproductive- Mr. C does not indicate sexuality, other
than he is possibly single.

Coping/Stress tolerance- Mr. C does not mention how he copes with
stress, however he does mention a weight gain of 100lbs in the last
recent years, and proves to have a poor diet. This could indicate that
Mr. C copes with stress by eating.

Five potential problems in Mr. C’s case that could be
identified are:

Mr. C has morbid obesity, as evidence by his BMI of 45.0 and his
overweight condition, diabetes, high blood pressure, sleep apnea, and
a respiratory rate of 26. Signs of morbid obesity include a BMI
greater than 40, 100lb overweight, diabetes, high blood pressure,
sleep apnea, and increased breathing, (Bariatric Surgery Center, 2018).

Mr. C it at risk for a heart attack or stroke as evidence by his
high cholesterol and triglyceride levels and low HDL levels. All
indicate signs of potential heart attack and stroke risk.

It appears Mr. C has a problem coping with stress and may be
emotionally eating as evidence by his weight of 295.9, his weight
gain, and poor diet. Emotional eating known as stress eating is using
food to feel better which can cause an increase in weight and
calories, (Emotional Eating. n.d.).

Since Mr. C does not mention family or friends he could also be
potentially at risk for no support and loneliness which can make it
difficult for him. It is important to have encouragement and
motivation from family and friends to help his health condition.

Mr. C has poor exercise and activity which can place him at risk for
increasing/worsening his health conditions. Exercise and activity is
important in order for Mr. C to lose weight and or maintain his weight
as well as a benefit and encouragement to a healthy lifestyle.

References

American College of Gastroenterology. (2018). Peptic Ulcer Disease.
Retrieved from http://patients.gi.org/topics/peptic-ulcer-disease…

American Heart Association. (2018). The Facts About High Blood
Pressure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050_Article.jsp#.Wzu-pjpKiM8

Bariatric Surgery Center. (2018). What is Morbid Obesity?. Retrieved
from https://www.urmc.rochester.edu/highland/bariatric-…

Dr. Axe Food is Medicine. (n.d). The Pros and Cons of Bariatric
Surgery & Healthier Alternatives. Retrieved from https://draxe.com/bariatric-surgery/

Emedicine Health. (2018). High Cholesterol. Retrieved from https://www.emedicinehealth.com/high_cholesterol/article_em.htm#what_causes_high_cholesterol

Emotional Eating. (n.d). How to Recognize and Stop Emotional and
Stress Eating. Retrieved from https://www.helpguide.org/articles/diets/emotional…

Mayo Clinic. (2018). Diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451

National Heart, Lung, and Blood Institute. (n.d).Calculate your Body
Mass. Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_…

WebMD. (2018). High Triglycerides: what you need to know. Retrieved
from https://www.webmd.com/cholesterol-management/high-…

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