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?
Health risks associated with obesity are as follow: Increased mortality rate, Type 2 diabetes, hypertension, hypercholesterolemia, heart disease, breathing problems, cancer, low quality of life, body pain, and mental illness. He has been already diagnosed with sleep apnea and hypertension. His fasting glucose is high, and triglycerides are high as well.
Is bariatric surgery an appropriate intervention? Why or why not?
To be a candidate for bariatric surgery are as follow: Patient needs to be 80-100 pounds overweight or have a BMI greater than 35 which he is. He is also between the age range of 14-75 years. All other options have been exhausted. Patient seems to be ready, but a mental evaluation should be done to make sure he has realistic expectations and is motivated. Also, he needs to understand all the risks involved.
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.
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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.
He can take Carafate an hour before breakfast. Mylanta at 1030 and Carafate again an hour before lunch. Mylanta again at 3:00pm then Carafate at 5:00PM. Then Mylanta at 9:30pm and zantac an hour after it at 10:30PM.
Assess each of Mr. C.'s functional health patterns using the information given.
Functional health patterns include health-perception – He is seeking for a solution to his weight gain. It mentions that he has always been overweight, but gained 100lbs in the past years. I health management/nutrition/metabolic- He is on a low sodium diet, but does not mention that he eats a healthy diet and it seems like he does not as he has gained 100 pounds in the last couple of years. His glucose is high as well as his cholesterol. Elimination: no information given to asses activity-exercise- no information given to asses. He does work on a desk all day, he might not get much exercise.
sleep-rest: Sleep apnea.
cognitive-perceptual, self-perception – self-concept. He knows and sees his overweight as a problems and now he is wanting to correct it.
role-relationship, sexuality – He is single, no other information was given to asses.
Reproductive. No info given to asses.
coping – stress tolerance. No info given to asses.
What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.
He has gained about 100 pounds. This puts him at a higher risk for sudden death and cardiac problems. This should be as important as the following problems.
He needs a CPAP for his sleep apnea. This will help with him feeling better and possibly help him feel rested ready to start a workout routine.
His blood pressure is still high, although he is trying to keep it down with diet. He might need medication to help him control it.
His fasting glucose is high. He needs a hbg A1C to measure how his glucose has been and possibly get him on medication for diabetes type 2.
His cholesterol is high. He is in need of medication to lower his risk of heart disease which is already high.
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