Part 2 paragraph 2 MR C Discussion
Writing
Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.
After reviewing the assessment data this nurse found that Mr. C’s BMI
After reviewing the assessment data this nurse found that Mr. C’s 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.aving 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 would be a candidate for bariatric surgery only after he lost weight and with the new diagnosis of peptic ulcer, and a high chance of type 2 diabetes diagnosis (A1c needs to be checked) would need to be managed. Typically, surgery could be performed until 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).
Health care providers should be sure to educate patients 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.
Treatment for peptic ulcers depends on the cause (Mayo Clinic, n.d). Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication (Mayo Clinic, n.d.). Proton pump inhibitors (PPIs) reduce stomach acid by blocking the action of the parts of cells that produce acid (Mayo Clinic, n.d.). Mr. C’s current medication regime could be simplified by adding a PPI continuing with Zantac and Carafate and removing Mylanta (Mayo Clinic, n.d.).
PPI: Commonly, these medicines are taken 30 minutes before the first meal of the day.
Carafate: take this medicine by mouth, usually 2 to 4 times daily, on an empty stomach at least 1 hour before a meal, or as directed by your doctor.
Zantac: It does not matter if you take it before, with or after food. If it is prescribed twice a day, the best time to take it is in the morning and at bedtime. If it is prescribed once daily, the best time to take it is at bedtime.
Schedule
6 am-Carafate
630 am- PPI
7am- Breakfast
11am- Carafate
12pm- Lunch
5pm- Carafate
6pm- Dinner
10pm- snack
Bedtime -Zantac
Functional Health Patterns
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 one can only 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.
Problems
- Altered nutritional/metabolic pattern: BMI of 46, HTN- BP 172/96, Hyperlipidemia – elevated lipid panel, DM FBS 146, and PUD
- 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 recent significant weight gain.
Copstead-Kirkhorn, L., Banasik, J. L. (2014). Pathophysiology, 5th Edition.[Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-455…
