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 high blood pressure, which he tries to control with sodium restriction and sleep apnea. 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: (a) Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime; (b) Ranitidine (Zantac) 300 mg PO at bedtime; and (c) Sucralfate / Carafate 1 g or 10m1 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.
Expert Solution Preview
Introduction:
The case scenario provided involves a 32-year-old single male, Mr. C., who is seeking information about bariatric surgery for his obesity. He has gained about 100 pounds in the last 2-3 years, has high blood pressure, sleep apnea, and is currently working at a catalog telephone center. The critical thinking questions focus on identifying health risks associated with obesity and determining if bariatric surgery is appropriate, planning medication administration for peptic ulcer disease, assessing Mr. C.’s functional health patterns, and identifying actual or potential health problems.
1. What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?
Mr. C. has several health risks associated with his obesity, including high blood pressure, sleep apnea, and high levels of fasting blood glucose, total cholesterol, triglycerides, and low levels of HDL. These risks increase his chance of developing heart disease, stroke, and type 2 diabetes. Bariatric surgery may be an appropriate intervention for Mr. C. as it can help him lose weight and improve his overall health. However, it is important to consider if Mr. C. is a suitable candidate for the surgery, which would require a thorough assessment of his physical and mental health, lifestyle habits, and willingness to make long-term dietary and exercise modifications.
2. Plan an administration schedule that will be most therapeutic and acceptable to the patient.
The medication administration schedule for Mr. C.’s peptic ulcer disease should be as follows:
– Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO: 1 hour before mealtime and at bedtime
– Ranitidine (Zantac) 300 mg PO: at bedtime
– Sucralfate / Carafate 1 g or 10mL suspension (500mg / 5mL) PO: 1 hour before meals and at bedtime
This schedule ensures that the Mylanta is taken before and after meals to neutralize stomach acid, and at bedtime to prevent nighttime reflux. The Zantac will help reduce stomach acid production at night when it is most likely to cause problems. The Sucralfate will form a protective layer over the ulcer site and should be taken one hour before meals and at bedtime to minimize the effect of stomach acid during mealtime and overnight.
3. Assess each of Mr. C.’s functional health patterns using the information given.
Health-Perception – Health Management: Mr. C. has sought medical advice for his obesity and related health issues, indicating that he is concerned about his health.
Nutritional-Metabolic: Mr. C. reports that he has always been heavy, even as a child, and has gained about 100 pounds in the last 2-3 years. He reports restricting his sodium intake to control his blood pressure, but he has other metabolic issues, including high blood glucose and cholesterol levels.
Elimination: No information provided.
Activity-Exercise: No information provided.
Sleep-Rest: Mr. C. reports having sleep apnea, which can negatively impact his sleep quality and exacerbate his metabolic issues.
Cognitive-Perceptual: No information provided.
Self-Perception – Self-Concept: Mr. C. may have low self-esteem and body image concerns due to his weight.
Role-Relationship: No information provided.
Sexuality – Reproductive: No information provided.
Coping – Stress Tolerance: No information provided.
4. What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.
1. Obesity: Mr. C.’s BMI indicates that he is obese, which increases his risk for numerous health problems, including heart disease, stroke, and type 2 diabetes.
2. Sleep Apnea: Mr. C.’s sleep apnea can worsen his metabolic issues and overall health if left untreated.
3. Peptic Ulcer Disease: Mr. C. has been diagnosed with peptic ulcer disease, which can cause pain and discomfort and negatively impact his quality of life.
4. High Blood Pressure: Mr. C. has high blood pressure, which increases his risk for heart disease and stroke.
5. Dyslipidemia: Mr. C.’s high levels of total cholesterol and triglycerides and low levels of HDL cholesterol increase his risk for heart disease and stroke.
