Please respond with a paragraph to the following question, add citations and references:
Mr. C. is morbidly obese and is experiencing many of the health risk associated with his condition. The most common tool healthcare providers use to determine a healthy weight for an individual is a body mass index (BMI) calculator. A BMI for an individual is an approximate calculation of how much fat you are carrying around in your body. Overall, it is a calculation tool used to help evaluate and determine a person’s risk for certain diseases. If a BMI is on the higher end of the scale it puts an individual at an increased risk for developing health issues. According to the National Heart, Lung and Blood Institute (National Heart, Lung and Blood Institute [NHLBI], n.d.) when Mr. C’s weight of 296 pounds and height of 5 feet 6 inches are compared it determines his body mass index (BMI) is at 47.8, which is considered morbidly obese. According to the University of Rochester Medical Center (University of Rochester Medical Center [URMC], 2019) a person is considered morbidly obese if they are 100 pounds over their ideal body weight, have a BMI of forty or more, or thirty-five or more and are experiencing obesity-related health conditions, like high blood pressure or diabetes. Mr. C. is experiencing these health risks:
High blood pressure (BP) that is at stage 2, systolic >160 and diastolic >100. His out of control BP can cause him multiple health risks such as, stroke, heart attack/failure, kidney failure, loss of eye site, peripheral artery disease (PAD), angina and sexual dysfunction (Center for Disease Control and Prevention [CDC], 2015).
Obstructive sleep apnea is another condition associated with his obesity. This occurs when fat deposits around the upper airway begin to obstruct breathing as well as loss of muscle tone (CDC, 2015).
An elevated fasting capillary blood glucose (CBG) signifying type 2 diabetes. A fasting CBG >126mg/dL is considered diabetes (American Diabetes Association [ADA], 2016).
A total cholesterol of 250mg/dL. A level <200mg/dL is considered an adequately controlled cholesterol. A level >240mg/dL is elevated and puts an individual at greater risk for vascular disease (American Heart Association [AHA], 2017).
High triglycerides of 312mg d/L. This is the fat that builds up in your arteries causing plaque, 200-499 is considered high and increases your risk of heart attack and stroke (AHA, 2017).
A low HDL of 30mg/dL. This is the good cholesterol and is responsible for removing the bad cholesterol out of your system preventing it from building up in your arteries. A level <40mg/dL is a desired number, it decreases risks for developing heart disease (AHA, 2017).
Mr. C.’s weight issues have been a struggle for him his whole life. A history of weight loss attempts is not available. According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK, 2016) Mr. C. is a potential candidate for gastric bypass based on his BMI of > 40 and having a serious health problem of type 2 diabetes and sleep apnea. The National Institute for Care and Health Excellence (National Institute for Health and Care Excellence [NICE], 2014) also states that adults with a BMI >30 and have had type 2 diabetes for less than 10 years should receive a bariatric surgical assessment without any prior attempts to reduce weight through diet and lifestyle changes.
Based on Mr. C and his daily schedule of meal times and sleep schedule, I would suggest the following schedule:
Mylanta- 10am, 3pm, 9pm and 10pm
Ranitidine- 10pm
Sucralfate/Carafate- 6am, 11am, 5pm and 8pm (Ranitidine and Carafate should be taken 2 hours apart for the best absorption).
Assessment of Mr. C. functional health patterns:
Health Perception- He realizes and acknowledges his weight has gotten out of control as evidenced by him seeking information on weight loss surgery. He is trying to manage his hypertension with diet changes and does not seek out medical help for proper management.
Nutritional/Metabolic- He weighs 296 pounds which puts him in the morbidly obese category. His BMI is 47 with hypertension and diabetes. He consumes three meals and a snack.
Activity/Exercise- Works at a telephone center where he is sedentary for eight hours in a day at minimum. There is no mention of any daily activity.
Sleep/Rest- He has sleep apnea which does not allow a good night’s rest due to frequent awakening from apneic episodes. States he goes to sleep at 10pm and is up by 6 am this would potentially give him approximately eight hours of sleep, but not with sleep apnea due to it does not allow the body to fall into the deep sleep (REM) in order to get adequate rest.
Cognitive Pattern- He is able to maintain a job. He communicates clearly based on the duties of his job at a telephone center. He understands he needs to seek help for his weight.
Self-Perception- He is definitely not comfortable with his weight and has not been since childhood based on his self-report of considering himself “heavy” as a child. He may have body image issues and low self-esteem.
Role relationship- His is 32 years old and single. There is no mention of a girlfriend and he may feel as though he is not wanted by the opposite sex based on his appearance.
Sexuality/Reproductive- Does not have any children.
Elimination-No info
Coping/Stress tolerance- He looks as though he may be coping with stress through food and using food as an outlet putting him in an unhealthy pattern.
The following are five actual or potential problems identified:
Ineffective health maintenance as evidence by multiple chronic conditions and lack of appropriate health seeking behaviors.
At risk for delayed surgical recovery due to high levels of blood glucose and insulin resistance.
Imbalanced nutrition more than body requirements as evidence by a BMI of 47.8, putting him at a dangerously level of obesity that requires immediate action.
Activity intolerance as evidence by being obese and sedentary lifestyle that includes working in an environment that requires sitting for majority of the work day.
At risk for non-compliance with new heart healthy diet and exercise regimen. If Mr. C does get obesity surgery, he will need extensive education and teaching on an appropriate diet and exercise program. He has been over weight as a child and has either never been educated on or was never able to comply with dietary restrictions to encourage weight loss or has incorporated levels of activity that promote a healthy heart and healthy weight.
References
American Diabetes Association. (2016). Diagnosing diabetes and learning about prediabetes. Retrieved March 24, 2019, from http://www.diabetes.org/diabetes-basics/diagnosis/…
American Heart Association. (2017). HDL (Good), LDL (Bad) cholesterol and triglycerides. Retrieved March 24, 2019, from https://www.heart.org/en/health-topics/cholesterol…
Center for Disease Control and Prevention. (2015). The health effects of overweight and obesity. Retrieved March 24, 2019, from https://www.cdc.gov/healthyweight/effects/index.ht…
National Heart, Lung and Blood Institute. (n.d.). Calculate your body mass index. Retrieved March 24, 2019, from https://www.nhlbi.nih.gov/health/educational/lose_…
National Institute for Health and Care Excellence. (2014). Obesity: identification, assessment and management. Retrieved from https://www.nice.org.uk/guidance/cg189/chapter/1-R…
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Potential candidates for bariatric surgery: Who is a good adult candidate for bariatric surgery? Retrieved from https://www.niddk.nih.gov/health-information/weigh…
University of Rochester Medical Center. (2019). What is morbid obesity. Retrieved March 24, 2019, from https://www.urmc.rochester.edu/highland/bariatric-…