Pathophysiology discussion response 5

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 (12^th 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 (12^th 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

References:

Nursing Standards

Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Clinical Guidelines

Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf

Living Guideline

Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E

Evidence-based practice

BMJ Best Practice

Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/

Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com

Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf

JBI: Evidence summary

Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global

JBI: Best practice information sheet

Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.

Cochrane Database of Systematic Reviews

Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2

Drug Information

Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au

Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm

 

Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html

Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/

Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html

Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis

Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia

Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367

NCBI Bookshelf

Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/

Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au

 

 

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