Question description

 

Please do a paragraph about this post with this instruction .

post most have 4 or more sentences .

you also have to have a high quality post from a content perspective. This means it also needs to do more than agree with or praise a class mate. If you agree with a classmate, explain why, give an example, share what you learned in the readings

What health risks associated with obesity does Mr. C. have?

· Hyperlipidemia

· Hypertension

· Breathing difficulties

–consistent with sleep apnea and activity intolerance

· ? Diabetes if not already diagnosed. Glucose 146/mg/dL

· Peptic Ulcer Disease

–At risk for bleeding, perforation, blockage

Is bariatric surgery an appropriate intervention? Why or why not?

First and foremost there are risks involved as with any surgery. The Risks vs Benefits must be addressed 1st! Patients considered for bariatric surgery must have tried and failed at all other attempts to lose weight. With help, guidance and assistance from personal trainers, dietitians, physicians, physical therapists, it is possible to lose weight without invasive procedures such as gastric bypass, sleeve etc. Bariatric surgery can be life saving or life taking.

Plan an administration schedule that will be most therapeutic and acceptable to the patient.

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.
2. Ranitidine (Zantac) 300 mg PO at bedtime.
3. 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.

This type of medication regimen can be difficult to manage due multiple doses and non-compliance. Shorter regimens have more effective compliance. The easiest administration schedule would be to keep the medications consistent. Due to the fact that Magnesium can decrease the effectiveness of Sucralfate, it is recommended to take ½ hr apart. This adds to the complicated medication regimen.

· Before Breakfast 6am – Sucralfate

· After Breakfast 10am – Mylanta

· Before Lunch 11am – Sucralfate

· After Lunch 1pm– Mylanta

· Before Dinner 5pm – Sucralfate

· 9pm – Ranitidine and Sucralfate

· 10pm – snack and dose of Magnesium before bed

As I sit here and write this medication administration, I think that there is no way that this patient is going to be compliant. Truthfully I would consider talking to the ordering provider for any alternatives that would be easier to comply to.

What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.

· Sedentary Lifestyle- r/t weight gain (BMI 46.4), working at a telephone call center (ie. Sitting at a desk all day). Adding physical activity slowly and gradually would be optimal, doing this would aide in sleep/rest patterns, his stress and coping mechanisms as well.

· Hyperlipidemia- as evidenced by lab values, consider diet management, plus supplements and/or medication regimens.

· Hypertension- education is important due to the statement “he tries to control with sodium restriction” although this is good to do, he would benefit from dietary education and medications.

· Nutritional Deficits- Mr. C will benefit from dietary education

· Medication Compliance- due to the strict medication regimen, this patient is at risk for non-compliance of medication administration

Overall it appears that Mr. C would be a good candidate for a bariatric surgery consult but I would consider looking in further in to his health patterns. Could he benefit from education, motivation and encouragement with someone helping him through a natural weight loss process of diet management and exercise? Resources are important. As mentioned previously, risk factors for surgery need to be addressed. Mr C presents with numerous problems that could be reduced by the consideration of bariatric surgery. “In the United States, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. 12 Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity co-morbidities, namely type 2 diabetes, dyslipidemias, hypertension, and obstructive sleep apnea syndrome” (Anderson, 2008).