Disease Management 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
1) What health risks associated with obesity
does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why
not?
2) 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
c) 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.
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).
What actual or potential problems can you
identify? Describe at least five problems and provide the rationale for each.
