Case Scenario: A 32-Year-Old Single Man Is Seeking Informati
Case Scenariomr C. A 32 Year Old Single Man Is Seeking Information
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 sleep apnea and high blood pressure, which he tries to control with sodium restriction. He currently 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: 250 mg/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: Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime. Ranitidine (Zantac) 300 mg PO at bedtime. Sucralfate/Carafate 1 g or 10 mL suspension (500 mg / 5 mL) 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.
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Obesity presents a significant health concern, especially when it reaches a level that increases the risk for comorbid conditions such as hypertension, sleep apnea, and dyslipidemia. Mr. C., a 32-year-old man, exhibits several high-risk factors associated with obesity, including elevated blood pressure of 172/96 mm Hg, hyperglycemia with a fasting blood glucose of 146 mg/dL indicative of prediabetes or diabetes mellitus, and lipid abnormalities indicated by a total cholesterol of 250 mg/dL, triglycerides of 312 mg/dL, and a low HDL level of 30 mg/dL. These factors collectively increase his susceptibility to cardiovascular disease, stroke, and metabolic syndrome (World Health Organization, 2021). Furthermore, his obesity and sleep apnea elevate his risk for cardiovascular morbidity, due to episodic hypoxia and sympathetic activation during apnea episodes (Peppard et al., 2013).
Assessing whether bariatric surgery is appropriate for Mr. C. depends on multiple considerations. Bariatric procedures, such as gastric bypass or sleeve gastrectomy, have been shown to produce substantial and sustained weight loss, improving obesity-related comorbidities (Santos et al., 2019). However, candidacy must be evaluated considering his overall health status, psychological readiness, and understanding of the lifestyle modifications required post-operation. Given his significant obesity, uncontrolled hypertension, dyslipidemia, and potential metabolic complications, bariatric surgery could be an appropriate intervention if he meets the clinical criteria, including a BMI of 40 or higher or BMI of 35 or higher with associated comorbidities, and has demonstrated a willingness to engage in postoperative lifestyle changes (American Society for Metabolic and Bariatric Surgery, 2021).
The medication regimen prescribed for his peptic ulcer disease (Mylanta, Zantac, and Carafate) needs careful scheduling to optimize therapy while avoiding drug interactions and ensuring symptomatic relief. Since Mylanta can interfere with the absorption of certain medications, administering it 1 hour before meals and at bedtime is appropriate, as this allows for maximal acid neutralization without compromising the absorption of ranitidine and sucralfate. Ranitidine, being an H2 blocker, should be taken at bedtime to reduce nocturnal acid secretion. Sucralfate, which forms a protective barrier on ulcers, should be taken 1 hour before meals and at bedtime for maximal effectiveness, and spaced from other medications to prevent interactions. An optimal schedule would be: Mylanta at 6 a.m., 9 a.m., 2 p.m., and 9 p.m.; ranitidine at 10 p.m.; and sucralfate at 6 a.m., 12 p.m., 6 p.m., and 10 p.m., ensuring proper spacing to enhance medication efficacy (Lehmann et al., 2018).
A comprehensive assessment of Mr. C.'s health using the functional health pattern framework identifies both actual and potential problems. First, his health perception indicates an awareness of weight-related issues, but his motivation for change may be compromised by psychological distress related to his obesity and potential body image concerns, contributing to ineffective health management (Funk & Tornquist, 2014). Second, his nutritional-metabolic pattern suggests overeating or poor dietary choices, with current meal times contributing to irregular eating habits that may exacerbate metabolic disturbances. Third, the elimination pattern is not explicitly described, but excessive weight and abnormal lipid/metabolic parameters suggest possible issues with bowel or urinary elimination that may be influenced by diet and hydration. Fourth, his activity-exercise pattern appears limited due to obesity-related discomfort and sleep apnea, which restrict physical activity and heighten the risk of deconditioning and further weight gain. Fifth, sleep-rest pattern is compromised owing to sleep apnea, leading to fragmented sleep and daytime fatigue, which adversely affect his cognitive-perceptual and coping abilities (Peppard et al., 2013).
Potential problems identified include: (1) Cardiovascular risk due to hypertension, dyslipidemia, and obesity, increasing the risk for myocardial infarction and stroke; (2) Uncontrolled sleep apnea causing sleep disturbances and hypoxemia, which may contribute to further cardiovascular strain; (3) Risk of progression to type 2 diabetes mellitus given his elevated fasting glucose; (4) Potential non-adherence or poor understanding of medication schedules and lifestyle modifications, impacting ulcer management and weight loss efforts; and (5) Psychological impacts related to body image, depression, or low self-esteem, which may impair motivation for lifestyle changes (Funk & Tornquist, 2014).
Addressing these issues requires a multifaceted approach that encompasses medical management, nutritional counseling, psychological support, and consideration of surgical interventions when appropriate. Close monitoring and patient education are essential to improve outcomes and mitigate risks associated with obesity and related comorbidities.