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 current works at a catalog telephone center.

Objective Data

1. Height: 68 inches; Weight 134.5 kg
2. BP: 172/96, HR 88, RR 26
3. Fasting Blood Glucose: 146/mg/dL
4. Total Cholesterol: 250mg/dL
5. Triglycerides: 312 mg/dL
6. 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:

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

1. 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.)
2. What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.

Discussion 1

Describe how your future practice as an advanced practice nurse can promote access to health care in your area.

Be specific about the interventions that you will do?

COMMENT1

Acute kidney injury has three categories, they are prerenal, postrenal, and intrarenal/intrinsic.  The first category, prerenal, means that the injury to the kidney occurs before the kidney itself.  This type of injury is caused because of reduced perfusion of the kidney. This reduction can be caused by absolute decrease in circulating volume caused by hemorrhage, dehydration, or burns. It can also be caused by relative decrease in circulating volume caused by, distributive shock, third-spacing and edema, or decreased cardiac output.  Another cause can be renal abnormalities such as occlusion or stenosis of the renal artery.  The second category is postrenal, this can be caused by obstruction of normal outflow of urine from the kidneys.  Things that can cause this are: benign prostatic hyperplasia, kinked or obstructed catheters, intraabdominal tumors, strictures, or calculi.  The third category is intrarenal/intrinsic, this involves either vascular, interstitial, glomerular, or tubular.  If it is vascular, it can be caused by vasculitis, emboli, or nephrosclerosis (due to primary hypertension, hypertensive emergencies, and urgency).  If interstitial, it can be caused by acute allergic interstitial nephritis or acute pyelonephritis.  If glomerular, it can be caused by acute glomerulonephritis.  If tubular, it can be caused by ischemic issues such as prolonged prerenal failure, transfusion reactions, or rhabdomyolysis.  Tubular can also be caused by nephrotoxic issues like prolonged post renal failure, certain antimicrobials (antibiotics, antifungals, and antiviral drugs), radiographic contrast media, certain cytotoxic chemotherapy agents, recreational drugs, environmental agents, and snake and insect venom.

COMMENT2

Obesity is measured by a screening tool measuring one’s body mass index (BMI). Body mass index is measured by your height and weight.  A BMI of 30.0 or higher means a person is obese. Being obese is an unhealthy weight that is over what would be normal.

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr.C’s health risk includes heart disease, diabetes, cancer, respiratory issues, physical immobility issues, and mental issues. Premature death. (1)

If Mr.C has done everything to try and lose weight on his own and nothing has worked, then I believe bariatric surgery would be an appropriate intervention. Some patients don’t even try to lose the weight the correct way and go for the easy way out. Complications of having bariatric surgery will pose problems when the patient continues to live this unhealthy life style post-surgery. Bariatric surgery may improve quality of health. It may treat or control diseases such as diabetes, hypertension, and heart disease (2).

1.
What strategies will you use in your new role in health care to review and critique. Strategies can come in many shapes and forms.Know there is a process to review and critique various types of literature. Look around on the Internet and in the library and find something that best suits your topic and the type of literature you will use. This is important to understand because next week an APA literature review is assigned.

2.

One of our objectives this week is to assess stakeholders, team roles, and leadership skills needed to bring about change. Create a flow process (doesn’t have to be formal you can list it in steps) that shows how you feel each of these impact the implementation of EBP when it comes to change.

3. 

Nobody likes change” is a frequent comment, but creating a culture that allows for new ways of knowing takes a unique set of leadership skills. As a leader, how would you create a culture of change?Change can be one of the biggest challenges in an organization but even more so when the culture is not conducive and administration is resistant. Keep this in mind as you address changing an entire culture!