Case Study Assignment for Unit V: Nutrition and Regulation of Food Intake & Energy Metabolism Directions: Each student will have the opportunity to earn a total of 70 points by completing two (2) Patient Case Analysis assignments from the six (6) units. The two case studies must be from two different units and not from the same units that you selected for your CE assignment. You will find a schedule of assignment due dates in the course calendar. Purpose: The purpose of this assignment is to encourage you to analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature. This assignment emphasizes critical thinking and problem-solving through the correlation of cellular and multi-system pathology with related assessment and diagnostic data, medical treatment and nursing management. The answers to the questions should be complete and include professional literature to support each answer. You should include at least 3 current references (< 5 years old) of which 2 must be journal articles. References should include current nursing journals and other professional health related literature. The assignment should be uploaded electronically into blackboard under the appropriate assignment link. The paper should be typed using APA format. APA format requires that you use correct grammar and spelling and double-space your entire paper. Use the questions as your headers. Please include the following rubric at the end of your paper. The assignment will be graded using the following criteria: Patient Case Analysis Assignment Grading Criteria Pos sible Score Earne d Score Answers to Questions 30 Format Answers are supported by references Follows APA format 5 3 2 Total Score 35 Obesity Case Study Patient Profile and Background Information SL is a 40-year-old white male who presented to a Weight Loss Center for evaluation in preparation for gastric bypass surgery. He has been obese for many years and tried unsuccessfully to lose weight through diet, exercise, and medical therapy with appetite suppressants. SLs health risk factors include a strong family history of coronary artery disease, diabetes type II, and obesity. His job as a salesman requires long trips away from home and his meals are frequently in the form of high caloric carbohydrate and fat fast foods. Physical exam reveals a very pleasant gentleman in no acute distress. Blood pressure is 152/92, pulse 98 and regular, respiratory rate 22, and oxygen saturation 94% on room air. SLs height and weight are 58, and 302 pounds, respectively. He has expiratory wheezing in bilateral lung fields, and a generalized redness of the face. The abdomen is large and soft on palpation with no discernible hepatosplenomegaly or masses. His waist circumference is 50 inches. Serum fasting glucose (FBS) was 118 mg/dl this morning. History revealed hypertension for the past 5 years that is treated with HCTZ; hip and knee pain (osteoarthritis) for which he takes Advil PRN; and asthma, diagnosed around 12 years of age, that is treated with Proventil. The patient also complained of shortness of breath on exertion and a generalized malaise during waking hours. Further discussion led to the revelation by SLs wife that her husband snored voraciously while sleeping and had frequent periods of apnea, lasting 1 to 1 minutes at a time. Question 1: What is Body Mass Index (BMI) and how is it calculated? Utilizing the patients information, what is his body mass index (BMI) and BMI classification? Include all weight ranges with classifications in your answer. (2 points) Physiology of Obesity There are many theories that attempt to explain the pathophysiology of obesity. These relate to the classification as either exogenous or endogenous. Exogenous obesity is that which results from the excessive intake of calories and lifestyle choices; and endogenous obesity results from genetic mutations and metabolic dysfunction inherent to the individual. Question 2: What are two major risk factors that may have influenced the development of obesity in this client? Provide a rationale for each factor. (2 points) Question 3: What are six major neuroendocrine hormones and/or peptides that regulate energy balance and food intake? Discuss the function of each. (6 points) Obesity may simply be due to the excessive number and size of the individual adipocytes, anthropometric measurements attempt to determine the presence of hyperplastic and hypertrophic adipocytes. Hypertrophy occurs in the obese individual when a positive energy balance exists. Cellular size increases as fat accumulates within the cellular components. Hyperplasia results from an increased rate of adipocyte cellular division. In order to measure SLs actual body fat composition, a triceps skin-fold thickness test was done. This test is a more reliable indicator of body fat than is weight. While in a sitting position, triceps skin-fold measurements were made using a skin fold caliper. Adipose tissue is measured in millimeters squared (mm) and was determined to be 42 mm. According to the American Society for Clinical Nutrition, this measurement placed SL considerably over the 95th percentile for skin fold thickness, supporting the diagnosis of obesity. Question 4: Discuss two other anthropometric measures used to assess body fat and muscle composition? (2 points) Diagnostic Studies Embracing the theory that there may be a genetic component to SLs obesity, diagnostic tests were ordered prior to surgery. A routine complete blood count (CBC) and thyroid panel was within normal range for SL and is not relevant to this case study. S.L.s chest x-ray and EKG were also normal. His other lab results are found in Table 1. Table 1 S.Ls Lab Results Lab Test Result Lab Test Result Albumin 4.16 g/dl Blood Gases: Fasting Blood Glucose 118 mg/dl PaO2 88 mmHg Insulin 86 pmol/L PaCO2 50 mmHg Leptin 100-260% of baseline pH 7.32 Cholesterol 320 mg/dL HCO3 30 HDLs 20 mg/dL O2 sat. 94% LDLs 195 mg/dL Triglycerides 220 mg/dL Question 5: Based on SLs history, PE and lab results, discuss the above lab results that support the diagnosis of metabolic syndrome. (3 points) Question 6: What is your interpretation of the above lab results related to his diagnosis of obesity and other health problems? Discuss only those lab results not addressed in question 5. (4 points) S.L. had spirometry tests that revealed a vital capacity (VC) of 4000 mL, total lung capacity (TLC) of 5000 mL and expiratory reserve volume (ERV) of 1000 mL. Question 7: Discuss the purpose and normal ranges for each of the spirometry tests and interpret the results. (2 points) Question 8: What is the physiological impact of asthma, obesity and sleep apnea on pulmonary function? (3 points) Medical Management and Surgical Intervention As all medical management protocols for obesity had been exhausted for SL, it was determined that the best method of treatment was gastric bypass or Roux-en-Y surgical intervention. Question 9: What are the physiological effects of gastric bypass surgery (Roux-en-Y)? What are the criteria for gastric bypass surgery and why is it indicated for SL? (2 points) Nursing Management Nursing care of the clinically obese patient can be challenging. Frequently patients who are overweight resist seeking treatment until their comorbidities are severe. SL was primarily concerned about the changes that he would be forced to make in his diet and lifestyle after surgery. An unanticipated response to the prospect of surgery for SL was the perception of loss that he felt in saying "goodbye" to his former self and the eating habits that had provided comfort to him over the years. Question 10: What are two pertinent nursing diagnoses with related interventions and rationale that should be discussed with . prior to gastric bypass surgery? (4 points) Summary Caring for the severely obese patient requires a solid understanding of the theoretical and actual physiology of obesity. SL presented with the understanding that all other measures taken to control his weight had been exhausted. Genetic predisposition, family history, and lifestyle issues contributed to his fulfilling, what was considered to be, his genetic potential or destiny. Through the study of the bodys ability to thwart starvation, surgical intervention has come to be a popular means to the end of obesity. SL underwent a Roux-en-Y and responded extremely well to surgical intervention. He is 6 months post-op and has lost 98 pounds. He no longer suffers from sleep apnea and is awaiting the results of post-op blood work to determine insulin levels. He is no longer short of breath, but continues to suffer from asthma, although the effects are less severe.
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