COMMENT JULIE

 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

Surgery Risk Factors

Mr. C is a young gentleman that has various medical problems. He is wishing to have bariatric surgery. At this time he does not qualify for bariatric surgery. He has uncontrolled hypertension, which makes him a risk for stroke, heart attack or death. He also has peptic ulcer disease, which makes him a risk for bleeding and infection. He also has high cholesterol which increases his risk for stroke and heart attack. Diet changes and possibly medication are needed to decrease his cholesterol. He needs to become more stable prior to his surgery. He needs to start an exercise routine, and change his diet to prepare his body for the drastic food intake changes. He needs blood pressure medication started. He also has sleep apnea, and prior to bariatric surgeries MD’s have you do a sleep study test to address and treat any sleep apnea (Pories, 2008).

The above are his risk factors that need to be addressed prior to surgery.

Functional Health Patterns

His functional health patterns are not able to be holistically addressed relating a lack of information in the patient history profile.

Health-perception including health management: health perception is that the patient is wanting to make life style changes by seeking bariatric surgery

Nutritional-metabolic: the patient has excess calories per energy expenditure as noted by obesity. He also has high cholesterol levels. He has peptic ulcer disease which would affect his nutritional status.

Elimination: not addressed

Activity-exercise: sedentary lifestyle with sit down job

Sleep-rest: sleep is disturbed, unrestful and his body is not getting oxygenated appropriately relating sleep apnea

Cognitive-Perception: cognitive and perception is not addressed. He is employable.

Self-perception-self -concept and role relationship:  this area is not addressed in the profile other than being a single male.

Sexuality-reproduction: his sexuality was not addressed

Coping-stress intolerance: his coping and stress tolerance has not been addressed.

Actual Problems and Rationale

1-      Disturbed sleep pattern as evidenced by sleep apnea

2-      Knowledge deficit relating healthy lifestyle

3-      Alteration in comfort relating peptic ulcer disease

4-      Alteration in cardiac output relating uncontrolled hypertension

5-      Alteration in nutrition relating hypercholesterolemia and elevated blood sugars

(Ackley  &  Ladwig, 2011)

1. Rationale: Patient has sleep apnea, which means he stops breathing many times during the night. Sleep apnea increases your risk for stroke and heart attack and causes weight gain. Sleep apnea causes decreased energy during the day.
2. Rationale: Patient is controlling his hypertension with a low sodium diet, and his blood pressure is uncontrolled and is elevated. He is not caring for his high blood pressure in a safe way. He has a sedentary lifestyle, which increases his chance for medical problems including cancer and heart problems. It increases obesity.
3. Rationale: He has been diagnosed with peptic ulcer disease which is uncomfortable relating pain, nausea food intolerance etc. 
4. Rationale: He has uncontrolled hypertension which effects his cardiac output. Hypertension increases his risk for stroke and heart attack
5. Rationale: His good cholesterol HDL is low at 30. His triglycerides are high at 312. His total cholesterol is 250 which is elevated. This puts him at risk for strokes and heart attacks. He should be on a low cholesterol diet. He also has elevated blood sugars. His fasting blood sugar is 146. It should be between 70-100.

Potential Problems

Potential for heart attack and stroke relating hypercholesterolemia, sleep apnea and uncontrolled blood pressure

Potential for bleeding relating peptic ulcer disease and uncontrolled blood pressure

Potential for malabsorption symptoms relating peptic ulcer disease

Medication Schedule

Carafate 1gm 6am

Mylanta 15cc 10am

Carafate 1gm 11am

Mylanta 15cc 3pm

Mylanta 15cc 9pm

Carafate 1gm 9pm

Carafate 1gm 10pm

Zantac 300mg 10pm

Mylanta 15cc 10pm

References

Ackley, B. & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence based guide to planning care (9th edition). St. Louis: Mosby, Elsevier  

Pories, W. J. (2008). Bariatric Surgery: Risks and Rewards. The Journal of Clinical Endocrinology and Metabolism, 93(11 Suppl 1), S89–S96. http://doi.org/10.1210/jc.2008-1641