CDC Adults BMI Calculator and the Multiple Condition DAPH1. Mr. C is obese according to CDC adults BMI calculator. Mr. C BMI is 45, which puts him obese categories.

Adults with this BMI are at high risk of multiple conditions according to CDC. He is already experiencing some of them such as high blood pressure, sleep apnea, low HDL and high LDL cholesterol, high levels of triglycerides according to data presented in this case.  Other health risks include coronary heart disease, stroke especially with uncontrolled high blood pressure, gallbladder disease, some cancers such as kidney, liver, colon.

CDC Adults BMI Calculator and the Multiple Condition

He is also high risk of type two diabetes, already his fasting blood glucose is high.
Bariatric surgery may be an option for Mr. C, according to Mayo Clinic, patients with BMI above 40 generally bariatric surgery is an option but patients must meet certain criteria to qualify for one of the bariatric surgeries. The patient and physician will determine which surgery is appropriate for certain patients. But Mr. C should try other mean first to lose weight and fix health problems such as his blood pressure, probably diabetes since his fasting glucose is high. Exercise regularly since his job requires many hours of sitting. Bariatric surgery should not be the first consideration in Mr. C weight loss programs.
Medication schedule for Mr. C for peptic ulcer:
Mylanta can schedule at 1000; 1500; 2100 since he eats at 6pm, it will be 3hours after meal and one hour before bedtime which is 10pm
Zantac can be administered at 2100 which close to bedtime, and the orders says to give it at bedtime. But should be taken at least an hour before meal
Sucralfate/Carafate can administer at 0600, 1100, 1700, and 2100. The order is to given one hour before meals and at bedtime. He eats meals at 0700, 1200, 1800 and snacks at 2200.

CDC Adults BMI Calculator and the Multiple Condition and Health Perception

. C realized that he needs help to lose weight, but he needs to understand other health issues he has and seek medical advice and physical examination. He tries to correct his blood pressure with sodium restriction but he still needs medical direction on that, a good part is that he recognizes he needs help.
Nutrition/metabolic: Mr. C appears to have metabolic syndrome. He has three of the medical conditions that a person is said to have metabolic syndrome: central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein.
Sleep/rest: Mr. C already has sleep apnea which means he might be very obese and accumulated fat around the neck restricting breathing, or might be something else. He needs to be checked and get medical help/advice.
Five actual problems for Mr. C:
Elevated blood pressure, data does not tell if he is on any medication other than limiting salt by himself.
Mr. C weight is not appropriate for his height, he is in the extremely obese category according to CDC BMI calculation
His fasting blood glucose is elevated. This is a problem he needs to check with medical services as soon as possible. He might have type II diabetes, which is a risk for obese people
Sleep apnea: this is also a medical condition he needs to check because it is affecting his breathing during sleep.
Elevated total cholesterol and triglycerides, and blood pressure :he is at high risks of heart disease
Mr. C has experienced obesity since he was young, and excessive weight gain about 100 pounds in the last 2~3 years. Given objective data indicated he is obesity (calculated BMI; 47), and other related co-morbidities such as type II diabetes, hypertension, sleep apnea, and lipid abnormalities. In the group of obesity, other conditions associated with obesity contribute to the progression of the disease. Obesity reduces mobility and the number of calories that would be burned in the performance of activity. Also, obesity can cause psychological or emotional distress regarding hormonal changes (American Society for Metabolic and Bariatric Surgery [ASMBS], 2018).
Is bariatric surgery an appropriate intervention? Why or why not?

CDC Adults BMI Calculator and the Multiple Condition and Recommendation

In case of childhood obesity, the disease may result in higher mortality with other complications. Therefore, bariatric surgery is recommended on Mr. C in aggravated obesity problem, since the surgery has been proven to produce long-lasting weight-loss and improvement in many obesity-related conditions such as type 2 diabetes, high blood pressure, sleep apnea and more. Also, by changing gastrointestinal anatomy, certain bariatric procedures affect the production of intestinal hormones in a way that reduces hunger and appetite and increases feelings of fullness (American Society for Metabolic and Bariatric Surgery [ASMBS], 2018).
Medication administration schedule
1) Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime –it will be at 10am, 3pm, and 9pm.
2) Ranitidine (Zantac) 300 mg PO at bedtime – it will be at 10pm.
3) Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime – it will be at 6am, 11am, 5pm, and 9pm, not with Mylanta.
Assess each of Mr. C.’s functional health pattern
health-perception – health management: Considering Mr. C is seeking information at the outpatient center for bariatric surgery in obesity, he addresses his health issues with obesity. In other words, Mr. C has a good perception of his health problems and tries to promote good health outcomes by the surgical treatment.
nutritional – metabolic, elimination: The data show that he has hypertension, diabetics, hyperlipidemia, which he tries to control with sodium restriction. Before his surgery, nutritionist needs to be involved to assess his on-going diet management. For obese patients, a reduction of 500 to 1,000 calories per day results in a weight loss of 1 to 2 lbs per week. Calorie restriction can be accomplished by avoiding alcohol, sugary drinks, and foods that are high in fat, sugar, and carbohydrates, while increasing consumption of vegetables, fruits, whole grains, and fiber.
activity-exercise: There is not specific data about his activity and/or exercise, primary nurse should assess about the patient’s current level of activity and whether the patient has considered the potential benefits of increasing that level. According to ‘Physical activity guidelines for Americans’, adults are recommended to exercise at least 2.5 hours of moderate-intensity physical activity weekly. The target heart rate for moderate-intensity physical activity should be 50% to 70% of maximum heart rate (U.S. Department of Health and Human Services, 2008).
sleep-rest: Mr. C complains about sleeping apnea, which easily interrupts quality of sleep.
cognitive-perceptual pattern: He current works at a catalog telephone center, and aware of his current health issue, thus, considers bariatric surgery for his obesity.
self-perception: MR. C worries his poor health problems, and tries to manage it better.
role-relationship: Mr. C. is a 32-year-old single man, but no more data regarding his relationships.
sexuality – reproductive pattern: There is no data regarding his sexuality-reproductive pattern.
coping – stress tolerance: He is young in single life, but struggles with the poor health issue since he was young. He may get stressed out for a while, because he is looking for information about bariatric surgery. He needs more supportive care from friends, family for control of hypertension, diabetics as well.
Identified actual or potential problems
1) Type 2 diabetes: Mr. C showed high level of fasting blood glucose: 146/mg/dL. More than 87% of adults with diabetes are overweight or obese. In the group of overweight, their bodies make resistant to the hormone insulin. Insulin carries sugar from blood to the cells, where it is used for energy. When a person is insulin resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar.
2) High blood pressure: He showed high blood pressure as 172/96mmHg. In hypertension group, a large body metabolic index can increase blood pressure since a heart needs to pump harder to supply blood to all cells. Also, over fat can damage kidneys, thus, higher risk of losing control of blood pressure.
3) Heart disease & stroke: Mr. C may get more heart diseases and/or potential stroke. Overweight can cause make a heart works harder to send blood to all the cells in a body. It results in heart problems such as high blood pressure, high cholesterol, and high blood sugar, those are the main causes of strokes as well.
4) Sleeping apnea: Obesity is the most important risk factor for sleep apnea. Mr. C is overweight, and he may have more fat stored around his neck. This may make the airway smaller. A smaller airway can make breathing difficult or loud, or breathing may stop altogether for short periods of time.
5) Osteoarthritis: Obesity increases the risk of osteoarthritis, since overweight may place extra pressure on joints and cartilage. Mr. C may have higher blood levels of substances that cause inflammation. Inflamed joints may raise the risk for osteoarthritis (National Institute of Diabetes and Digestive and Kidney Diseases [NIH], 2015).
Conclusion: Health care professionals should identify health problems in obesity, and consistently promote healthy weight management strategies, having a multidisciplinary team of experts for follow-up care (Budd & Peterson, 2015).
JOM3. Mr. C’s  health risks associated with obesityMr. C is obese since childhood and has many co-morbidities associated with obesity.  He has a recent weight gain of 100 pounds in the last 2-3 years and a history of hypertension and sleep apnea. His current job in a catalog telephone center does not involve much of movement or physical excretion. His height: 68″ (1.73 meter), weight: 134.5 kg (295.9lb) with a calculated BMI of 45, high FBS:146, high Cholesterol: 250mg/dL, and low HDL:30 mg/dL are indicative of metabolic disease like hyperglycemia and hypercholesterolemia; his BP: 172/96 which indicated poorly controlled hypertension; and his RR: 26 indicates tachypnea due to activity intolerance and obesity. The recent weight gain also could indicate Congestive Heart Failure (CHF). There is no data regarding edema or a BNP level. He also has recent onset of Peptic Ulcer Disease. This can predispose him to bleeding, perforation, and blockage (Wolfe, Kvach, & Eckel, 2016; Hruby & Hu, 2015).
Is bariatric surgery an appropriate intervention for him?Co-morbid conditions associated with obesity can be managed or improved with effective and sustained weight loss. Those include extensive medical management, diet control, exercise, and education regarding life modifications as well as motivation and encouragement with support group and resources. If he will not make any improvement with the above suggestions, and since Mr. C’s conditions are chronic in nature with multiple risk factors, he may be benefited with surgical interventions (bariatric Surgery).  According to Wolfe et al. (2016), the National Institutes of Health consensus panel specified that bariatric surgery is appropriate for all patients who failed medical or non-surgical means of weight control, with body mass index (BMI= kg/m2) >40, and for patients with BMI 35 to 40 with associated comorbid conditions. Mr. C’s BMI is 45 and has numerous comorbidities as mentioned above that make him a perfect candidate for bariatric surgery. Although there are risks involved as with any surgery, if he properly follows instructions, bariatric surgery will help him to reduce weight and its related complications.
Therapeutic Medication  administration schedule for Mr. CIt is not easy for Mr. C to follow this administration schedule since it requires multiple doses of various medications in different times. Therefore, thorough education and administration instructions need to be provided as per his learning level to keep the medications consistent. After providing the administration instructions, I will  teach him about each medication time as given below.
Mylanta:  an antacid that may interfere with absorption of many medications including Zantac and Carafate, needing therapeutic and acceptable scheduling of medication administration (Drug.com, 2018). Mr. C could take his Mylanta at 10 a.m., 3 p.m., and 9 pm which is therapeutic and most probably acceptable to him.
Zantac: a histamine H2 receptor antagonist to be taken at bedtime (10 pm), and its absorption is not affected by food (Drug.com, 2018). Therefore, 10 pm dose is therapeutic and acceptable because this could ensure at least one hour after the administration of Mylanta.
Carafate: forms a protective coating in the GI tract and is often prescribed for patients with PUD which should be taken on an empty stomach (Drug.com, 2018). Therefore, it can be administered at 6 a.m., 11 a.m., 5 p.m., and just before his bedtime snack at 10 p.m. This allows him to take each dose on an empty stomach and  a minimum one-hour gap from the administration of Mylanta.
Functional health patterns of Mr. C as per Gulanick & Myers (2014) & Wolfe et al. (2016) are as follows:
Health perception and health management: Seeking information regarding bariatric surgery indicates that Mr. C is concerned about his health condition especially obesity. He has a good perception of his poor health and is willing and wanting to improve it. People’s perception regarding their health conditions and acceptance and awareness of their health condition lays the foundation for better clinical outcomes (Wolfe et al., 2016). However, looking at all the assessment findings, diagnostic tests results, sedentary life/work, and history of uncontrolled HTN, DM and other co-existing conditions specify  that he was poorly managing his health. He needs a lot of education regarding life style modifications, needing to improve existing health conditions, and regarding the risks and benefits of a bariatric surgery.
Nutritional and metabolic pattern: Despite the information that he was managing hypertension with sodium restricted diet, there is not much data available to derive at any conclusion regarding the nutritional and metabolic patterns. Since he is living single, there is more chance that he may be surviving on fast foods or canned foods, both of which are very unhealthy. However, his BP measurement indicated that his HTN was poorly controlled/managed. Hence, Mr. C’s perception and knowledge regarding low sodium diet and healthy diet may be unhealthy. Moreover, his high FBG:146, high Cholesterol: 250mg/dL, and low HDL:30 mg/dL are indicative of a metabolic imbalance/disease (Wolfe et al., 2016). So, he  needs tremendous education regarding diet and life style modifications to improve his clinical conditions.
Elimination pattern: It is quite likely that Mr. C is suffering from undiagnosed CHF, as evidence by recent weight gain of 100 lbs., shortness of breath, and tachypnea. It is also possible that he has poor cardiac and kidney functions due to poorly controlled HTN and blood sugar, causing retention of fluids and weight gain. Stress tests, echocardiograms, and kidney function tests should be done to determine baseline and mediations and interventions that are most therapeutic for him should be initiated (Gulanick & Myers, 2014).
Activity and exercise pattern: He is obese, single, and has a sedentary job that specifies lack of physical exercise/activity. He is tachypneic and short of breath, which either indicates poor cardiac or respiratory function or activity intolerance. If Mr. C’s activity and exercise pattern was adequate, he might not have required bariatric surgery.
Cognitive and perceptual pattern: Mr. C is employed which requires at least minimum cognitive abilities. He admits the fact that he was obese from his childhood and currently wants to have an elective bariatric surgery. Noncompliance as well as lack of knowledge and resources could have contributed to his failing health.
Sleep and rest pattern: History of sleep apnea, tachypnea, shortness of breath,  obesity, and recent weight gain shows he has sleep and rest disturbance. As a result, it is very likely that Mr. C feels un-rested, and less energetic during the day. It is very important that  Mr. C undergoes a sleep study and if diagnosed with sleep apnea, the CPAP machine needs to be used while sleeping (Gulanick & Myers, 2014).
Self-perception and self-concept pattern: Being obese, single, and with failing health, Mr. C could be in a depressive state. He has basic knowledge regarding his health but not in detail. That may be the reason that we are missing a lot of valuable information pertaining to his medical management. His current health, self-perception, and self-concept patterns made him contemplate on an elective bariatric sugary.
Role and relationships pattern: It is stated that Mr. C is single, and no family or social support system is available. His obesity, poor health, and nature of his work make him more reserved and less active.
Sexuality and reproduction pattern: There is not enough data to interpret his sexuality and reproduction patterns. His current health conditions and state of being single may make him less sexually active.
Coping and stress tolerance pattern: Mr. C is single and does not have any family or social support system available for help. His religious affiliations, social role, relationship pattern, and ability to maintain relationships are not identified. Hence, it will be wrong to assume and come to any conclusions. Without proper support systems or coping mechanisms, it is very difficult for someone like Mr. C to have a successful surgical outcome.
Five actual or potential problems and their rationale
Problem #1: Imbalanced Nutrition: More than body requirements related to excessive intake in relationship to metabolic needs as evidenced by significant weight gain and elevated cholesterol level (Gulanick & Myers, 2014).
Rationale: Mr. C is reported to be obese with a weight: 134.5 kg (295.9lb), height: 68″ (5′ 8″), BMI: 45, recent 100lb weight gain in 2-3 years, high Cholesterol: 250mg/dL, and a low HDL:30 mg/dL. A BMI >30 which is considered obesity. All these findings indicate that Mr. C’s nutritional intake is more than metabolic requirement or imbalanced nutrition.
Problem #2: Ineffective Breathing Pattern related to obesity as evidenced by shortness of breath, respiratory rate of 26, history of sleep apnea, a BMI of 45, and a recent 100lb weight gain (Gulanick & Myers, 2014).
Rationale: All the assessment findings including height, weight, BMI, and increased respiratory rate (26) indicate that he has compromised respiratory status. It is also reported that Mr. C was diagnosed with sleep apnea, but no interventions to manage it has been recorded. He has recent weight gain which possibly indicates CHF and respiratory complications.
Problem #3: Risk for decreased cardiac output related to increase after load, vasoconstriction, myocardial ischemia, ventricular hypertrophy as evidenced by poorly controlled hypertension, diabetes, and severe obesity (Wolfe et al., 2016).
Rationale: Many assessment and diagnostic findings suggest that Mr. C has cardiac, respiratory, and metabolic risk factors. Poorly controlled HTN, DM, obesity, high cholesterol, and untreated sleep apnea  increase his cardiac work load, decrease cardiac output, and eventually cause his heart to fail. He obviously exhibits signs of HF.
Problem #4: Disturbed Body Image related to overweight/obesity as evidenced by a BMI of 45 and his desire to have bariatric surgery to correct obesity and enhance body image  (Gulanick & Myers, 2014).
Rationale: People look at obese people with a low profile. It is a chronic health condition which has no quick fix. This imposes them to social isolation, decreased tolerance to activity, clumsiness, decreased self-esteem, eating/behavioral disorders, depression, and suicidal ideation. Research says that obesity also may cause lower life expectancy due to cardiac, respiratory, and metabolic complications (Hruby & Hu, 2015).
Problem #5: Risk for Injury related to elective bariatric surgery (Wolfe et al., 2016).
Rationale: Mr. C already has many risk factors (cardiac, respiratory, and metabolic). Uncontrolled, HTN, DM, and his obesity increase risk for poor surgical outcome due to existing cardiac, respiratory, and metabolic imbalances. Poor wound healing and dehiscence can result due to obesity and uncontrolled diabetes. Bariatric surgery has additional risk factors when compared to other surgeries, although the outcome may be very desirable (Gulanick & Myers, 2014; Wolfe et al., 2016).
JAS4. Based upon Mr. C’s BMI which is 46 is considered in the morbid obesity range according to Mayo Clinic’s BMI calculator and obesity scale (mayo clinic, 2018). The risk factors associated with the classification of morbid obesity includes Hypertension, High Cholesterol, Coronary Artery Disease, Diabetes, Arthritis, increased risk for various types of cancer. The rapid rate in which he gained the last 100lbs places him at high risk for these conditions due to the lack of opportunity for his body to adjust to these major changes in body mass.The use of bariatric surgery is often used as a quick fix for those who are obese. There is great success that can occur from the various types of surgeries available, but also significant side effects and risks associated with them as well. While there are many varieties of bariatric surgeries available, they all have a similar goal, which is to reduce the size of the stomach which in turn will limit the amount of food consumed because the patient will feel full quicker. Also, less of the food nutrients are absorbed as well. For someone to be qualified they must meet certain criteria that include:
Efforts to lose weight with diet and exercise have been unsuccessful.
Your BMI is 40 or higher.
Your BMI is 25 or more and you have serious weight-related health problems.
You’re a teenager who’s gone through puberty, your BMI is 35 or more, and you have serious obesity-related health problems (MayoClinic 2, 2017).
Risk factors associated with having the surgery are similar to the risks of any surgery that include blood clots, infections, etc. However, with bariatric surgery there is risk of malnutrition from decreased absorbability of the stomach to absorb vital nutrition. If the amount of food that the patient consumes is not reduced there is risk that injury to the stomach or other areas could be damaged. Weight gain can return over time as the stomach can stretch allowing the patient to eat as much as prior to surgery, so lifestyle change is important.
For Mr C. it is difficult to say whether bariatric surgery is right for him. On one hand he has significant risk of beginning to develop severe cardiovascular, and metabolic disease which is suggested by his lab work, so this surgery would be useful to reverse that trend quickly. On the other hand, his age does not classify him as a great candidate for being approved for surgery because there is significant opportunity that he could use other resources to help lose weight (dietary, weight loss programs, exercise, etc.). The side effects and risks of the surgery to a 32-year-old could be significant which is not exactly the best route to take in a young person.Medication administration is important to maximize the effectiveness of each medication. His meal times should be adjusted to reduce any late-night eating to avoid acid production while sleeping. An example of an eating schedule would be as follows:
Breakfast at 0700
Snack at 0930
Lunch at 1200
Snack at 1430
Dinner at 1700
Light snack at 1900
These meals should follow a healthy eating plan that includes low-fat, low- salt, low- sugar food that is high in protein including fruits and vegetables. His medication schedule should include:
Mylanta should be taken at 2200 if a snack was consumed or 2000 if not.
Zantac should be taken at 2200 which is bedtime to reduce acid production during sleeping in a semi supine position.
Sucralfate should be taken at 0600, 1100, 1600, 2200.
Functional Health Patterns
Health- perception- The fact that Mr. C. is looking for information regarding bariatric surgery is an indicator that he realizes that his health is not trending in a positive direction. He wants to correct his weight and medical conditions and is having difficulty through dieting alone.
Nutritional- metabolic- After review of his medical history and dietary habits it is clear that there is significant room for improvement. He states he has gained 100 pounds over the last 2-3 years which is evidence of poor nutritional habits. His reported eating schedule has him eating his last meal just prior to sleeping which is not recommended for weight control. He should not be eating after 5pm to promote his metabolism to use stored energy during sleep.
Elimination- Mr. C has not reported any bowel or bladder complaints at this time.
Activity-exercise- Due to the patients rapid weight gain it can be assumed that he has a limited or non-existent exercise routine and works in a desk type job which limits his mobility further reducing his calorie burn vs, intake each day.
Sleep-rest- Mr. C reports having sleep apnea and a peptic ulcer both of which can drastically interfere with a normal sleep cycle. If correction is made to reduce or eliminate these conditions, he can sleep much better and awake with increased energy to be active.
Cognitive perceptual- Patient appears to have clear cognition and is mentally capable of complex decision making.Self-perception- Mr. C does not have a positive perception of himself, he is 32 and is morbidly obese, this has led to his desire to make quick changes that include bariatric surgery.
Role-relationship- The case study does not indicate the relationships in Mr. C’s life. However, a common desire of those who seek weight loss is to improve relationships with those around them.
Sexuality- There is no indication as to the sexual activity of Mr. C. Being morbidly obese can have significant impact on self-esteem which make it difficult to be sexually active.
Coping- stress tolerance- The stress that can be assumed is that Mr. C is emotionally strained by his weight gain and finds it difficult to do the activities of a normal 32-year-old male. Because of this he will have an increased stress level.
5 problems identified:
Risk for diabetes- With Mr. C’s elevated fasting glucose and reported diabetic history it is essential to lose substantial weight to reduce risks for worsening disease, or he will begin to have diabetes complications.
Risk for psychological compromise- The risk of depression is greatly increased with patients who are morbidly obese. The self-perceived image is poor and the stress and pressure of society to have a certain body type is increased.
Risk for heart disease- The increased cholesterol levels combined with the sedentary lifestyle, and the obesity increase the strain placed upon Mr. C’s cardiovascular system.
Increased knowledge deficit- the lack of understanding regarding the significance of weight gain and health issues presents an area of improvement that can have increase effect on patient’s health.
Imbalanced nutrition- The lack of proper diet presents an area of improvement that needs to be changed to reduce weight and increase overall health.
KRIS5. Mr. C has a variety of potential health risks associated with obesity including diabetes, hypertension, heart disease and stroke.
Blood Work:
Total cholesterol 250 mg/dl (normal <200 mg/dl)
Triglycerides: 312 mg/dl (normal <150 mg/dl
HDL: 30 mg/dl (normal 40-59 mg/dl)
Fasting blood sugar: 146
Each of the above lab values increase the risks for present and future medical issues and concerns regarding Mr. C’s obesity. Elevated triglycerides and low HDL increase his risk for both heart disease and stroke. High levels increase the potential of fatty build up in the arteries leading to obstruction and making the potential of stroke a possibility.
Bariatric surgery is something to consider in reducing obesity and therefore decreasing the potential risk of complications. Bariatric surgery intervention has been shown to help mend or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more. Often, individuals who improve their weight find themselves taking less and less medications to treat their obesity-related conditions. (Benefits of Bariatric Surgery, 2018)
With increased weight loss, patients will find themselves engaging in more physical activity and exercise. Individuals who find themselves on a weight-loss trend often engage in physical activity, such as walking, biking, swimming, and more. Additionally, increased physical activity combined with weight loss may often improve your body’s ability to burn fat, lead to a positive personal attitude, and decrease stress levels. (Benefits of Bariatric Surgery, 2018)
The best plan for Mr C.’s medication schedule is as follows:
Mylanta at 10:00 15:00 21:00
Carafate 0600 1700 and 2000
Zantac at 2200
Health Perception: Based on the information provided Mr. C. overall general health has been up and down with weight gain throughout his life.
Nutritional/Metabolic: Patient BMI is high. He has gained a lot of weight over the past 2 years. He is trying to address the issue with the possibility of bariatric surgery and reduced sodium diet.
Elimination: No concerns mentioned at this time.
Health Management: Currently, the patient is inquiring about Bariatric surgery suggests he is wanting to do something to decrease his weight therefore decreasing his risks of heart disease, hypertension and diabetes.
Activity – Exercise: Mr. C works in an office at a desk so there is limited activity or ROM.
Sleep Patterns-Rest: Patient has history of sleep apnea which requires a CPAP machine at night.
Cognitive/perceptual: No issues at this time.
Self-Concept: Patient describes his health by an up and down struggle with weight gain. He stated a weight gain of 100 lbs. over the past 2-3 yrs.
Role Relationship: Mr. C.  is currently working as a catalog telephone center. No concerns were mentioned.
Sexuality/Reproductive: No concerns were mentioned in the case scenario.
Coping: Mr. C.’s is seeking an alternative to his current treatment of his obesity by gaining information on surgery.
Hypertension: Obesity increases the risk of the development of hypertension Pharmacotherapy is effective in controlling blood pressure but must be along with a weight loss program. (Benefits of Bariatric Surgery, 2018)
Depression: Forty-three percent of adults with depression were obese, and adults with depression were more likely to be obese than adults without depression. (Benefits of Bariatric Surgery, 2018)
Diabetes: Obesity is the leading risk factor for type 2 diabetes. Excess weight affects two thirds of the U.S. adult population and increases risk for cardiovascular disease and diabetes. The best treatment for diabetes is prevention
Stoke: Studies have consistently linked high triglycerides levels with heart disease, heart attacks, and stroke, especially in people with low levels of “good” cholesterol and in those with type 2 diabetes. (Benefits of Bariatric Surgery, 2018)
Risk for DVT: Obesity has emerged as a global health issue that is associated with wide spectrum of disorders, including coronary artery disease, diabetes mellitus, hypertension, stroke, and venous thromboembolism (VTE). (Benefits of Bariatric Surgery, 2018)