1803NRS Nursing Practice: Case Study - Obesity and Diabetes
The Case Scenario
Michael Anderson is a 48 year old male with morbid obesity and type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Michael was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and finding it difficult to breathe when he sleeps. On the previous admission, Michael was seen by the dietician and was commenced on low energy, high protein diet (LEHP) to help him reduce weight. His GP had previously mentioned weight loss however he had never wanted to do anything about it as it ‘seemed too hard’. Michael had also been seen by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.
Michael has been discharged home, with referral to community care unit for ongoing support and follow up, after three weeks in the medical ward to manage his weight and clinical comorbidities.
Past medical history
- Obesity (weight165kgs with a BMI of 57.09m2).
- Type 2 diabetes ( diagnosed 9 years ago)
- Hypertension, (HTN)
- Depression (Diagnosed three months ago y GP).
- Sleep apnoea
- Gastro oesophageal disease reflux disease
Social History
Michael is an unemployed male who is on financial benefits. Michael lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland. Michael states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 95kg but since starting insulin and losing his job he has gained a significant amount of weight. Consequently, because of his weight issues Michael has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Michael is a divorcee who lives alone, his daughter and son live in the same state but live in different cities and rarely visit him. He is socially isolated because he is embarrassed by his size and he rarely goes out. Michael is also finding it increasingly hard to perform activities of daily living (ADL). Michael realises that he is in the prime of his middle age life and he wants to lose weight.
Current Medication
- Insulin novamix 30/70 DB (20 units mane and 10 units nocte)
- Novarapid sliding scale
- Metformin 500mg BD
- Lisinopril 10mg daily
- Nexium 20mg daily
- Metoprolol 50mg BD
- Pregabalin (Lyrica) 50mg nocte
Last observation on discharge
- Weight 165kgs (obese)
- BP 180/92 (hypertensive)
- RR 23 ( Tachypnoea )
- HR 102 ( tachycardia )
- Sp02 RA 95% on Room Air (R/A)
Task:
Discuss obesity and type 2 diabetes and facts that surrounds these conditions basing on Mr. Anderson’s case. In addition, this essay will also identify issues of Mr. Anderson’s condition to be able to choose a two top care priorities and address it through goals, comprehensive nursing interventions, and finally, evaluating and reflecting on the whole process.
Answer:
Introduction
Obesity has become a global problem due to the changing lifestyles and patterns of eating. Most people live luxurious lives, hence finding it easy to feed on processed and fast foods that have high levels of fats. This mode of lifestyle has highly affected individuals who are living in urban areas. As a result of eating foods with high fats, the prevalence of obesity has increased 13% of the world’s population being obese as at 2014. According to the World Health Organization reports, 39% of adults who are 18 years and above were overweight in 2014, which raised an alarm to the heath sector. It is not only the adults who are affected by obesity and being overweight, statistics also show that 41 million of children aged 5 years and below were overweight or obese by 2014, indication that parents are also not watching the types of food they were giving their children (Keating, Backholer, & Peeters, 2014).
In Australia, the rate of obesity and being overweight is very high compared to other parts of the world. According to 2012 statistics recorded by the Australian government states that 63% of the Australian adults were either overweight or obese. This was a 10% increase compared to 1995 statistics, indicating that the Australian's lifestyle has changed hence it has led to increase in the population of individuals with a BMI greater than 25 kg/m2 (Walls et al., 2011). As a result of the increasing population of individuals who are obese and overweight, incidence rates of diseases such as heart failure, high blood pressure and diabetes type 1 and 2 have increased. Medical centres have recorded a high number of individuals who have been diagnosed with these hence conditions, hence becoming a national health problem, with a need for a solution.
Body
i. HistoryMr. Michael Anderson is a 48-year-old man who has been jobless after losing his job as a Forklift driver in a Coal mine company. He is divorced with two children who are living in the state but in a different town, but they do visit him rarely. Since Michael lost his job, he has been staying at home alone, performing his daily activities and he does not socialise much with the outside world. Michael has been suffering from diabetes type 2 and he has been taking insulin to control blood sugars. Michael was 95kgs by the time he was losing the job but currently, he is 165kgs with a BMI of 57.09kg/m2 (Pi-Sunyer, 2009). Due to his weight increase, he suffers depression and he is not comfortable searching for another job because he feels that other people will isolate him. He has been unable to perform his duties comfortable due to fatigue, hence mismanaging the diabetes condition. Mr. Anderson was admitted to the hospital ward after being diagnosed with poorly controlled type 2 diabetes, obesity ventilation syndrome and sleep apnea. Some of the observable symptoms were increased hunger, diaphoresis, shakiness, finding it hard to sleep and high levels of blood glucose. Previously, he was advised by his dietician and GP to manage his weight by doing some light exercises but it was hard to manage (McCardle, 2015).
ii. Sleep apnea and obesityAccording to Mr. Anderson's case, his manifestations were caused by his morbid obesity and type 2 diabetes. Michael has been exposed to most of these risk factors leading to sleep apnea, hence being affected (Panossian, & Veasey, 2012). Due to his weight, his neck must be large than 17 inches, airway blocks during respiration process when he sleeps. In the past, Michael was also diagnosed with gastroesophageal reflux disease, which is also a risk factor that is highly connected to sleep apnea. Most of these characteristics are related to obesity, hence defining its ideal connection with sleep apnea (Hargens, 2012).
Michael’s obese ventilation syndrome is resulted by his overweight, hence a BMI of more than 30kg/m2. According to Pi-Sunyer (2009) an approximate of 90% of the patients suffering from obese ventilation syndrome, they always develop obstructive sleep apnea. After developing this health condition, the chances of being affected by other diseases such as hypertension, diabetes, depression, stroke and headaches among others increases (Valham et al., 2012). Due to the untreated and uncontrolled sleep apnea condition, individuals might drop in general performance such as performing daily activities at home, school or work (Panossian, & Veasey, 2012). Michaels claims to be lazy in performing his activities at homes and applying for new jobs. This might be as an effect of sleep apnea, which affects the functioning of the body due to the reduced oxygen supply to the body parts (Robinson, & Christiansen, 2014).
iii. Diabetes and obesityIn the contemporary world, research has identified obesity as one of the main risk factors for diabetes. As stated above, obesity leads to sleep apnea which is connected to an insufficient supply of blood to the body. Mr. Anderson experiences blockage of blood in the arteries due to the increased amount of fats that accumulate in the walls. Due to reduced volume of the arteries and veins, there is increased work of the heart in pumping blood from the heart to the brain and the other parts of the body, which led to hypertension condition (Valham et al., 2012). Michael has not been managing diabetes well by following the doctor’s prescription. This has led to high blood sugars that are connected to shakiness, excessive sweating and diaphoresis. Also, due to the unmanaged insulin levels, Michael has increased hunger that makes him feed a lot against the weight reduction plan. As a result of increased and uncontrolled eating, he is not able to manage obesity and all the other connected conditions. Sleep apnea condition persists and his body cells are fatigued due to insufficient supply of oxygen during his sleep. Due to the fatigue caused by insufficient supply of blood, he is not able to comfortably perform his personal activities (Xie, 2011).
iv. DepressionDepression is a condition that is elevated by reduced socialisation levels. Michael lives alone in his house and this contributes to in-depth personal thoughts. Due to his obesity condition, he might think that the society does not like him because of his weight (Robinson, & Christiansen, 2014). When he was working in Moranbah Coal Mine, Michael states that he weighed 95kgs and the other people always identified him as a big guy. After he lost his job and started to take insulin because of the diabetes conditions, his body added more weight. This must have reduced his self-esteem since he does not socialise with people frequently. Even his family does not visit him frequently, which translates to elevated thoughts on the issues leading his isolation (Hargens, 2012).
v. Sleep apnea nursing interventionSleep apnea can be managed effectively with the help of nursing support in the hospital or at home. The management plan is a continuous process that needs to be embraced every time to completely control the problem. Firstly, the nurses to help the victims understand that their lungs need some more space. Therefore, deep breathing should be highly advised by the nurses, which allows sufficient oxygen flow into the body and expansion of the lungs. The patient’s bed can be propped up from to elevate the body from the waist, which ensures that the respiratory system is enhanced (Lee, 2011).
vi. Obesity hypoventilation syndrome interventionObesity hypoventilation syndrome (OHS) is characterised by poor sleeping patterns, depressions, daytime sleepiness and sleep apnea. Nurses can help OHS patients to manage the condition by performing oxygen therapy, use of tracheostomy for severe and extended cases. The nurses can also use the continuous positive airway pressure (CPAP), which is mechanical ventilation system that helps OHS patients mainly during sleeping period. The importance of this system is to increase the breathing air pressure that reduces chances of airway collapsing (Panossian, & Veasey, 2012). A mask that covers the mouth and nose completely or the nose alone can be used in this process. Mr. Anderson can be supported by this mechanism to improve his sleeping comfort and patterns during his stay in the hospital ward.
vii. Managing diabetes and obesity effectsMr. Michael should concentrate on managing his weight, blood pressure, respiratory rate, heart rate and oxygen saturation in the blood to be able to reduce fatigue and muscle weakness. Eating a healthy diet that avoids foods that have high amounts of sodium, calories, carbs and fats that might elevate the levels of cholesterol in the body. Anderson should also increase his exercise rates by walking frequently among other recommended exercises (McCardle, 2015). This activity will reduce the extra pounds significantly, hence improving his health state. The insulin level should also be effectively managed by direct injection according to the doctor's prescriptions. Improving the blood sugars will reduce the rate of feeling hunger, which decrements rate and amount of calorie intake, hence managing his body weight systematically (Skyler, 2014).
The significant increase of body exercises also reduces the blood pressure due to the reduced cholesterol levels. The blood veins and arteries are resumed to normal sizes which balance the elevated blood pressure. As a result of the managed blood pressure, the respiratory rate will be reduced because the oxygen intake into the body will be effectively managed (Pi-Sunyer, 2009). Due to the reduced rates of blockage in the blood vessels, the heart rate will be managed because the flow of blood will be smooth from the heart to all the body part and back. The fatigued blood cells will be supplied with sufficient oxygen, which makes Michael feel strong to perform his activities. Finally, Mr. Anderson's oxygen saturation will be improved to lie with the acceptable range [95% - 100%].
Reflection
Health management is a critical concern for every individual person to avoid health conditions that are related to lifestyle issues. Physical exercises and a balanced diet are the key concern towards managing body weight, hence keeping away from diseases and health conditions such as diabetes and hypertension. Individuals who are overweight just like Mr. Anderson should develop a weight management program in order to reduce their weight and manage their BMI. As a medical practitioner, I can advise on frequent medical check-up, which helps in early detection of diseases for better health management.
References
Bohl, M. et al., (2014). Management of Type 2 diabetes with liraglutide. Diabetes Management, 4(2), 189-201. https://dx.doi.org/10.2217/dmt.13.72
Brijnath, B., & Antoniades, J. (2016). “I'm running my depression:” Self-management of depression in neoliberal Australia. Social Science & Medicine, 152, 1-8. https://dx.doi.org/10.1016/j.socscimed.2016.01.022
Gozal, D. (2015). Diet and exercise in obstructive sleep apnea patients with obesity: I'll breathe to that! Obesity, 23(8), 1526-1527. https://dx.doi.org/10.1002/oby.21178
Hargens, T. (2012). Heart rate recovery in obstructive sleep apnea: obesity or not? Sleep and Breathing, 17(1), 3-4. https://dx.doi.org/10.1007/s11325-012-0650-1
Lee, N. (2011). Self-management of blood sugar levels is essential. Nursing Standard, 25(46), 32-32. https://dx.doi.org/10.7748/ns2011.07.25.46.32.p5926
McCardle, J. (2015). The diabetic foot: a core component of diabetes management. Diabetes Management, 5(2), 63-65. https://dx.doi.org/10.2217/dmt.14.60
Panossian, L., & Veasey, S. (2012). Daytime Sleepiness in Obesity: Mechanisms Beyond Obstructive Sleep Apnea—A Review. SLEEP, 35(5), 605-615. https://dx.doi.org/10.5665/sleep.1812
Pi-Sunyer, F. (2009). Obesity and Hypertension. Obesity Management, 5(2), 57-61. https://dx.doi.org/10.1089/obe.2009.0204
Robinson, E., & Christiansen, P. (2014). The changing face of obesity: Exposure to and acceptance of obesity. Obesity, 22(5), 1380-1386. https://dx.doi.org/10.1002/oby.20699
Skyler, J. (2014). Defeating diabetes. Diabetes Management, 4(6), 473-477. https://dx.doi.org/10.2217/dmt.14.40
Type 2 diabetes. (2012). Nursing Management (Springhouse), 43(1), 25-26. https://dx.doi.org/10.1097/01.numa.0000410740.51779.30
Valham, F., Sahlin, C., Stenlund, H., & Franklin, K. (2012). Ambient Temperature and Obstructive Sleep Apnea: Effects on Sleep, Sleep Apnea, and Morning Alertness. SLEEP. https://dx.doi.org/10.5665/sleep.1736
Walls, H. et al., (2011). Projected Progression of the Prevalence of Obesity in Australia. Obesity, 20(4), 872-878. https://dx.doi.org/10.1038/oby.2010.338
Xie, A. (2011). The Heterogeneity of Obstructive Sleep Apnea (Predominant Obstructive vs Pure Obstructive Apnea). Sleep, 34(6), 745-750. https://dx.doi.org/10.5665/sleep.1040
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