Qualifications for bariatric surgery in most areas include:
BMI ≥ 40, or more than 100 pounds’ overweight (ASMBS, n.d.).
≥35 and at least two obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease (ASMBS, n.d.).
- Inability to achieve a healthy weight loss sustained for a period with prior weight loss efforts. (ASMBS, n.d.)
- In this scenario, Mr. C’s BMI is 47.65. He has a history of hypertension and sleep apnea. Based on these observations Mr. C would be a candidate for bariatric surgery. However, a contraindication to the bariatric surgery would be his diagnosis of peptic ulcer disease (ASMBS, n.d.).
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 3hours 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. For administration of the medications provided to Mr. C for his peptic ulcer it is important to know how the medications interact with one another. Zantac and Carafate need to be given with a gap of 2 hours between the doses. Mylanta and Zantac need to be given in between the doses of Carafate. With the schedule the patient follows for his meal plan it would be most beneficial if he took the Mylanta at 10 am, 3 pm, 9pm. The Zantac can be taken at 10pm. The Carafate can be taken at 6am, 11am, 5pm, and 8pm.
Health management- Based on the information gathered Mr. C states he has always been overweight even as a child and he has gained 100 pounds in the past 2-3 years, seeking this surgery to help with his sleep apnea.
Nutritional/Metabolic- Based on his meal times he has a healthy meal plan, it would be good to get an idea of the food that he is consuming at these meals. He did state that he tries to maintain a low sodium diet to help with his high blood pressure.
Elimination- getting a thorough report on his elimination and how often would help get a better understanding.
Activity-exercise- based on the information received he is not an active man, he recently has a desk job that does not help with his inactivity.
Sleep-rest- The information gathered mentions that he has sleep apnea, this can cause him to not get enough rest throughout the night and cause him to be sleepy during the day.
Cognitive health perception- He appears to aware of his health condition and wanting to change to prevent his diagnosis’s from getting worse. Five potential problems:
1. Medication errors if not taken at the time they are prescribed due to the medications not fully working when interacting with other medications.
2. Since he has a history of obesity since childhood, it’s important to make sure the patient has an understanding of a diet and the importance of following a diet to maintain weight loss.
3. Education to this patient that bariatric surgery alone is not a “fix” to obesity it is to help get you to where you need to be along with a proper diet and exercise regimen.
4. Making sure he is continuing to work on treating his underlying health problems such as hypertension and the elevated blood glucose levels. This can prevent these disease processes from getting worse.
5. Sleep apnea is not just going to go away after the procedure, proper management of his sleep apnea must be continued until the diagnosis has been taken away by a physician.