Obesity Nutritional Disorder
\nPatient\u2019s Chief Complaints
\n\u201cI need to lose some weight and I can\u2019t do it by myself. I\u2019m always tired and out of breath and my back and knees are killing me. I\u2019d like to have stomach staples, if possible.\u201d
\nHPI
\nB.L. is a 57 yo Hispanic woman of Puerto Rican heritage who states that she maintained her ideal weight, which she believes is about 115 lbs, until she was divorced 15 years ago. \u201cI was in the military years ago and I was very trim at that time.\u201d She has been continually gaining weight, mostly through \u201ccomfort eating\u201d after her divorce. She also admits to nibbling on snacks at work\u2014mostly high-calorie foods like brownies and Twinkies. She has previously tried OTC diet pills, multiple fad diets (South Beach and Sugar Busters), meal replacement diets (Slim-Fast), \u201cwater pills,\u201d and most recently a combination of herbal products (chitosan and Garcinia). \u201cI lose a bunch of weight over one or two months and then I gain it all back plus some.\u201d She is tearful as she talks about her weight struggles. \u201cI realize that my weight is affecting my health and I want to finally get some help to lose some and then keep it off for good.\u201d
\nPMH
\n\u2022 HTN \u0001 8 years
\n\u2022 Gallstones 5 years ago, treated with lithotripsy and ursodeoxycholic acid
\n\u2022 Hypothyroidism \u0001 5 years
\n\u2022 Bilateral osteoarthritis of knees and lower back
\n\u2022 Depression \u0001 4 years
\nPSH
\n\u2022 TAH 20 years ago
\n\u2022 Carpal tunnel release surgery in both wrists 3 years ago
\nFH
\n\u2022 Father died at age 65 from complications after a traumatic fall; had \u201cheart trouble\u201d and HTN
\n\u2022 Mother died at age 80 from hip fracture and pneumonia
\n\u2022 Her only sibling is a brother who died at age 67 from bladder cancer
\n\u2022 One son and one daughter, both thin, alive, and well
\n\u2022 She states that her \u201cmother and grandmother were heavy, but not obese\u201d
\n\u2022 No other family members have a significant medical history
\nSH
\n\u2022 The patient is a divorced woman who lives with her 30 yo daughter
\n\u2022 She has never smoked and denies IVDA
\n\u2022 She has been a data entry clerk for the past 11 years and has been limited to sedentary
\nwork because of her weight
\n\u2022 She feels insecure at work, because she is \u201cthe only employee working there without a college degree and I always have to prove myself\u201d
\n\u2022 Before her divorce, she enjoyed walking for exercise. Now she is limited by her knee and back pain, limited mobility, and breathlessness.
\n\u2022 Except for her daughter, she is socially isolated and rarely has friends or family over to her house
\n\u2022 She watches a lot of television and feeds the birds and squirrels for enjoyment
\nDiet
\nB.L. met with a nutritionist several years ago and learned about the benefits of a low-fat, lowcarbohydrate diet, but soon became bored and frustrated with her food plan and stopped dieting. In her current attempt to lose weight, she has cut down her number of meals to one daily each evening that includes larger portion sizes and usually a baked dessert. Upon further probing, she admits to some snacking throughout the evening.
\nMeds
\n\u2022 Levothyroxine 0.15 \u00b5g po QD
\n\u2022 Acetaminophen 500 mg po PRN
\n\u2022 HCTZ 12.5 mg po QD
\n\u2022 Benazepril 10 mg po QD
\n\u2022 Doxazosin 4 mg po Q HS
\n\u2022 Imipramine 100 mg po QD
\nPatient Case Question 1. Which three medications is the patient taking for hypertension?
\nPE and Lab Tests
\nGen
\nThe patient is a pleasant, but tearful, extremely overweight Hispanic female in NAD.
\nVS
\nSee Patient Case Table 98.1
\nPatient Case Table 98.1 Vital Signs
\nBP 138\/88 T 97.5\u00b0F Waist 48 in
\nP 85 and regular HT 5 ft-1 in Hips 39 in
\nRR 30 WT 290 lbs SaO2 96%
\nSkin
\n\u2022 Warm with normal distribution of body hair
\n\u2022 No rashes or moles noted
\nHEENT
\n\u2022 Funduscopic exam normal
\n\u2022 Ears, nose and throat all WNL
\nCardiac
\n\u2022 RRR
\n\u2022 S1 and S2 normal with no m\/r\/g
\nLungs
\nCTA & P bilaterally
\nBreasts
\nExam deferred
\nAbd
\n\u2022 Severely obese with multiple striae
\n\u2022 NT\/ND
\n\u2022 () BS
\n\u2022 No palpable masses or bruits
\n\u2022 () HSM
\n\u2022 Hysterectomy scar well healed
\nGenit\/Rect
\nExam deferred
\nExt
\n\u2022 () for lower extremity varicosities
\n\u2022 Palpation of knees reveals limited ROM, bony crepitus, and patient discomfort bilaterally
\n\u2022 Pedal pulses 2 bilaterally
\nNeuro
\n\u2022 A & O \u0001 3
\n\u2022 CNs II\u2013XII intact
\n\u2022 Sensory and motor levels intact
\n\u2022 DTRs 2
\n\u2022 () Babinski
\nLaboratory Blood Test Results
\nSee Patient Case Table 98.2
\nPatient Case Table 98.2 Laboratory Blood Test Results
\nNa 140 meq\/L Ins 190 \u00b5U\/mL PLT 190,000\/mm3
\nK 3.9 meq\/L AST 14 IU\/L Cholesterol 314 mg\/dL
\nCl 107 meq\/L ALT 29 IU\/L LDL 195 mg\/dL
\nHCO3 29 meq\/L Bilirubin, total 0.9 mg\/dL HDL 14 mg\/dL
\nBUN 15 mg\/dL Hct 49% Triglycerides 219 mg\/dL
\nCr 0.8 mg\/dL Hb 17.4 g\/dL TSH 3.7 \u00b5U\/mL
\nGlu, fasting 118 mg\/dL WBC 6,700\/mm3 Uric acid 1.7 mg\/dL
\nArterial Blood Gases
\nPaO2 \u0004 90 mm Hg; PaCO2 \u0004 33 mm Hg; pH \u0004 7.35
\nSpirometry Tests
\n\u2022 VC \u0004 4000 mL
\n\u2022 TLC \u0004 5000 mL
\n\u2022 ERV \u0004 1000 mL
\nChest X-Ray
\nWNL
\nPatient Case Question 2. Identify ten risk factors for obesity in this case study.
\nPatient Case Question 3. Identify ten health consequences that may have developed
\nin this patient from obesity.
\nPatient Case Question 4. Does the patient have any signs of liver dysfunction?
\nPatient Case Question 5. Other than the patient\u2019s complaint of \u201calways being out of
\nbreath,\u201d does she have any signs of abnormal pulmonary function at this time?
\nPatient Case Question 6. Does the patient\u2019s hypothyroid condition need a drug dosage
\nadjustment at this time?
\nPatient Case Question 7. Into which class of obesity can this patient be categorized:
\nI, II, or III?
\nPatient Case Question 8. What is the risk for this patient to develop disease if she
\ncontinues at this weight?
\nPatient Case Question 9. Calculate the body fat percentage in this patient.<\/p>\n","protected":false},"excerpt":{"rendered":"
Obesity Nutritional Disorder Patient\u2019s Chief Complaints \u201cI need to lose some weight and I can\u2019t do it by myself. I\u2019m always tired and out of breath and my back and knees are killing me. I\u2019d like to have stomach staples, if possible.\u201d HPI B.L. is a 57 yo Hispanic woman of Puerto Rican heritage who […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1644,798,1645,774,782,780,1647],"tags":[1655,1654,1656,1652,1653],"class_list":["post-5216","post","type-post","status-publish","format-standard","hentry","category-patient-case-study-assignment-help","category-advanced-pathophysiology","category-assignment-help-writing-a-pathophysiology-paper","category-assignment-pathophysiology-case-study-homework-help","category-nursing-pathophysiology-case-study-assignment","category-pathophysiology-case-study-answers-examples","category-write-my-pathophysiology-assignment","tag-b-l-is-a-57-yo-hispanic-woman-of-puerto-rican-heritage-who-states-that-she-maintained-her-ideal-weight","tag-comorbidities","tag-medical-papers","tag-nutritional-counseling","tag-obesity-management"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/comments?post=5216"}],"version-history":[{"count":1,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5216\/revisions"}],"predecessor-version":[{"id":5217,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5216\/revisions\/5217"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/media?parent=5216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/categories?post=5216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/tags?post=5216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}