1-Mr. C has a variety of health issues related to his obesity. He has an elevated fasting blood glucose which indicate that he could be diabetic, an A1C level should be drawn to follow up with that. He also has elevated triglycerides, normal levels for a male should be between 40-170, his is 312. His total cholesterol are elevated as well, which normal levels should be less than 200, and his is 250 (Comprehensive Guide to Normal Lab Values, 2019).  Keeping that in mind, he probably has high cholesterol diagnosis as well. His blood pressure is also elevated, which means that he needs more than just sodium restriction in his diet to control. Without him being on any medication, he is asking for a stroke in my opinion. Further education needs to be provided for him especially in needing to change his diet. Not only does he need to control his sodium intake, he also needs to monitor, carbs and sweets. 

Personally, I would not recommend bariatric surgery until I am convinced that he is ready for the change. I would recommend that he loses some weight first since it would be risky with him being obese, to even undergo anesthesia. 

1. Health      perception- Mr. C has a poor general health as evidenced by his lab levels      and vitals. It seems that with his sedentary lifestyle, he is lacking      exercise which would be very beneficial for him at this point. He is      realizing that he needs help with his obesity and is considering bariatric      surgery, so that is a positive. 

Nutritional-Metobolic Pattern- It seems that with his high BMI, high HDL and cholesterol levels, he has a poor eating habits. He did mention that he attempts to control his blood pressure with sodium restriction. 

Elimination- This category was not discussed. 

Activity-Exercise Pattern- He works at a catalog telephone center, which means that he probably does not get much exercise with this job. He lives a sedentary lifestyle. 

Sleep-Rest Pattern- He mentioned that he has sleep apnea. 

Cognitive-Perceptual Pattern- He did not mention any cognitive deficits or hearing difficulties. He works at a telephone center so he must have good communication skills. 

Self perception- He did not mention much of his life outside of his job, so he may have low self-esteem associated with the obesity. 

Sexuality reproductive pattern- This was not discussed. 

Coping stress tolerance pattern- This was not discussed but he is seeking help with his obesity. 

Values Beliefs pattern- This was not discussed. 

1. 5      problems- His sedentary lifestyle is a problem that needs to be addressed.      Mentioning that including even walking on his lunch break could make a      huge difference in losing weight. Him not being able to control his blood      pressure with just restricting sodium from his diet alone. With this high      of blood pressure and high cholesterol he is a major risk for a stroke, as      I mentioned above. Getting him started on medication would be crucial for      him. I would also address that sleep apnea a little further as well.      Asking if he is using a CPAP machine at home and how deligiant he is at      using it. Another problem, is his diet. I would have him be referred to a      nutritionist or further educate him on learning to maintain his diet. I      would recommend weight watchers, they have a great program that is easy to      manage with just an app. They even have support groups as well so he can      meet people through it. If he does not control his diet and continue      gaining weight, he would be at risk for many other diseases that cause a      shorter life and could be life threatening. 

Reference 

Comprehensive Guide to Normal Lab Values. (2019). Meditec. Retrieved from https://www.meditec.com/resourcestools/medical-reference-links/normal-lab-values/

2-I agree that these days people look for a quick pill to take care of their problems. There are so many fad diets and they are just not realistic in helping people to maintain a healthy lifestyle. A family friend once did an all shake diet and of course lost several pounds because of the lack of caloric intake. He maintained the weight loss for less than a year before quickly regaining it plus some. Changing lifestyle behaviors and educating yourself on the importance of a well-balanced diet is extremely important for making positive and long-term changes for yourself. I think the same would go for Mr. C. He needs to know how to continue to strive for a healthy lifestyle after the surgery in order to maintain his weight after.

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3-it can be tough to face things like obesity and hypertension, especially at such a young age. It is good that she has you and your family for support. It is also good that she is identifying that she has issues that need to be addressed and taking the steps to make better choices. Weight watchers can help to teach individuals about healthy nutrition and portion control. Walking her dog everyday is also a good step towards getting more steps in and living a healthier lifestyle. It can be hard I’m sure to sit behind a desk all day and then come home and find the energy to exercise. Keep on encouraging her!

4-Yes the follow through of diet is so important. When my sister had the surgery several years ago she had to lose about 50# prior to the actual surgery. Part of that process was to shrink the stomach and get used to smaller meals. One of the complications after the surgery can be”dumping syndrome”. This is when a rapid emptying of the stomach occurs and moves into the small intestine. Many people experience this and can have symptoms of bloat, diarrhea, dizziness, nausea and sweating (Rovito, 2019). Ways to prevent this is to have no refined sugar or unnecessary fat, eat 5-6 smaller meals and no liquids between meals (Rovito, 2019). I read that doctors actually don’t mind when thsi occurs in patients because it helps them to try and to eat better. I know for my sister she had to really learn how to eat..she intiially lost an incredible amount of weight and looked quite unhealthy but then it stabilized. She started to gain her weight back but the physician put her on some medication to reduce her appetite and that helped and she lost more weight. She goes to a physician every 6 months and this has helped to keep her on track. She eats very little because she gets so full but she doesn’t mind..her brain has learned to be okay with smaller amounts.

Reference

Rovito, P. (2019, February 4). Complications of gastric bypass surgery 22 potential problems. Retrieved from https://www.bariatricsurgerysource.com

   5- Weight loss has to do with burning more calories than you take in.  You could theoretically eat junk food that totals 1200 calories a day and loose weight.  The problem comes in when you are hungry shortly after eating that junk food.  The trick is to eat foods that help you feel full for a longer amount of time and use portion control.  I would rather eat foods that keep me from feeling hungry.  With bariatric surgery, your stomach is shrunk down so you should only ingest teaspoons of broth at a time.  If you have psychological need to eat foods, you will stretch your stomach out again and regain all the weight you lost.  Eating for most people in this country is not a survival thing….it is an emotional thing.  You tie your emotions to food.  People in Africa or India do not have the luxury of eating due to stress.  Until you recognize food as fuel, you will not likely keep off the weight you lost.  

    I think it is important to teach our children a different way of looking at food.  It should be gas for your body and we should be putting in unleaded.  We should teach them to not overfill the tank; stop associating food with love or other emotions.

   6- I would say most of the people in this class already understand the difference between type 1 and type 2 diabetes.  Type 1 being an autoimmune disease that attacks individuals who are genetic carriers of HLA type genes.  Type 2 has a genetic component however, it is an acquired disorder that becomes active due to obesity and lack of exercise causing insulin resistance.

    There is a very long and detailed explanation regarding your question about obesity and type 1 diabetes.  In the past, type 1 diabetes was only diagnosed in childhood and these children were diagnosed after a significant weight loss.  Children in general were already thin, active and healthy eaters because this was the lifestyle.  In recent times, the increase in technology and junk food has caused a rise in obesity in all populations but especially children.  Type 1 diabetics do not escape this trend.  One article even says that there is a higher incidence of obesity in type 1 diabetics than any other people group (Mottalib et al., 2017).  This article goes further into detail about insulin and the growth hormone along with how they affect the basal metabolic rate.  You can read the details for yourself, but to sum it up, type 1 diabetes does not make your body immune to fat accumulation anymore than anyone else.  If you left type 1 diabetes untreated with insulin for a long period of time, you would have weight loss from cell starvation.  Of course, you would go into significant keto acidosis and could die.

    Treating the type 1 diabetes with insulin reverses the effects of weight loss.  In fact, hyperinsulinemia causes obesity and increases the growth hormone.  This is seen particularly in mothers with gestational diabetes.  The mother has increased glucose levels that increases her need for insulin.  Her body cannot meet the demand, but the fetus has no problem with insulin production.  Glucose crosses the placenta, but insulin does not.  The baby produces the correct amounts of insulin to cover the increased glucose that crossed the placenta.  This hyperinsulinemia causes the baby to grow to an alarming size.  This causes macrosomia.; a baby that is too large for the gestational age.  As a side note, this increases the baby’s risk of developing type 2 diabetes later in life.

    A trend that has been seen in recent years is to have double diabetes.  Now that we are able to do extensive diagnostic testing, we can see that a patient could have the antibodies present with type 1 diabetes and the insulin resistance seen with type 2 diabetes.  Incidentally, obesity in a person with the antibodies that are seen with the type 1 diabetes causes that person to become an actual diabetic sooner.  I would think in layman’s terms it is from placing undue stress on the pancreas to produce higher levels of insulin and the islet cells run out of juice.

    I could go on, but I am guessing this answers your question. 

References

Mottalib, A., Kasetty, M., Mar, J. Y., Elseaidy, T., Ashrafadeh, S., & Hamdy, O. (2017, August 23). Weight management in patients with type 1 diabetes and obesity. Current Diabetes Reports, 17(10). https://doi.org/10.1007/s11892-017-0918-8

Respond to the Post that is bellow using one or more of the following approaches: 

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

NOTE: THE ANSWER THAT YOU ARE GOING TO DO IN REFERENCE OF THIS POST, HAS TO BE IN A POSITIVE WAY, REFLECTING THE POSITIVE OF THE POST THAT THE STUDENT MADE. 

                                           Initial Discussion Post

                                             Literature Searches

          Nursing is a field filled with numerous  policies and procedures.  To understand these policies and procedures,  the practice of research and knowledge acquisition is essential.  The  method of incorporating proper research into daily practice is called  evidence-based practice (Polit & Beck, 2017).  The goal of using  evidence-based practice is to move away from traditions and ritual by  incorporating tested research evidence that supports clinical practices  (Polit & Beck, 2017).

Summary of Article Search

            Based on the  evidence hierarchy by Polit & Beck (2017), and the levels of  evidence presented in class I was able to evaluate research articles  (Walden University, 2018).  When looking for specific research for my  topic, I searched for the highest level of evidence.  There are three  types of research which are: primary, synthesized or secondary, and  others such as expert opinions or practice questions (Polit & Beck,  2017). 

            My PICOT  question is: In patients with acute pain in the emergency department,  what is the effect of Ketamine use for the reduction of pain compared to  opioid medications during their ED visit? To begin the search, I used  the keywords Ketamine, analgesia, sedation and emergency medicine.   Using these words, I was able to find 408 results.  I further limited my  search to ten years which yielded 297 results.  Finally, I used  systematic reviews, meta-analysis and randomized control trials (RCTs)  for my final search narrowing the articles to 111.  Upon examination of  the articles, I found the articles based on systematic reviews,  meta-analysis and RCTs provided detailed research including abstracts,  methods of trials, results, discussion, limitations, and conclusion.   Each of these sections specifies the purpose of the study in detail. 

          Using this framework for literature review  ensures relevant research is used to answer evidence seeking questions.   Davies (2011) comments, “detailed knowledge of the frameworks enables  the searcher to refine strategies to suit each particular situation  rather than trying to fit a search situation to a framework” (p. 79).   By using a timeframe such as the past ten years, it is easier to see the  relevance of the information to clinical practice today.  An active  literature search will yield the most appropriate information for the  question being posed.

References

Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/97418144

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Walden University Library. (2018). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=52322

• Type of paperResearch Summary
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Executive Summary of Non-nursing Theorist You will be assigned a theory or theories to research (General systems Theory). Complete a 1 page executive summary; you must include references. APA format must be used. Presentations are to be submitted as directed. NO LATE SUBMISSIONS WILL BE ACCEPTED. Students will be assigned theories or models on which to write questions (3 per theory) for an in-class discussion. Questions are to be written to reflect the student’s understanding of the theory or model; the student must be able to thoroughly discuss the content. Be prepared to explain the theory as it applies to a family. References must include scholarly, non-textbook primary and secondary sources (although textbooks may also be used)

• Type of paperCoursework
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• Number of pages1
• Format of citationAPA
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• Type of serviceWriting

For the following 7 ideas, using the SIX HAT THEORY , comment on these post attempting to provide balance and insight to each of the perspectives given. Using your hat color, my is BLUE. 1. Break into small groups and do an Escape Room 2. Small groups meet every month to work on and create a funny skit to perform at the end of the year for staff, clients etc. 3. Quarterly retreat where staff plays games, ropes course, trust/team-building activities etc. 4. Wellness activity each month, such as: – A step challenge between small groups – Offer yoga or exercise class once a week for a month – A workshop on budgeting – Start a running group – Book club 5. “Favorite Dish Friday:” A few employees sign up once a week to bring in their favorite meals to share accompanied by the recipe—at the end of the year, create a printable recipe book accessible to staff, volunteers, clients 6. Have a talent show once a year 7. Have some sort of laminated icon (or something that can be written on) that employees can pass around to each other. When an employee notices another doing something kind, or going above and beyond (something noteworthy), write it on the icon, and give it to that person. It is then up to that person to do the same for the next person. Keep this rolling for the month, and at a monthly staff meeting, read all the comments out loud. Then start fresh for the next month.