PJ is a 28-year-old patient suffering from type diabetes and isreferred by her physician for an evaluation of obesity followed by arecommendation for the treatment options, some including theweight-loss surgery. PJ has been in the hospital for about 12 hoursfor evaluation and assessment of her condition following the referralfrom the physician. The analysis of the data results in theidentification of the problem that PJ is suffering from.
Based on the patient’s medical history and previous treatmentoptions, crucial aspects are presented explaining the rationalebehind her condition. The vital signs indicate hypertriglyceridemiarecorded at 1200 mg/dl, which exceeds the normal range of 200 mg/dl(Nikolopoulou & Kadoglou, 2012). The condition is associatedwith diabetes mellitus, and obesity has been identified as asignificant exacerbating factor. Further, the patient has lowhigh-density lipoprotein cholesterol which was recorded at 35 mg/dl.It can be attributed to the prevalence of the low-density lipoproteinwhich may be high in blood circulation (Nikolopoulou & Kadoglou,2012). The low amount of HDL is seen in obesity since the conditionis characterized by an increase in the LDLs instead. The vital signequally indicates that she has hypertension 150/87, which is abovethe recommended baseline as identified by the American HeartAssociation (AHA, 2016). According to the Association, the systolicvalue should be less than 120, while the diastolic value should notbe more than 80. Her pulse was recorded at 80/min. However, thepatient did not portray signs of abdominal tenderness. The valuesfrom her evaluation indicate otherwise. The patient indicates thatshe is having a problem controlling her diet. Notably, she admits tohaving a craving for junk food and finds it difficult to avoid them.Also, she states that she does not engage in regular physicalexercise but instead prefers staying indoors. On a physicalassessment, the patient was determined to have a height of 5’10’’and weighed 240 lb. PJ had a body mass index of 34.4 kg/m2.
During the process of evaluation, the patient was uneasy andconstantly asked for a break in the process of assessment. Theassessment indicated that there was an elevation in the plasmatriglycerides. The increase in the levels of plasma triglyceridescould be a reflection of the fact that there was a problem withmetabolism such that the body was unable to process the sugarsfurther for use by the cellular machinery (Nikolopoulou &Kadoglou, 2012). It could further be due to diabetes which ischaracterized by the hypertriglyceridemia. The patient was obese andhad a build-up of excess fats. A laboratory examination of hercondition portrayed that she had serum glucose of 398 mg/dl. She wassubjected to a urinalysis test that revealed the presence of glucosewith a figure of 3+. However, the patient had ketones.
Based on the management of her health status, glycosuria (3+), highblood pressure (150/87), high pulse rate (80/min), BMI (34.4 kg/m2),the patient could be suffering from a metabolic disorder syndrome.The priority diagnosis in the case presented is obesity. Thesituation could further be aggravated by the presence of diabetesmellitus (Yeste & Carrascosa, 2011).
PJ is evidently obese. The high blood pressure that she is sufferingfrom could be the result of the accumulation of fat in her system.The heart is facing challenges pumping blood to the rest of the bodyparts due to the presence of the barrier (Hryhorczuk, Sharma, &Fulton, 2013). It could be attributed to the buildup of fat dropletsin the blood vessels. Because of the same, the heart is encounteringchallenges in successfully pumping blood to the rest of the organs.The priority diagnosis which is obese relates to the traits that havebeen identified which affect the patient. Further, the patient admitsto having a problem when it comes to resisting the intake of junkfood. It is evident that the continued intake of the junk food andlack of active physical exercise could be affecting her since she isnot in a position to control her diet. Obesity is attributed to poordietary habits and lack of physical exercise. However, it is criticalto understand that she is suffering from type diabetes. The buildupof plasma triglycerides could be an indication of the fact that hercells are unable to take in glucose (Yeste & Carrascosa, 2011).It is a reflection of the insensitivity of the cells to insulin orrather resistance to the hormone affecting the intake of the sugars.However, it is critical to evaluate the situation and come up with aconclusive approach on the best way to deal with the situation. It isa priority for PJ to embrace a new diet and exercise regularly.However, since type 2 diabetes can be managed, it is essential thatshe focuses on aspects of weight loss to help her in the propermanagement of the disease.
The other assessment of critical significance is about her bloodpressure. The patient is at risk of developing heart problems becausethere is evidence indicating the same. PJ has a high blood pressure,and the pulse rate is equally high. It means that the heart is facingchallenges when it comes to the supply of blood to vital organs. Thepatient is at risk of suffering a heart attack especially ifthe problem persists (Nikolopoulou & Kadoglou, 2012). Thebuildup of fat in the tissues and blood vessels due to obesity couldaffect the transmission of blood. The heart is forced to pump harderto ensure that all the vital organs get access to blood. In theprocess of doing so, the chances are that the organ is affected.
The next is a physiological need due to the buildup of excess sugarsin the blood stream. In the course of assessment, the patientdepicted an increase in glucose levels in plasma. Glucose was presentin the urine at amounts classified as 3+. The diagnosis could beglycosuria. It is a reflection of the efforts adopted by thebody to get rid of the excess sugars. A situation that ischaracterized by an increase in blood sugar could be followed bycorresponding measures to help in the reduction of the overall levelsof the same. If there is an excess of it, significant measures areadopted by the body including excretion via urine. It is a reflectionof the increase in the overall amount of glucose in circulation. Thepatient should be subjected to an intervention that helps in thereduction of the sugar levels in the bloodstream.
The next priority diagnosis is physiological based on the presence ofketones in the blood stream. A buildup of ketones could be areflection of the inability of the body to use the available glucoseand instead resort to the use of fats. The primary diagnosis for thecondition could be ketoacidosis (Hryhorczuk et al., 2013).The breakdown of fat in excess is detrimental since it can leadto the production of ketones. In such a state, the chances are thatthe patient would encounter a condition where the blood PH becomesacidic. The change in the Ph. of the blood too acidic significantlyaffects the metabolic functions of the body. The cells areparticularly sensitive to a change in the Ph. It is a risky conditionfor the patient negating the need to introduce an intervention thathelps address the problem.
The assessment condition conducted is essential in helping thepatient gain knowledge on the need to exercise a healthy lifestyle.It is imperative that the patient embraces the need to observe abalanced diet and exercise frequently. Further, it would be vital tohave the patient take medication that is helping in the reduction ofobesity. The ability to understand the information presentedregarding her nutritious state would be instrumental in helping herregain control of her health and help in dealing with the problem athand.
Nursing Diagnosis List
Activity intolerance because of being overweight. The patient does not engage in physical exercises.
Impaired tissue perfusion due to the inability of the heart to pump blood reaching all the vital body organs.
Low self-esteem because of being overweight and this is related to the psychosocial factors.
Metabolic syndrome due to the buildup of excess fat with less intake of glucose into the cells.
High blood pressure due to buildup of fat in the blood vessels.
Hryhorczuk, C., Sharma, S., & Fulton, S. E. (2013). Metabolicdisturbances connecting obesity and depression. Frontiers inNeuroscience. http://doi.org/10.3389/fnins.2013.00177
Nikolopoulou, A., & Kadoglou, N. P. E. (2012). Obesity andmetabolic syndrome as related to cardiovascular disease. ExpertReview of Cardiovascular Therapy, 10(7), 933–9.http://doi.org/10.1586/erc.12.74
Yeste, D., & Carrascosa, A. (2011). [Obesity-related metabolicdisorders in childhood and adolescence]. Anales de Pediatría(Barcelona, Spain : 2003), 75(2), 135.e1-9.http://doi.org/10.1016/j.anpedi.2011.03.025