Link between Obesity and Type 2 Diabetes
Discuss about the Aetiology and Pathophysiology.
Obesity is one of the greatest public health priorities of the nation and almost half of the population of the developing nations are suffering from obesity or are at risk for the disease. There are various external and internal factors that contribute to the development of the obesity in the most of the individuals and each of the factors differ in different patients, their lifestyle and genetic predisposition plays a very important role in the development of such health conditions. That is the reason many of the patients and health care providers opt for the sleeve gastrectomy, however for many of the patents that are extremely obese have the chance of postoperative complications (Gill et al., 2010). This assignment will attempt to discover the factors associated with the sleeve gastrectomy surgeries and the underlying pathophysiology of post operative complications.
Gastrectomy can be defined as the surgery where some or the other part of the stomach is removed out of the patient body in an attempt to treat acute or chronic diseases of the stomach or as a intervention option targeted at weight loss for patients with morbid obesity. Gastrectomy is a simple surgical procedure and can be of three different types (Himpens, Dobbeleir & Peeters, 2010). According to the case study, the patient had been suffering from morbid obesity which might have contributed to the type 2 diabetes she had been also diagnosed with. According to the research, close to 90% of the people suffering type 2 diabetes also have morbid obesity. Hence the aetiology of the type two diabetes of the patient in the case study, Kathleen Johnson, is also linked to morbid obesity.
Elaborating more on the possible etiology or pathophysiology route of the type 2 diabetes and obesity, there is a significantly important the link between the both of the co-morbodities. The endoplasmic reticulum stress is a very important aspect that leads directly to the occurence of impaired insulin optimization and usage in the body, which, in turn direct culminates to the incidence of type 2 diabetes. It has to be mentioned that as the patient, Kathline had been extreme obese at the BMI of 40 above, the chances of her endoplasmic reticulum stress being over activated is extremely high. According to the Lemanu et al. (2013), this particular phenomenon initiates a chain reaction in the body that triggers aberrant glucose production in the lover of the patient. As it is a key facilitating factor leading to eventual insulin resistance in the patients, for Kathline Jones as well this is the most plausible pathophysiology of her obesity and resultant type 2 Diabetes.
External Factors Contributing to Obesity and Type 2 Diabetes
Along with that it has been mentioned here as well, that the patient in the case study had Tobacco addiction and well, as the psychological burden of her obesity and her altered body image she smoked one packet of cigarette a day in an attempt to cope with the stress. Along with that, Kathleen also had an alcohol addiction with drinking four beers and several glasses of whisky a day. It has to be understood that excessive tobacco usage has a graded effect on the aggravation of both obesity and type 2 diabetes. Along with that alcohol addiction also pay a key role in further complicating the obesity and diabetes management of the patient. In case of Kathleen, the patient under consideration in the case study, the added risk of caffeine addiction contributed to counteracting the benefits she might have had attained for her dieting and altered the desired outcome of the self management if both of her Comorbid disorders that she attempted. And hence the patient had been instructed to have sleeve gastrectomy surgery in a grave attempt to surgically intervene and control her continually increasing body weight and get deteriorating diabetes type 2 (Mortensen et al., 2014).
Due to the physiological changes and the impact of the external factors like her addiction to alcohol, tobacco or her caffeine dependency, her obesity and her diabetes both became uncontrollable for the patient. As a result for her deteriorating health and altered body image of the patient, she was admitted to the hospital for a sleeve gastrectomy surgical operation. She had been commenced for the operation under general anesthesia however there are some post operative complications that the patient had been suffering from (Damms-Machado et al., 2012). The assessment of the post operative complications are generally carried out with ABCDE approach.
For airway and breathing assessment, the respiration rate of the patient had been at 28 per minute whereas the normal breathing rate of a person is 10 to 12 breaths per minute. Along with that the patient had also been exhibiting signs of accelerated heart rate under circulation assessment. Where the patient had a pulse rate at 130 beats per minute, the normal heart rate of the any individual is 100 beats per minute in general. Elaborating more on the vital signs of the patient, it has to be understood that the patient had been exhibiting signs of postoperative respiratory complication which is a very common phenomenon for patients due to anesthesia effect and surgical anxiety. It has to be mentioned in this context that the effect of general anesthesia and the ventilation that the patients are generally put on for such surgical procedure can temporarily impair the pulmonary functions of the patient which can lead to the postoperative complications as such in the PARU unit (Sarkhosh et al., 2013).
Postoperative Complications Following Sleeve Gastrectomy Surgery
Along with that it has to be mentioned here as well that the excessive and uncontrolled obesity of the patient in this condition could also have contributed to the respiratory complications that has been recorded in the patient. It has to be mentioned here that the patient had been extremely obese at the BMI of 40 kg/ m2. According to the Gagner et al. (2013), the excessive weight on the thoracic cage and the abdomen of the patient often detrimental impacts the respiratory physiology of an Individual. On a more elaborative note, this extra weight on the major part of the respiratory apparatus alters the respiratory compliance in the patient and can also disrupt the respiratory muscle functions of the patient leading to various respiratory complications post surgery and leading to airway resistance.
Furthermore, it has also been observed in the patient that she had been showing signs of high blood pressure or hypertension at the rate of 190/100, when the normal blood pressure of any individual is at 120/80. The pathophysiology related to the excessive blood pressure in the patient is mainly related to the uncontrolled type 2 diabetes in the patient. It has to be mentioned that the uncontrolled diabetes acts like a key contributor to the pathways of patients accumulating hypertension. It has to be understood that for the obese people the impact of the imbalanced dietary pattern and in turn uncontrolled energy uptake- expenditure exchange leads to many hypertension trajectories. Along with that it has to be mentioned that for the diabetic patients, the insulin resistance often leads to high blood pressure post administration of anesthesia (Boza et al., 2012).
Moreover for circulation assessment of the patient, it has to be mentioned that the for obese patients the increased sodium uptake in the post anesthetic phase can further increase the chances of high blood pressure of the patient. In case of the disability assessment under the ABCDE approach the consciousness of the patient is checked and the assessments include glucose level monitoring, urine dip check and assessment of DKA or diabetic ketoacidosis is carried. The last assessment is the exposure assessment of the patient, the pain scale o the patent is checked. In case for the patient in the case study, the skin integrity of the patient is checked for any rashes. Along with that, it has to be mentioned that for surgical wound it is very important for the nursing professional to assess the catheter output and the signs of internal bleeding. As the pain score of the patient had been at 7 and the indwelling catheter release of 5 ml in last hour the most pertinent pathophysiology for the pain is infection.
ABCDE Approach to Postoperative Complications
With respect to the care priorities of the patient, it has to be mentioned that the patient had been suffering from high respiratory rate, high pulse rate, elevated body temperature, hypertension, and acute pain due to bleeding and acute infection. Hence the acre priorities for the patient will need to focus on managing the respiratory rate of the patient, external oxygen therapy can be provide to the patient. The high pulse rate and high blood pressure of the patient can be managed with the help of the beta blockers. For the pain management the patient can be prescribed non-steroidal pain medication along with effective and systematic infection control and would management can be carried out with antibiotics and meticulous and aseptic wound cleaning and catheter refill (Alqahtani et al., 2012).
Along with the nursing care that the patient in the case study will require, for a more systematic and targeted recovery, Kathleen will require the assistance of the interdisciplinary team as well. First and foremost the patent will require the assistance of a dietician to control her obesity effectively. The assistance from a dietician will help her take control of her everyday calorie intake and will give her the opportunity to maintain a balanced and effective diet that will evade the chances of hyperglycaemia events (Lagerros & Rössner, 2013). The next membnursinger of an interdisciplinary team that the patient will need is a alcohol and drug counsellor who will help the patient take control of her binge drinking and tobacco addiction. Both one to one and group therapies coupled with pharmacological interventions provided by the alcohol and drug counsellor will help the patient find the motivation and necessary means to get over her addiction. Lastly, the patient will require the assistance of a social worker will help the patient with the benefits of community care with different physiotherapeutic session and group session for her to be motivated at all times (Evert et al., 2014). Along with that the patient will be supported with a 24*7 care worker for her own care along with her dementia patient father.
Conclusion:
On a concluding note, it has to be mentioned that the patient under case study had been suffering from the consequences of excessive obesity and the chances of the patent suffering from post operative complications is extrem3. It has to be mentioned that the sleeve gastrectomy is a surgical procedure that has many complications in case of a patient with the obesity. This case study could discover the different post operative complications that are associated with this surgery and the underlying pathophysilogy associated with it. Along with that, this case study outlined a comprehensive care including interdisciplinary interventions that would help her attain recovery.
References:
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Alqahtani, A., Alamri, H., Elahmedi, M., & Mohammed, R. (2012). Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study. Surgical endoscopy, 26(11), 3094-3100.
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Gill, R. S., Birch, D. W., Shi, X., Sharma, A. M., & Karmali, S. (2010). Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surgery for Obesity and Related Diseases, 6(6), 707-713.
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Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007.
Mortensen, K., Nilsson, M., Slim, K., Schäfer, M., Mariette, C., Braga, M., … & Lassen, K. (2014). Consensus guidelines for enhanced recovery after gastrectomy. British Journal of Surgery, 101(10), 1209-1229.
Sarkhosh, K., Birch, D. W., Sharma, A., & Karmali, S. (2013). Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Canadian journal of surgery, 56(5), 347.
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