Etiology and Pathophysiology of Obesity
Discuss About The Obesity Indian Journal Clinical Biochemistry.
The essay paper focuses on analyzing the etiology and pathophysiology behind the presenting condition of Kathleen Johnson, a 45 years old patient who was recently admitted to the hospital for sleeve gastrectomy surgery to help her lose weight. Bases on the evaluation of Kathleen’s observation 2 hours after the surgery in the post-anaesthetic recovery room (PARU), the paper outline and justifies key nursing management priorities for the patient at this time. It also suggest the role of other three members of the interdisciplinary health care team in the care and management of patient before discharge.
The Aetiology and pathophysiology of the patient’s presenting condition is understood from this section. Considering Kathleen’s presenting condition, the main health issue for patient is obesity. She has a BMI of 40kg/m2, which means that she is very overweight. A BMI higher than 30.0 comes under the obese category. Obesity is a condition that leads to excessive accumulation of body fat resulting in adverse effects on health. It increases the risk of many other disease like type 2 diabetes and cardiovascular disease. There are many factors that make people prone to obesity. Firstly, many people are more likely to become obese because of genetic susceptibility to obesity. Evidence has revealed that presence of obesity susceptible genes increases risk of developing obesity. Other common cause of obesity includes intake of high calorie food and lack of physical activity in affected individuals (Srivastava, Srivastava & Mittal, 2016). Hence, it can be said that genetics factors, appetite behavioral factors and the interaction of these element with the environment leads to obesity. These endogenous and exogenous factors play a major role in the management and treatment of obesity too.
In case of Kathleen, exaggeration of normal adiposity was found which affected her appearance and also affected her ability to manage Type 2 diabetes. The main cellular basis for obesity is the adipocyte tissue, whose number or size increases in a person, who are obese. Adipose tissue consists of many types of cells like endothelial cells, fibroblast, mast cells and immune cells. Lee, Wu and Fried (2010) argued that turnover of these cells in adipose tissue is the main pathophysiology behind obesity. Although the normal expansion of adipocyte has no negative impact on a person, however due to over-nutrition, excessive adipocyte hyperplasia take place leading to metabolic stress and impact on physiological functions of other organs of the body. If obesity is left untreated, it may lead to dysfunction of other organs in the body such as liver, endocrine, reproductive and pulmonary functions. For this reason, people with obesity are most likely to be diagnosed with type-2 diabetes and they suffer from impaired glucose tolerance (Fernández-Sánchez et al., 2011). The same issue was found in Kathleen’s case too.
Obesity affected her ability to cope with uncontrolled diabetes and manage her appearance. Due to issues related to weight gain and appearance, Kathleen had to undergo sleeve gastrectomy surgery. There are many surgical options available for obese patient and the main effect of all such surgeries is that it leads to sustainable weight loss and health improvements too. Sleeve gastrectomy surgery promotes weight loss in students by removing parts of the stomach and changing hormonal signals in the brain. Evidence has shown that Sleeve gastrectomy surgery leads to significant improvement in high blood pressure and sleep apnea and increase patient’s ability to engage in physical activity too (Tritsch, et al., 2015). Surgical management produces health improvement in patient and reduces mortality in patients like Kathleen who suffer from severe obesity (Bray et al., 2016).
Presentation of Patient and Surgical Management
The pathophysiology of the patient’s post-operative deterioration is presented in this section. After the sleeve gastrectomy surgery, Kathleen was admitted to the PARU. Kathleen’s observation in PARU showed respiratory rate of 28 breaths per minute and pulse rate of 130 beats per minute. The normal respiratory rate of a healthy person is 12-20 breaths and Kathleen’s RR of 28 suggests high RR. In addition, her pulse rate is found to be extremely high as normal pulse rate is 100 beats per minute. This abnormal sign has been observed because of the effect of surgery as well as presenting conditions in patients like obesity and hypertension. Obesity is found to have a vital impact on respiratory function and for this reason, proper patient assessment is necessary (Brown et al., 2015). Obese patients mostly have higher respiratory rate and lower tidal volume compared to normal individuals because of reduction in total respiratory system compliance. Chest wall compliance is low in obese people and this in turn contributes to a less compliant respiratory system (Littleton, 2012). Respiratory complication is also seen due to the effect of general anesthesia and mechanical ventilation (Elrazek, Elbanna & Bilasy, 2014). For this reason, high respiratory rate was observed in the post operative period following surgery in the patient.
The blood pressure of Kathleen was found to be 190/100. It indicated a high blood pressure as her BP was higher than the normal average of 120/90. Multiple factors like obesity, smoking, drinking and surgery contributed to high BP in patient. Obese individuals are more likely to be obese and association between obesity and hypertension has been found because obesity increases blood flow in tissues and increases cardiac output (Hall et al., 2015). Hence, obese people have high cardiac output because blood flow to the extra adipose tissue increases. This conditions leads to functional vasodilation and rise in BP in obese patients. Kathleen used to smoke one packet cigarette and drink bear every day. This habit might be contributing to abnormal BP in patient. This can be said because smoking stimulates the sympathetic nervous system and elevate BP level of patient (Farsalinos et al., 2016). The mechanism for alcohol-induce hypertension enhances sympathetic activity, increase in cortisol levels and increased vascular reactivity in patient due to alcohol intake (Husain, Ansari & Ferder, 2014). Hence, reducing smoking rate and alcohol intakes will be necessary to manage deteriorating symptoms in patient post surgery.
Other observations for Kathleen’s 2 hours post-op includes body temperature of 35.1 degree C, pain score of 7/10 and indwelling urinary catheter volume of 5 mls in the last hour. . As the normal body temperature is 37 degree Celsius, Kathleen’s body temperature suggests that she is hypothermic. Hypothermia is a common complication in surgical patient, however this must be immediately managed as it is associated with significant morbidity and mortality in patient. Certain factors like altered thermoregulatory mechanism, cooler room temperature and anesthesia decreases core temperature of women. Anesthetics particularly change the thermoregulatory mechanism of human body (Hart et al. 2011). The pain score of Kathleen suggest that she was in severe pain after surgery and high intensity of pain might also be having an impact on her other vital signs. Acute pain increases sympathetic activity thus leading to increased blood pressure (Saccò et al., 2013). Unrelieved pain also has an impact of the respiratory physiology as pain limit’s patient ability to move thoracic and abdominal pain. This led to respiratory dysfunction and symptoms of high respiratory rate and pulse rate in patient (Jafari et al., 2017).
Pathophysiology of Post-Operative Deterioration
Kathleen’s urinary output was also abnormal than normal unit output per hours. Her IDC volume was 5 mls in the last hour and this is too low as normal rate is 50-60 ml per hour. The reason for such poor urine output might include poor replacement of surgical blood and dehydration in patient (Chenit & Lane-Fall 2012). Hence, based on this analysis, the main nursing priorities and criteria for care of patient post surgery can be accurately framed.
Based on evaluation of presenting condition of patient and analysis of her abnormal vital signs, the most important nursing care priority is to control and manager her abnormal vital signs. Firstly, to control respiratory rate and pulse rate of patient, bringing these parameters in the nurse will a major nursing responsibility. As Kathleen was found to be hypothermic, temperature monitoring at regular interval will be important for nurse. Secondly, her abnormal body temperature, urine output and IDC volume also needs to be monitored to prevent further complication in patient. Controlling respiratory function is important because leaving the patient untreated may further decrease oxygenation in patient and lead to post-operative hypoxemic event in patient. Severe pain was also the reason for impaired respiratory and vascular function in patient. Hence, nurse can consult physicians regarding use of best opioid for patient. Opioids and sedatives are class of respiratory depressants and they act as common therapeutic approach for treatment of acute pain as well as respiratory complications in patient post surgery (Karcz & Papadakos, 2013). Secondly, the nurse also need to take action to control BP as Kathleen is a patient with severe obesity and the pathophysiology of obesity further increases the risk of cardiovascular disease related events in patient (Booth, Prevost & Gulliford, 2016). The nurse also needs to give education to patient regarding the harmful effect of smoking and drinking on hypertension and recovery. Hence, nurse need to empower patient to quit smoking and drinking for her recovery post surgery.
The definition for safe care in the context of Kathleen is to preserve patient’s optimal health and take all approach needed to keep all her vital signs in stable level. It also means providing adequate environment for safety of patient. As Kathleen has undergone sleeve gastrectomy, special care is needed for her stomach area which had been removed. The nurse needs to check the surgical site for infection and drainage. Proper dressing and wound assessment needs to be done to find out any challenges in wound healing. Dietary restriction and control of fluid intakes also needs to be considered for early recovery of new gastric sleeve.
Based on patient problem, the role of other allied health care professionals apart from surgical team are also important for the recovery of patient (Bryant & Knights, 2015). The involvement of dietician is necessary because Kathleen cannot have fluids post sleeve gastrectomy. Since she is a diabetic patient, the dietician can make appropriate diet plans for patient based on her presenting condition and past medical history (Snyder-Marlow, Taylor & Lenhard, 2010). The involvement of a physiotherapist is also essential in case of Kathleen because long term bed rest may limit movement and increase complication in patient. Hence, physiotherapist can improve residual function, improve quality of life and minimize chances of repeat hospitalization for patient. As the patient might suffer from challenges in coping with surgery, she might also suffer from depression and stress (Makhabah, Martino & Ambrosino, 2013).. Hence, a rehabilitation counselor can also be involved in the care of Kathleen so that she gets adequate support during recovery at the PARU.
Nursing assessment plays a vital part in collecting vital information of patient and deciding the best intervention for the recovery of patient. This essay provided an insight into the challenges found in an obese patient by evaluating the case of study of Kathleen, a patient who had undergone sleeve gastrectomy. Changes in her vitals sign and signs of deteriorations were identified by the analysis of observation 2hours post surgery in the PARU and the all such deterioration were explained by the pathophysiology of obesity. The association between vital signs and obesity and client’s drinking and smoking habits were also found. This assessment paved way for planning comprehensive care priorities for patient as well as identifying role of other interprofessional team in the care of patient.
References:
Booth, H. P., Prevost, A. T., & Gulliford, M. C. (2016). Severity of obesity and management of hypertension, hypercholesterolaemia and smoking in primary care: population-based cohort study. Journal of human hypertension, 30(1), 40.
Bray, G. A., Frühbeck, G., Ryan, D. H., & Wilding, J. P. (2016). Management of obesity. The Lancet, 387(10031), 1947-1956.
Brown, D., Edwards, H., Seaton, L., Buckley, T. (Eds.). (2015). Lewis’s medical-surgical nursing. Assessment & management of clinical problems. (4th Australia & New Zealand ed.). Sydney: Elsevier.
Bryant, B. & Knights, K. (2015). Pharmacology for health professionals (4th ed.). St Louis: Elsevier.
Chenitz, K. B., & Lane-Fall, M. B. (2012). Decreased urine output and acute kidney injury in the postanesthesia care unit. Anesthesiology clinics, 30(3), 513-526.
Elrazek, A. E. M. A. A., Elbanna, A. E. M., & Bilasy, S. E. (2014). Medical management of patients after bariatric surgery: Principles and guidelines. World journal of gastrointestinal surgery, 6(11), 220.
Farsalinos, K., Cibella, F., Caponnetto, P., Campagna, D., Morjaria, J. B., Battaglia, E., … & Polosa, R. (2016). Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes. Internal and emergency medicine, 11(1), 85-94.
Fernández-Sánchez, A., Madrigal-Santillán, E., Bautista, M., Esquivel-Soto, J., Morales-González, Á., Esquivel-Chirino, C., … & Morales-González, J. A. (2011). Inflammation, oxidative stress, and obesity. International journal of molecular sciences, 12(5), 3117-3132.
Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., & Hall, M. E. (2015). Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circulation research, 116(6), 991-1006.
Hart, S. R., Bordes, B., Hart, J., Corsino, D., & Harmon, D. (2011). Unintended perioperative hypothermia. The Ochsner Journal, 11(3), 259-270.
Husain, K., Ansari, R. A., & Ferder, L. (2014). Alcohol-induced hypertension: Mechanism and prevention. World journal of cardiology, 6(5), 245.
Jafari, H., Courtois, I., Van den Bergh, O., Vlaeyen, J. W., & Van Diest, I. (2017). Pain and respiration: a systematic review. Pain, 158(6), 995-1006.
Karcz, M., & Papadakos, P. J. (2013). Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR, 49(4), 21.
Lee, M. J., Wu, Y., & Fried, S. K. (2010). Adipose tissue remodeling in pathophysiology of obesity. Current opinion in clinical nutrition and metabolic care, 13(4), 371.
Littleton, S. W. (2012). Impact of obesity on respiratory function. Respirology, 17(1), 43-49.
Makhabah, D. N., Martino, F., & Ambrosino, N. (2013). Peri-operative physiotherapy. Multidisciplinary respiratory medicine, 8(1), 4.
Saccò, M., Meschi, M., Regolisti, G., Detrenis, S., Bianchi, L., Bertorelli, M., … & Fiaccadori, E. (2013). The relationship between blood pressure and pain. The Journal of Clinical Hypertension, 15(8), 600-605.
Snyder-Marlow, G., Taylor, D., & Lenhard, M. J. (2010). Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. Journal of the American Dietetic Association, 110(4), 600-607.
Srivastava, A., Srivastava, N., & Mittal, B. (2016). Genetics of obesity. Indian Journal of Clinical Biochemistry, 31(4), 361-371.
Tritsch, A. M., Bland, C. M., Hatzigeorgiou, C., Sweeney, L. B., & Phillips, M. (2015). A retrospective review of the medical management of hypertension and diabetes mellitus following sleeve gastrectomy. Obesity surgery, 25(4), 642-647.
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