Morbid Obesity Type 2 diabetic

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Assessment One-Case Study 1
Case Study-A 48 year old man with morbid obesity, poorly controlled diabetes type 2, sleep apnoea and obesity ventilation syndrome
Multiple factors influence the care of patients with chronic conditions. As a Primary
Heath Care nurse, it is important that care given is prioritised based on clinical and
patient needs. Prioritisation of the patient needs for care is integral to daily nursing
practice. This requires integrating and collaborating different aspects of patient needs
in order to maximise care activities and the effectiveness of nursing interventions.
This case study is designed to demonstrate the integration of various principles of
managing care of patients with chronic conditions. Students will be expected to
analyse the case scenario, identify the care needs and from the list of identified needs
discuss two COMPLEX care priorities. Please refer to the subject outline and marking
rubric when answering this question.

NRSG366 Assessment task 1- CASE STUDY 1
The case scenario
Michael Anderson is a 48 year old male with morbid obesity and type 2 diabetes who
was admitted to the medical ward with poorly controlled diabetes, obesity ventilation
syndrome and sleep apnoea. Michael was referred by his GP after he presented with
symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and finding it
difficult to breathe when he sleeps.
On the previous admission, Michael was seen by the dietician and was commenced
on low energy, high protein diet (LEHP) to help him reduce weight. His GP had
previously mentioned weight loss however he had never wanted to do anything about
it as it ‘seemed too hard’. Michael had also been seen by the physiotherapist and was
commenced on light exercises which he was to continue at home on discharge.
Michael has been discharged home, with referral to community care unit for ongoing
support and follow up, after three weeks in the medical ward to manage his weight
and clinical comorbidities.
Past medical history
? Obesity (weight165kgs with a BMI of 57.09m2). ? Type 2 diabetes ( diagnosed 9 years ago) ? Hypertension, (HTN) ? Depression (Diagnosed three months ago y GP). ? Sleep apnoea ? Gastro oesophageal disease reflux disease
Social History
Michael is an unemployed male who is on financial benefits. Michael lost his job three
years ago as a fork lift driver at the Moranbah coal mine in far North Queensland.
Michael states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting
at around 95kg but since starting insulin and losing his job he has gained a significant
NRSG366 Assessment task 1- CASE STUDY 1
amount of weight. Consequently, because of his weight issues Michael has difficulty
finding work due to fatigue and feeling generally ‘uncomfortable’ about his size.
Michael is a divorcee who lives alone, his daughter and son live in the same state but
live in different cities and rarely visit him. He is socially isolated because he is
embarrassed by his size and he rarely goes out. Michael is also finding it increasingly
hard to perform activities of daily living (ADL). Michael realises that he is in the prime
of his middle age life and he wants to lose weight.
Current Medication
? Insulin novamix 30/70 DB (20 units mane and 10 units nocte)
? Novarapid sliding scale
? Metformin 500mg BD
? Lisinopril 10mg daily
? Nexium 20mg daily
? Metoprolol 50mg BD
? Pregabalin (Lyrica) 50mg nocte
Last observation on discharge
? Weight 165kgs
? BP 180/92
? RR 23
? HR 102
? Sp02 RA 95% on Room Air (R/A)

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