Final Case Study Presentation - Obesity (2025 Spring) PDF

Final Case Study Presentation - Obesity Amanda James, Hui Jiang 2025 - Spring NUR-307 Integrated Case Studies in Nursing University of Michigan - Flint Brief Patient History A 48-year-old male presents to the ED with complaints of nausea and upper right abdomin...

Final Case Study Presentation - Obesity Amanda James, Hui Jiang 2025 - Spring NUR-307 Integrated Case Studies in Nursing University of Michigan - Flint Brief Patient History A 48-year-old male presents to the ED with complaints of nausea and upper right abdominal pain. He reports that his symptoms have been intermittent for the past couple of weeks but have worsened over the last 24 hours after consuming chicken wings and beer. He also mentions feeling fatigued and experiencing generalized itchiness. Demographic: Caucasian History of present illness: obesity and fatty liver diseases Other medical diseases: type 2 diabetes, hypertension, hyperlipidemia, sleep apnea, arthritis, CKD2, depression Surgical history: none Family history: obesity, type 2 diabetes, coronary artery disease Psychosocial history: Has worked as a software engineer for the past 20 years. Divorced and lives alone in a single- story house. Spends most of his day on the computer and enjoys fast food, often delivered through DoorDash. History of alcohol abuse. Anticipated discharge needs: Relief nausea and abdominal pain Medications currently prescribed/taking: metformin, atorvastatin, amlodipine Current Condition Physical Condition Laboratory Results Other Diagnostic/Medical Test Results A & O x 4. Appears unkempt, quiet, and Lab: CBC (WBC 12.5 x 10^9/L; RBC 5.0 x Abd CT scan: Absence of bowel withdrawn. BMI: 38. 10^12/L; platelet 161 x 10^9/L) obstruction, aneurysm, or enlargement HR: 89; BP: 145/86; Temp: 98.8 F; RR: 18; CRP: 2.0 mg/dL. of appendix. Decreased attenuation of SpO2: 93%. Pulse +2 in all extremities. Skin the liver with enlargement and signs of is warm with mild jaundice. ALT: 330 IU/L; AST 256 IU/L; ALP 220 IU/L; total portal hypertension. No remarkable bilirubin: 1.8 mg/dL. finding in other organs. Total cholesterol: 298 mg/dL; LDL: 200 mg/dL; 12-lead EKG: normal sinus HDL: 38 mg/dL; triglycerides: 188 mg/dL. Fecal occult blood test: negative Complains of pain (3 out of 10) in the upper BMP: WDL right abdomen, radiating to the right Random BG: 230 mg/dL shoulder, along with a sensation of fullness Amylase and lipase: WDL and continuous nausea. Abdominal HBV & HCV: negative distension noted. Absence of wounds or COVID 19, norovirus, and rotavirus: negative discoloration. Normoactive bowel sounds. Troponin T: WDL No appetite. Last bowel movement yesterday. Denies diarrhea or constipation. Diagnosis Medical Pathophysiology R/T Medical Diagnosis Nursing Diagnosis Diagnosis Multiple factors contribute to the pathogenesis of Nausea related to gastrointestinal issues and stomach fatty liver disease, including obesity/over-nutrition, upset as evidenced by abdominal pain, a sensation of Fatty liver diabetes, genetics, and gut microbiota (Makri et al., fullness, and food aversion (Ackley et al., 2021). disease with 2021). In this case, the patient’s long-term sedentary mild cirrhosis lifestyle and poor diet have led to obesity and lipid Obesity related to sedentary behavior, frequent accumulation in the liver. Excess fat tissue also causes consumption of fast food, sleep disturbances, and chronic low-grade inflammation in the liver (Makri et parental obesity as evidenced by a BMI greater than al., 2021). Obesity further contributes to type 2 30 kg/m² (Ackley et al., 2021). diabetes, resulting in insulin resistance and increased lipid synthesis in the liver (Makri et al., 2021). Ineffective health maintenance related to poor Additionally, his depression is linked to both obesity communication skills, limited social connections, and hepatic steatosis (Cho et al., 2021). These decreased gross motor skills, and psychological combined factors contribute to the progression of distress as evidenced by insufficient knowledge of fatty liver disease and cirrhosis. basic health and a pattern of inadequate health- seeking behavior (Ackley et al., 2021). Medications Name Purpose, Mechanism of Action Side Effects Nursing Implications/Safety Concerns reference Ondansetron Manage nausea and Headache, Ondansetron is contraindicated in clients with long (Holman vomiting by blocking diarrhea, QT syndrome. et al., dizziness, 2019) serotonin receptors in the dysrhythmia. chemoreceptor trigger zone and antagonizing serotonin receptors on afferent vagal neurons. Acetaminophen Inhibit prostaglandin Overdosing Assess the client's liver function and (Holman production in the central causes acute liver alcohol consumption. Ensure the client’s et al., damage. 2019) nervous system, relieving daily acetaminophen intake does not mild to moderate pain and exceed the recommended limits: 4g/day reducing fever. for most healthy adults, 3g/day for undernourished individuals, and 2g/day for clients with liver disease. Resmetirom Activate the thyroid Diarrhea, nausea, Take Resmetirom as prescribed by (Elste, hormone receptor-beta, itching, vomiting, healthcare providers. Stay hydrated if 2024; constipation, Suvarna resulting in reduced stomach pain, and experiencing vomiting or diarrhea. Avoid et al., cholesterol production in dizziness. sudden head movements or rising 2024) the liver. quickly if feeling dizzy. Interdisciplinary Treatment and Communication Interdisciplinary Care Team Purpose Important Communication Needs for Interdisciplinary Care with Listed Department Dietician Educate the client about a healthy diet. Design a Provide detailed information about the client, personalized dietary plan and evaluate the including medical history, allergies, food effectiveness of the program. intolerances, and relevant lab values. Exercise physiologists Assess the client's health status and mobility. Design Provide detailed information about the client, an exercise plan to help control body weight and including medical history, current medications, and modify the plan based on progress and outcomes. physical limitations. State the client's exercise goals, such as controlling body weight and improving fatty liver disease in this case. Hepatologist Diagnose and treat liver diseases with appropriate Use a concise and structured approach, such as medications. Refer the client to a surgeon for liver or SBAR, to provide updated information about the bile duct surgery if needed. client. Nursing Care Plan – Goals and Interventions Nursing Diagnosis Patient Goal 3 Intervention for each Diagnosis Nausea related to In three days, the 1. Administer appropriate antiemetics based on the underlying causes, using the most gastrointestinal issues client states relief of effective route. Consider non-pharmacological interventions, such as music therapy and stomach upset as nausea with (Zhong et al., 2023). evidenced by abdominal improvement in food 2. Implement appropriate dietary measures. Encourage small frequent meals, and low- pain, a sensation of intake. fat options. Avoid spicy, fatty, or highly salty food (Ackley et al., 2021). fullness, and food 3. Recognize and address complications associated with nausea and vomiting, including aversion. the administration of intravenous fluids and electrolytes (Taylor et al., 2022). Obesity related to In one year, the client 1. Assess the client to determine if he is ready to discuss weight loss and if he would sedentary behavior, decreases his body like weight loss information. Then, evaluate the client’s current nutrition, daily frequent consumption of weight to the normal physical activity, and understanding of body weight control (Ackley et al., 2021). fast food, sleep range for height and 2. Collaborate with the client and dietitians to design dietary modifications. Encourage disturbances, and age. the client to adopt a healthy eating style, such as having regular meals and avoiding parental obesity as fast food (Burgoine et al., 2021; Lopez-Minguez et al., 2019). evidenced by a BMI 3. Encourage the client to engage in regular physical activity (Perreault, et al., 2024). greater than 30 kg/m². Nursing Care Plan – Goals and Interventions (continue) Nursing Diagnosis Patient Goal 3 Intervention for each Diagnosis Ineffective health maintenance In one year, the client 1. Assess the client’s feelings, values, and reasons for ineffective health related to poor communication follows health care maintenance. Consider family patterns, economic factors, and spiritual or skills, limited social maintenance plan and cultural influences that impact health (Taylor et al., 2022). connections, decreased gross meets the goals in the 2. Assist the client in managing complex medication schedules and explore motor skills, and psychological plan. complementary healing modalities that align with their health goals (Taylor et distress as evidenced by al., 2022). insufficient knowledge of basic 3. Identify appropriate resources for the client, such as social services, support health and a pattern of groups, and telehealth interventions, to enhance their overall care and support inadequate health-seeking (Ackley et al., 2021). behavior.  Nursing Care Plan - Outcomes and Evaluation Nursing Diagnosis Outcome Evaluation Nausea related to 1. Before discharge, the client reports relief 1. After administering ondansetron, the client reports gastrointestinal issues and from nausea. relief from nausea. Goal met. stomach upset as evidenced by 2. Before discharge, the client is hydrated, and 2. The client remains hydrated, and his electrolyte levels abdominal pain, a sensation of electrolyte levels are within normal ranges. stay within normal ranges until discharge. Goal met. fullness, and food aversion. 3. In three days, the client is able to tolerate 3. Before discharge, the client is able to consume 4 oz of frequent small amounts of food without apple juice and some crackers without vomiting. He vomiting, progressing from a clear liquid diet advances to a general diet within five days. Goal met. to a general diet. Obesity related to sedentary 1. In two weeks, the client works with dieticians 1. In one week, the client collaborates with a dietitian to behavior, frequent to design dietary modifications. modify his diet. Goal met. consumption of fast food, sleep 2. In two weeks, the client can explain how to 2. In one week, the client is able to explain how to read disturbances, and parental eat according to the U.S. Dietary Guidelines food labels and follow the U.S. Dietary Guidelines. obesity as evidenced by a BMI 3. The client loses 1-2 pounds per week and Goal met. greater than 30 kg/m². decrease BMI to 30 kg/m² or lower in one 3. By the end of one year, the client loses 30 pounds, and year. his BMI is 34 kg/m². Goal partially met. Nursing Care Plan - Outcomes and Evaluation (continue) Nursing Diagnosis Outcome Evaluation Ineffective health 1. In two weeks, the client is able to discuss 1. In one week, the client discusses health maintenance related to poor health maintenance strategies with dietitians, maintenance strategies with dietitians, exercise communication skills, limited exercise physiologists, and other professionals. physiologists, and other professionals. Goal met. social connections, decreased 2. In two weeks, the client can design a healthcare 2. In one week, the client is able to design a gross motor skills, and maintenance plan, including healthy eating and healthcare maintenance plan, including healthy psychological distress as increased physical activity. eating and increased physical activity. Goal met. evidenced by insufficient 3. In one year, the client successfully follows the 3. In one year, the client follows the healthcare knowledge of basic health and healthcare maintenance plan. His health maintenance plan most of the time. His BMI is a pattern of inadequate health- conditions improve, with a BMI lower than 30 34 kg/m², and lipid levels and liver functions seeking behavior. kg/m² and lab values (e.g., lipid panel and liver (e.g., ALT, AST, and ASP) improve, but remain functions) returning to normal ranges. outside the normal range. Goal partially met.  Patient Education Needs Education Need Patient Specific Education Topic Rationale (Citation/reference required for each need) Treatment/nursing 1. Educate the patient on methods for maintaining hydration and electrolyte balance during (Ackley et al., 2021; interventions episodes of vomiting. Taylor et al., 2022) 2. Teach appropriate dietary measures for managing nausea and vomiting (e.g., initially NPO, then gradually advancing the diet) Pharmacology 1. Educate the client on the effects of acetaminophen overdose on liver function, (Holman et al., 2019; emphasizing that acetaminophen intake should not exceed the recommended limits. Elste, 2024) 2. Educate the client about the side effects of Resmetirom and related precautions (e.g., avoid sudden head movements or quickly standing up if experiencing dizziness). 3. Educate the client on taking other prescribed home medications as directed to manage comorbidities. Health promotion 1. Provide education on maintaining a healthy diet (e.g., interpreting food labels, portion (Ackley et al., 2021; control, recipe modification, having a regular and healthy breakfast, and avoiding fast Taylor et al., 2022) food). 2. Offer strategies for body weight control (e.g., personalized physical activity plans and social support) SBAR Report to New HCP I: This is XXX, the nurse caring for patient YYY. S: Patient YYY presents to the ED with complaints of nausea, abdominal pain, fatigue, and body itchiness. B: The patient reports that his symptoms have been intermittent for a couple of weeks but worsened over the past 24 hours after consuming chicken wings and beer. His medical history includes obesity, fatty liver disease, type 2 diabetes, and other comorbidities. He lives a sedentary lifestyle and prefers fast food. A: The patient is alert and oriented x4. Vital signs are stable, except for mild hypertension. He reports upper right abdominal pain (3 out of 10) radiating to the right shoulder, along with a sensation of fullness and continuous nausea. His last bowel movement was yesterday. Labs show elevated WBC, CRP, and abnormal liver function and lipid panels. CT imaging indicates decreased attenuation and liver enlargement with portal hypertension. Other test results are unremarkable. The patient has a diagnosis of fatty liver disease. He is on a clear liquid diet, and ondansetron and acetaminophen were administered two hours ago. He reports improvement in nausea and pain and requests solid food. R: Could you please assess the patient and determine if we can advance his diet? References Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2021). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier. Burgoine, T., Monsivais, P., Sharp, S. J., Forouhi, N. G., & Wareham, N. J. (2021). Independent and combined associations between fast-food outlet exposure and genetic risk for obesity: a population-based, cross-sectional study in the UK. BMC Medicine, 19(1), 49–49. https://doi.org/10.1186/s12916-021-01902-z Cho, I. Y., Chang, Y., Sung, E., Kang, J. H., Wild, S. H., Byrne, C. D., Shin, H., & Ryu, S. (2021). Depression and increased risk of non-alcoholic fatty liver disease in individuals with obesity. Epidemiology and psychiatric sciences, 30, e23. https://doi.org/10.1017/S204579602000116X Elste J. (2024). Rezdiffra for nonalcoholic steatohepatitis.webmd.com. https://www.webmd.com/digestive-disorders/rezdiffra-nonalcoholic- steatohepatitis  References Holman, H. C., Williams, D., Sommer, S., Johnson, J., Ball, B. S., Morris, C., Wheless, L., McMichael, M. G., Roland, P., Leehy, P., & Hertel, R. (2019). RN pharmacology for nursing (11th ed.). Assessment Technologies Institute. Lopez-Minguez, J., Gómez-Abellán, P., & Garaulet, M. (2019). Timing of breakfast, lunch, and dinner. Effects on obesity and metabolic risk. Nutrients, 11(11), 2624. https://doi.org/10.3390/nu11112624 Makri, E., Goulas, A., & Polyzos, S. A. (2021). Epidemiology, pathogenesis, diagnosis and emerging treatment of nonalcoholic fatty liver disease. Archives of medical research, 52(1), 25–37. https://doi.org/10.1016/j.arcmed.2020.11.010 Perreault, L., Apovian, C., & Reid, T. J. (2024). Obesity in adults: Overview of management. UpToDate. Retrieved February 6th, 2025, from https://www.uptodate.com/contents/obesity-in-adults-overview-of-management References Suvarna, R., Shetty, S., & Pappachan, J. M. (2024). Efficacy and safety of Resmetirom, a selective thyroid hormone receptor-β agonist, in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD): a systematic review and meta-analysis. Scientific reports, 14(1), 19790. https://doi.org/10.1038/s41598-024-70242-8 Taylor, C. R., Lynn, P. B., & Bartlett, J. L. (2022). Fundamentals of nursing: The art and science of person-centered care (10th ed.). Lippincott Williams & Wilkins. Zhong, F. P., Zhong, J., & Zhong, M. Y. (2023). Effect of music therapy on chemotherapy-induced nausea and vomiting in gastrointestinal cancer: A systematic review and meta-analysis. World journal of gastrointestinal surgery, 15(3), 471–479. https://doi.org/10.4240/wjgs.v15.i3.471