Care Priorities in Obese Patient

Question: Discuss about the Care Priorities in Obese Patient. Answer: Introduction Clinical reasoning is an important element of providing quality nursing care to the patients. Clinical reasoning involves critical thinking through evidence based study and help the patients to display better outcomes. Clinical reasoning is the core of primary healthcare in Australia, which helps in identifying the complex care needs of patients by obtaining their medical and social history. The purpose of this essay is to identify the complex care priorities of the patient in the given case study. Case study present the information about the 48 years old Michael Anderson. He is suffering from morbid obesity and many chronic conditions associated with morbid obesity, such as obesity ventilation syndrome, sleep apnoea, diabetes and also Gastro-esophageal reflux disease. He clinical comorbities are associated with his heavy weight. Obesity is a serious medical condition that impacts the daily life activities, metal condition and mobility of the patients. Therefore, paper will discuss t he health assessment details of the patient to identify care needs followed by two care priorities and nursing intervention to improve patients outcomes. Assessment and Care Needs Miacheal was presented to the medical ward with the problems of shakiness, diaphoresis, increased hunger, high BGL levels and finding it difficult to breathe when he sleeps. Respiratory problem and difficulty in breathing are commonly associated with obesity. Obesity reduces the sleep and results in problem of breathing while sleeping. Sleep apnea does not have specific or limited treatment, but requires multidisciplinaryapproach and integrated strategy to reduce other symptoms and disease as well (Romero-Corral et al, 2010). Sleeping and breathing problem is also associated with hypertension (Fredheim, 2014). According to the given case study, Michael also suffers from hypertension. Therefore, all the conditions and factors in his case are related to each other. He has poorly controlled diabetes and he is dependent on insulin. He also has poorly controlled diet. On earlier admission to medical ward, he was instructed to reduce high energy diet and start taking high protein dirt. However, Michael found it difficult and his hunger has also been increased. Abnormal eating behavior is common in obese people, which increases the risk of further weight gain (Pinto-Bastos et al, 2016). Clinical reasoning allows understanding the condition of patients and associate physical condition with mental problems (Levett-Jones et al, 2010). Increased hunger in obesity patients is called as emotional eating. Emotional and mental regulation is very significant in morbid obesity patients (Silva, 2015). According to the social history obtained from the patient. His social condition is highly responsible for his emotion and mental problems (depression and hypertension). According to the study of Silva, I. (2015) obesity increases the risk of depression, anxiety and other emotional disorders. Obesity and mental problems are associated with stigma. He lives also because he is divorced and his children live away from him. He lost his job three years ago, which reduced social interactions and after being insulin dependent, his weight started increasing. Social isolation is associated with weight stigma, as Michael feels uncomfortable about his weight and avoids going out of his home. The multifaceted etiology of obesity involves many biological, environmental and behavioral factors. It is very important to consider various associated factors and prepare a collaborative care plan. The complex care priorities identified in the case of Michael Anderson are controlling eating disordered behavior for reducing weight and reducing weight stigma to promote social inclusion. These two complex care priorities are identified in the basis of appropriate clinical reasoning. The first complex care priority for Michael is addressing the issue of weight gain and eating disorder. Obesity is the problem that poses a great barrier in the healthy life and quality of life for patients. Clinical reasoning cycle helped to identiufy the priority need of the patient. Michael wants to lose weight and his strengths can be used to design evidence based interventions for him (Levett-Jones et al, 2010). Michael is the patient of morbid obesity, which means his problem of reduced ability to complete activities of daily life (ADLs). Obesity is associated with diabetes, respiratory problems and physical functioning. It is important to encourage physical activities in patients lifestyle. Though, Michael was asked to continue light exercise, but he was not able to adhere to given recommendations of diet and physical exercise. Therefore, patient will be associated with the class of life style intervention for obesity patients (Kernen, 2011). Factors affecting the lifestyle of patient are lack of motivation and support. Michael will be asked to attend the physical activity classes three to four times in a week. Physical activities will help him to strengthen his muscles and limbs, and he will be able to manage ADLs in a better way (Baillot et al, 2015). Patient will also be encouraged to self-monitor his physical improvements. Self-monitoring will develop confidence, and promote personal well-being in patients. Patient will be encouraged to start low calorie diet. Though, patient is not able to adhere to diet, so he will be supported by the community based programs. According to the study of Habib, Samam, Galvani, (2013) states that diet regimes includes two significant factors. First is the calorie restriction and second is modified composition of diet. Community based program and educational session will provide information and knowledge about consequences of morbid obesity. These sessions will also help Michael to understand important to controlled diet and how diet can be controlled through various regulation strategies. Comprehensive education is an important intervention that helps in providing nutritional education (Nijamkin et al, 2012). Such education effectively helps patient in reducing weight. Medically supervised weight management programs and educational sessions will encourage physical activities, changed eating patter, controlling emotional eating and improving physical fun ctioning (Habib, Samam, Galvani, 2013). Weight stigma is a very significant problem. Morbid obesity is a serious concern that significantly affects the quality of life of the patients. Michael is also suffering from weight stigma, due to which he is not able to find job and have become socially isolated. He feels uncomfortable about his size. Social biases and discrimination often results in emotional and mental problems. The patients become highly stigmatized of facing various forms of prejudices in the society (Puhl Heuer, 2009). The goal of the care plan is to improve the quality of life for the patient. Stigma is also associated with depression and low self-esteem. In order to enhance the self-esteem and confidence in patient, nurse will focus on developing partnership with patient. Partnering with consumers is an effective way of applying patient centered care. Empathetic and therapeutic relationship with patient will help him to come out of his stigma and participate in social activities (Phelan et al, 2015). One of the most significant approaches to address the issue of social stigma and social isolation, nurse will refer the patient to the session of Cognitive behavior therapy (CBT). This therapy helps in promoting mental health and relieving depression, social and emotional ravages. The mental effects of CBT also help to alter the eating patterns that help in reducing weight. CBT is very beneficial in altering the negative thoughts irrational thinking and emotional illness (Alimoradi et al, 2016). The main focus of this therapy is on the thoughts and feelings of the patient, as it is believed that psychological problems are associated with physical problems. This therapy can help in altering the poor belief of stigma associated with boy image, which can lead to social isolation and bad eating habits (Alimoradi et al, 2016). Mindfulness based cognitive therapy is also beneficial for the obese patients. Obese patient often feel disrespected, unwelcomed and inadequate that negative affects their life and their willingness to seek care. For improving patient condition and reducing stigma behavioral changes can also be initiated. Behavioral change strategies will encourage self-monitoring, problem solving and adopting healthy lifestyle (Gjevestad, 2015). Reducing depression and encouraging social inclusion will require patient to participate in social activities. Social contacts will also be identified. Michaels friends and family members will be included in care plan and will be asked to visit him frequently. Social support will reduce stigma and isolation. Support of family and peers will help patient to have a sense of belongingness, support and relationships. Social connectedness is very significant for every individual, because humans are the social beings and requires working and living within the society. Isolation can worsen the condition of the patient and increase the risk of mortality and reduced life expectancy. The community based programs will allow him to make social contact and social interactions. He will be able to meet other people like him and will not feel inadequate or unwelcome. Clinical reasoning cycle helped to identify the most significant problems of the patient. Through this it become easy to identify the symptoms of loss of social contact, lack of family support and peers. Conclusion Paper presents the case study of Michael Anderson, who is a 48 years old man and he is suffering from morbid obesity. Morbid obesity is a serious condition, which states that person suffers from obesity as well as many other chronic conditions occurred due to obesity. Paper is based on using the Levett-Jones clinical reasoning cycle. Clinical reasoning allowed to understand the various factors associated with poor health condition of patient. Poor health is not just associated with physical condition, but it is also associated with social and psychological factors. The two complex care priorities identified for Michael Anderson are initiating weight loss activities and reducing social isolation. Care plan is designed according to priority needs of the patient that can promote overall physical, mental and emotional health in patient. References Alimoradi, M., Abdolahi, M., Aryan, L., Vazirijavid, R., Ajami, M. (2016). Cognitive Behavioral Therapy for Treatment of Adult Obesity.International Journal of Medical Reviews,3(1), 371-379. Baillot, A., Romain, A. J., Boisvert-Vigneault, K., Audet, M., Baillargeon, J. P., Dionne, I. J., ... Langlois, M. F. (2015). Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis.PLoS One,10(4), e0119017. Fredheim, J. M. (2014). Obstructive sleep apnea in severely obese subjects. Diagnosis, association with glucose intolerance and the effect of surgical and non-surgical weight loss. Gjevestad, E. (2015). Comparative effects of lifestyle intervention, low calorie diet and bariatric surgery on weight loss and arterial stiffness. Non-randomized clinical trials including treatment seeking morbidly obese patients. Habib, S., Samam, J., Galvani, C. A. (2013). Treatment of Morbid Obesity.Surgery Curr Res,3(135), 2161-1076. Kernen, A. M. (2011).Lifestyle interventions in treatment of obese adults(Doctoral dissertation, OULU UNIVERSITY). Koski, M., Naukkarinen, H. (2017). Severe obesity, emotions and eating habits: a case-control study.BMC obesity,4(1), 2. Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... Hickey, N. (2010). The five rights of clinical reasoning: An educational model to enhance nursing students ability to identify and manage clinically at riskpatients.Nurse education today,30(6), 515-520. Nijamkin, M. P., Campa, A., Sosa, J., Baum, M., Himburg, S., Johnson, P. (2012). Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial.Journal of the Academy of Nutrition and Dietetics,112(3), 382-390. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. obesity reviews, 16(4), 319-326. Pinto-Bastos, A., Ramalho, S. M., Conceio, E., Mitchell, J. (2016). Disordered Eating and Obesity. InObesity(pp. 309-319). Springer International Publishing. Puhl, R. M., Heuer, C. A. (2009). The stigma of obesity: a review and update.Obesity,17(5), 941-964. Romero-Corral, A., Caples, S. M., Lopez-Jimenez, F., Somers, V. K. (2010). Interactions between obesity and obstructive sleep apnea: implications for treatment.CHEST Journal,137(3), 711-719. Silva, I. (2015). Importance of emotional regulation in obesity and weight loss treatment.Fractal: Revista de Psicologia,27(3), 286-290.