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Evidence-based nursing (EBN)

   

Added on  2021-04-24

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Running head: EVIDENCE BASED NURSINGEvidence based nursingName of the studentUniversity nameAuthor’s note

1EVIDENCE BASED NURSINGTable of ContentsBackground.................................................................................................2Aetiology and pathophysiology of the present condition of the patient.....2Underlying pathophysiology of the patient’s post-operative deterioration3Appropriate nursing management of the patient.......................................4Justification for involvement of three members of the interdisciplinaryhealthcare team..........................................................................................5Conclusion..................................................................................................6References..................................................................................................8

2EVIDENCE BASED NURSINGBackground The current assignment deals with post-operative nursing care practices. Here, the patient Kathleen Johnson is a 45 years old lady who had been admitted to the hospital for sleeve gastrectomy surgery. Kathleen has morbid obesity with a BMI index of 40kg/m2 alongwith type 2 diabetes. She is also the sole carer of her father who has been suffering from dementia and suffers from low self esteem due to her negative body image. Kathleen has been dependent upon addictives such as alcohol, cigarettes and coffee for dealing with the stress in her life. Therefore, after the gastrectomy surgery the patient has been transferred to the general ward where a nursing professional has been employed for looking after her care concerns.Aetiology and pathophysiology of the present condition of the patient The patient here is a 45 years old lady suffering from type 2 diabetes and is morbidly obese. Therefore, she had been suggested sleeve gastrectomy surgery by the doctor. However, it is necessary to understand the aetiology and the pathophsyiology of the conditionof the patient. The aetiology and pathophysiology of type 2 diabetes and obesity has been linked over here. It helps in understanding the effect of obesity on the overall health and well being in people. Obesity is a hetergenous group of conditions with multiple causes each of which is expressed as an obese phenotype (Berman et al., 2014). As commented by Bryant & Knights (2014), the influence of genotype on the aetiology of obesity is either attenuated or exacerbated by non-genetic factors. There are a number of aetiological determinants of obesity which are endocrine and hypothalamic disorders, heritability, eating and energy storing patterns. Additionally, obesity has been strongly related to the development of type 2 diabetes. The BMI is strongly related to diabetes and insulin resistance as in obese individuals the amount of non-esterified fatty acids, glycerol, hormones, cytokines, pro-

3EVIDENCE BASED NURSINGinflammatory markers are increased. Serum free fatty acids (FFA) are frequently high in obese individuals which are the one of the major contributors to peripheral insulin resistance. Elevated levels of FFA in the blood have been seen to promote gluconeogenesis inducing hepatic and muscle insulin resistance. FFAS also enhances the accumulation of triglycerides in liver and skeletal muscle, which could be correlated with insulin resistance (Hoogervorst-Schilp et al., 2016). BMI equal to or greater than 40 kg/m2 has been categorised under class III obesity which increases the risk for illness and death manifold times (Broyles, Smith, Coon & Bonawitz, 2016). The obese condition of Kathleen could be attributed to her lifestyle and eating habits. In order to cope up with her life stress Kathleen had been overtly dependent upon alcohol, smoking. Kathleen has been drinking upto four bottles of beer on a single night. Therefore, excessive alcohol uptake results in increased amount of calories. Therefore excess amount of stored energy whereas less expenditure can result in increased body weight.As commented by Bullock & Hales (2012), the psychosocial factors have also been seen to trigger binge drinking in people. Thus, binge drinking with long intermittent gaps have been seen to enhance weight gain by disturbing the facultative thermogenesis cycle.Underlying pathophysiology of the patient’s post-operative deterioration The patient had been suggested a sleeve gastrectomy surgery in order to facilitate weight loss. In the following procedure most of the stomach is removed except a small sleeveshaped pouch. It restricts the amount of food which could be consumed by the patient improving metabolic s syndrome. It acts by changing hormonal signal between stomach, liverand brain by establishing lower set points. As supported by Broyles, Smith, Coon & Bonawitz (2016), undertaking sleeve gastrectomy surgery helped in controlling type 2 diabetes in 58% of the cases.

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