Nursing Assignment: Kathleen Johnson Case Study Analysis

This nursing assignment analyzes the case of Kathleen Johnson, a 45-year-old patient who underwent sleeve gastrectomy surgery. The paper delves into the etiology and pathophysiology of obesity, Kathleen's presenting condition, and the impact on her health, including type 2 diabetes. The assignment focuses on Kathleen's observations in the post-anesthetic recovery room (PARU), highlighting abnormal vital signs such as respiratory rate, pulse rate, blood pressure, body temperature, pain score, and urine output. It outlines the key nursing management priorities, including controlling vital signs, managing pain, and ensuring patient safety, while also addressing the importance of patient education regarding smoking and alcohol consumption. Furthermore, the assignment emphasizes the roles of other interdisciplinary healthcare team members, such as dieticians, physiotherapists, and rehabilitation counselors, in Kathleen's recovery and overall care before discharge. The analysis provides a comprehensive understanding of the challenges faced by obese patients post-surgery and highlights the importance of nursing assessment and interprofessional collaboration.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
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Author’s note

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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.

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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).
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

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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,

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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).
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.

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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

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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.

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