University Nursing Case Study: Kathleen Jones' Health and Treatment

This nursing case study focuses on Kathleen Jones, a 45-year-old woman with type 2 diabetes and obesity (BMI of 40 kg/m2), who is undergoing sleeve gastrectomy surgery. The case explores the etiology of her conditions, including her unhealthy lifestyle, sedentary work, alcohol and cigarette addiction, and stress from caring for her father with dementia. The study details her pre- and post-operative observations, including elevated respiration, blood pressure, and pulse rate, and discusses the associated nursing management strategies. It emphasizes the importance of an interdisciplinary approach involving a dietician, counselor, and social worker to support Kathleen's recovery, address her addictions, and manage her stress. The analysis underscores the significance of understanding both the pathophysiology and etiology of diseases for effective patient care and treatment outcomes, as well as the role of bariatric surgery in managing severe obesity and related comorbidities. The assignment includes references to support the analysis and conclusions.

Running head: NURSING CASE STUDY
Nursing Case Study of Kathleen Jones
Name of the Student:
Name of the University:
Author Note:

1NURSING CASE STUDY
The excess intake of the energy when exceeds the energy expenditure, then it leads to a
condition called obesity. The aetiology of obesity can be designated as the accumulation of the
adipose tissue and leads to increase in mass of the body. It is also vital to mention that the small
energy imbalance on a daily basis can also lead to gain in body weight (Baqai & Wilding, 2015).
The deregulation of the glucose and the lipid metabolism along with the insulin resistance and
the lipotoxicity are the pathophysiological conditions of obesity. The effects of untreated obesity
are type 2 diabetes, cardiovascular diseases, hypertension, hyperlipidaemia, osteoarthritis and
joint pain. The causes of obesity are overeating, diet having a high content of carbohydrates,
genetics, physical inactivity, anti-depressant medications, and psychological factors like stress,
social issues and diseases like hyperthyroidism. Surgery alone offers the most viable option for
treatment of obesity through the long-term weight loss and also provide the maintenance options
for the morbidly obese persons. The surgical treatments help in the treatment of obesity that is
associated with comorbid conditions and surgeries for weight loss are termed as bariatric
surgeries (Zhang et al., 2014).
The case is based on Kathleen Johnson who is aged 45 years and works as a part-timer in
a library which involves the returning of books to the shelves. Kathleen has type 2 diabetes and
is overweight with a BMI of 40 kg/m2. Kathleen tries hard to control her diet in order to control
her obesity and type 2 diabetes. Kathleen is the only person in the family that can look after her
father who has dementia. Kathleen also admits that she consumes four bottles of beer every
night, and along with several glasses of whiskey and the smoking of cigarettes every day and
several cups of coffee. Kathleen says that the reason for her addiction is to manage the stress that
arises from managing her father, her appearance, and diabetes. The point of discussion starts
when Kathleen was admitted to a hospital for the sleeve gastrectomy surgery for the purpose of

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weight loss. Kathleen was transferred to the ward after 2 hours of a post-anaesthetic room
(PARU) and uneventful recovery.
Kathleen Johnson is having type 2 diabetes and is over overweight with a BMI of 40
kg/m2. The aetiology of both the type 2 diabetes and obesity can be attributed to the unhealthy
lifestyle of Kathleen Johnson. According to the case study of Kathleen Johnson, she works in a
library as a part-timer and she returns books to the shelves. Thus, there is a high chance that a
person who is performing less physical activity is sure to gain more weight. The sedentary work
life is one of the major contributing factors for the Kathleen Johnson in gaining more weight (Al-
Nakeeb et al., 2012). Kathleen Johnson has a BMI of 40 kg/m2 which is considered as a severe
obese condition and severity level falls within the class III of obesity. The severe obese condition
leads to different kinds of diseases and diabetes is among them (Kitahara et al., 2014). It has
been also found that Kathleen is experiencing stress due to the care she is providing to her father
had dementia. According to win et al. (2017), interview conducted revealed that the caregivers
experience stress when caring for a family member suffering from dementia. Kathleen has
mentioned herself that she in order to reduce her stress levels she takes four bottles of beer every
single night and several glasses of whiskey and also she smokes a single pack of cigarettes a day.
The levels of stress not only build up from the concern of caring her but it also arises from her
diabetic condition and her obese condition. According to Sinha & Jastreboff (2013), people of
often become addicted to alcohol and is one of the main reason to cope up with the stress
according to the people that are addicted to alcohol. There is a strong relationship with the
stressful events in that leads a person to become addicted to alcohol and smoking. Addiction to
smoking and alcohol not only increases a person's BMI but also affects body's internal
physiology. Stress affects both the BMI and the weight gain, it affects the insulin resistance,

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insulin resistance, and glucose resistance. Kathleen is also found that she takes several cups of
coffee every day and this must have a positive control type 2 diabetes in Kathleen, however, it is
seen that the insulin resistance has played a significant factor in diminishing the positive effect of
insulin externally administered. Also, smoking and overweight increase the risk of a type 2
diabetes (Type 2 diabetes: Overview, 2018).
Kathleen was admitted to a hospital for the purpose of weight loss through a procedure
called sleeve gastrectomy. Kathleen was kept in a post-anaesthetic recovery room for a period of
2 hours when Kathleen showed signs of improvement, she was then transferred to the ward. The
several observations that were collected during the stay inward are rate of respiration is 28
breaths per minute; the blood pressure is 190/100; rate of pulse is 130 beats per minute; the
temperature measured remained at 35.1 degree Celsius; pain score was 7 out of 10; in the last
hour the indwelling urinary catheter collected 5mls of urine; 50mls of gastric fluid was
administered through the nasogastric tube. The elevated levels of the rate of respiration (28
breaths per minute), high blood pressure (BP 190/100) and a high pulse rate of 130 beats per
minute. The high rates of respiration can be attributed to the increased lung space after Kathleen
underwent the sleeve gastrectomy surgery in order to lose weight (Bhammar et al., 2016). The
pulse rate of 130 beats per minute can be attributed to multifocal atrial tachycardia which is
characterized by irregular atrial rhythm and is caused due to the several ectopic foci that exit
within the atria. This leads to a high pulse rate of over 100 beats per minute. This type of
condition is typically seen in patients that are old and suffering from the chronic obstructive
pulmonary disease (COPD). The multifocal atrial tachycardia is associated with certain medical
conditions like major surgery, which in this case Kathleen has undergone (Custer & Lappin,
2018). The high blood pressure is usually observed in patients that are diabetic and as per the

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case, Kathleen already has type 2 diabetes which contributes to the increased blood pressure
(Lastra et al., 2014). The nursing management comes into play just after the surgery is carried
out. The patients that are having a BMI of over 40 are considered as the potential candidates for
this type of perioperative care. The patients undergo a comprehensive weight loss program which
includes a moderate amount of exercise, low-fat diet, low carbohydrate diet, and a high protein
diet which will actually enhance the weight loss program. The smokers are told to quit smoking.
Early ambulation of the patient is both promoted and encouraged. Patients are instructed to have
sips of water just after 1 day of the surgery and an intravenous fluid is administered depending
on the weight of the patient. Analgesia which is opioid is kept to the minimum. Heparin of low
molecular weight is administered as prophylaxis (Hoogerboord et al., 2014).
The three other members that will be required other than the team of the healthcare,
primary nurse, and primary medical team are a dietician, a counsellor, and a social worker. This
team of three people will work as an interdisciplinary team and will help in the recovery of
Kathleen after the surgery. Firstly, the most important interdisciplinary healthcare team include
the dietician. Kathleen has a sedentary life and her eating habits just after the sleeve gastrectomy
surgery has got more complex. The sleeve gastrectomy surgery involves the shortening of the
stomach; this leads to the change in the diet plan which can only be managed and controlled by a
dietician. The dietician can effectively plan the diet chart for Kathleen which will consist of low
carbohydrate, low fat and high protein content diet which will prevent Kathleen to gain weight
(Johnson Stoklossa & Atwal, 2013). The second most important member of the interdisciplinary
is the counsellor. The counsellor here will play a major role in counselling Kathleen regarding
the addiction. Previously, it was the stress due to which Kathleen was addicted to the beer and
cigarettes. This, however, can be managed only through an effective counselling. Addiction

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towards alcohol and cigarettes are not good for health and a counsellor will perform the same
task of making Kathleen understand that stress can be effectively reduced through better and
balanced lifestyle with proper nutrition and health management. The counsellor will provide
Kathleen with the necessary motivation to move out of the addiction and stress (Nadkarni et al.,
2017). Lastly, Kathleen will require a social worker to assist her in recovering from the surgery
through the different types of the group session and physiotherapeutic session. These sessions
will help Kathleen to stay motivated and experience less stress due to the burden of caring her
father who is suffering from dementia. Kathleen's father being a dementia patient will require
additional care from other care providers for an initial period of time in order to reduce the levels
of stress from Kathleen (Reckrey et al., 2014). At the same time, Kathleen can be provided with
the minimal education of how to take care of the dementia patient after she recovers totally and
takes the responsibility of taking care of his father.
Thus, from the above study, it can be concluded that both the pathophysiology and the aetiology
of a disease is necessary in order to identify the underlying reasons for a particular disease. This
study specifically focuses on Kathleen Johnson who is an overweight patient and is also
suffering from type 2 diabetes. The BMI of Kathleen has reached a severe condition and a
surgery needs to be done in order to reduce the ill effects of obesity.

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Reference
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Custer, A., & Lappin, S. (2018). Rhythm, Tachycardia, Multifocal Atrial (MAT).
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