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C155 Pathpharmacological Foundations for Advanced Nursing Practice C155

C 155 Pathpharmacological Foundations for Advanced Nursing Practice

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C 155 Pathpharmacological Foundations for Advanced Nursing Practice
C 155 Pathpharmacological Foundations for Advanced Nursing Practice Investigation of Disease Process Obesity is one of the major global health issues of the 21st century. About one-third of the population of the world is either obese or overweight. In the United States, 34 percent of the adults live with obesity (Nakaya, 2018). The prevalence of the condition tends to be higher among women than among men. Obesity is a metabolic condition that is characterized by excessive body fat. It develops when one’s caloric expenditure is lower than intake. This leads to the conversion of the excess nutrients to fat. Obesity is measured using the body mass index (BMI). When an individual’s BMI is over 30kg/m2, he or she is said to be obese. View less
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C 155 Pathpharmacological Foundations for Advanced Nursing Practice Obesity A. Investigation of Disease Process Obesity is one of the major global health issues of the 21st century. About one-third of the population of the world is either obese or overweight. In the United States, 34 percent of the adults live with obesity (Nakaya, 2018). The prevalence of the condition tends to be higher among women than among men. Obesity is a metabolic condition that is characterized by excessive body fat. It develops when one’s caloric expenditure is lower than intake. This leads to the conversion of the excess nutrients to fat. Obesity is measured using the body mass index (BMI). When an individual’s BMI is over 30kg/m 2 , he or she is said to be obese. It is important to note that obesity is a frustrating disorder which is not easy to manage. Although the causes of the condition and its health implications are now fully understood by many, nothing significant has been done in order to promote effective treatment and prevention. (Strissel et al., 2007). This makes obesity a serious risk factor for death, morbidity, and high cost of care. For instance, more than 300,000 people die every year in the United States because of the complications associated with obesity (Strissel et al., 2007). Yet the condition is preventable. Obesity can cause other serious illnesses. These include hypertension, type 2 diabetes, stroke, and cardiovascular disease

A 1. Pathophysiology Obesity is caused by both genetic and environmental factors.

This makes it a complex disorder. The disease is a product of the imbalance between food intake and energy us in the body (O’Brien, Holubkov & Reis, 2004). When more energy comes into the body than it goes out, one is likely to gain weight. The excess energy gained by the body is often due to inactive lifestyles, bad eating habits, and hereditary factors. The genetic causes of obesity are rare as a result of polygenetic interactions. This is unlike the case of environmental factors. However, more types of obesity have been discovered through genetic obesity (Wellman & Friedberg, 2003). This contributed to the knowledge of the treatment of obesity. The development of obesity involves an interaction between hormones, and neurotransmitters, and cytokines. Cytokines refer to small proteins secreted by cells. They control communication within the cell. The cellular basis of obesity is adipocyte. This is a fat cell which secretes cytokines and hormones called adipokines (Wellman & Friedberg, 2003). The adipokines serve to regulate the intake of food, storage of lipid, energy metabolism, insulin, and blood pressure. When visceral fats accumulate in the body, the adipocyte gets affected and it malfunctions. This in turn leads to the alteration and inflammation of hormones, adipokines, and neurotransmitters. This sets the stage for the onset of obesity. A 2. Standard of Practice The standard of practice for the management of obesity involves meaningful collaboration between healthcare workers and patients. This leads to positive healthcare outcomes. A healthcare worker should measure the weight and height of a patient who exhibit some signs and symptoms of obesity (Freedhoff & Sharma, 2010). The process can help to determine whether he or she is obese. It is important to inform the patient that one is obese when

inactive. More than 40% of the adults in the state do not take healthy foodstuff (Kennedy, Evans & Laughlin, 2018). These lifestyles put them at risk for conditions such as diabetes, heart disease, stroke, and cancer. All these conditions top the list of the major causes of death in Louisiana and the United States at large. A 2 b. Clinical Guidelines The clinical guidelines for the management of obesity involve the assessment and diagnosis of the condition, and provision of patient education. During assessment, a healthcare practitioner needs to carry out a thoroughly physical examination of the obese patient. This has to be accompanied with the examination of the family history, physical and eating habits, and other risk factors for obesity (Apovian, Aronne & Powell, 2015). Assessment helps to determine the causes of the condition. During diagnosis, the signs and symptoms exhibited by the obese patient should be studied in detail. This may include measurement of the BMI (Apovian, Aronne & Powell, 2015). If the patient has a BMI of more than 30kg/m 2 , the healthcare provider can conclude that he or she has obesity. Obesity education involves informing patients about their BMI. This will help them to make important health decisions. It is also important for the healthcare practitioner to sensitize the patient on other healthcare conditions associated with obesity. These include diabetes, stroke, and cancer. This information can help the patient to understand the health risks associated with obesity and being overweight (Apovian, Aronne & Powell, 2015). It is as well necessary for the patient to be educated on the importance of lifestyle changes in the management of obesity. For example, the healthcare can highlight the role that physical activity plays in the management of the condition. A 2 c. Standard Practice of Disease Management

The standard practice of management of obesity management at my local community in Louisiana is similar to the national practices used in the management of the condition. The practice comprises a multiple system approach where a primary care provider plays a crucial role in the evaluation and monitoring of obesity. It involves physical assessments, history examinations, laboratory work, and medication (Bray et al., 2016). Counseling and support groups also plays a crucial role in the management of obesity. They serve as important resources for the patients who live with the disease. The initiatives help the patients to understand the right approaches for the effective management of the condition. Just like national obesity management practices, the community practices advocate for healthy lifestyles. People at the local level are sensitized on the importance of keeping physical fitness, and embracing healthy eating habits (Freedhoff & Sharma, 2010). These efforts help to control the BMI. The sensitization is made through seminars, local education, and other local avenues. Perhaps what is done differently at the local level in terms of best obesity management practices is the approach taken in lifestyle change. Dietary and physical activity preferences vary from one community to another. There is no set national standard on the same. Therefore, the choices made by an individual depend on where he or she lives. A 3. Managed Disease Process The process of proper obesity management requires one to make an effort. Patients are required to embrace complex lifestyle management practices. This involves changes in their diets, physical activities, and behaviors in general (O’Brien, Holubkov & Reis, 2004). Obese patients carry out self-monitoring of their calorie intake. They also engage themselves in various physical exercises. All these efforts play a vital role in controlling their BMI. The characteristics of a patient who is managing his or her obese condition well include a BMI which ranges

that of the US. However, the pharmacological treatment differed, with the UK only using Orlistat as a treatment option (Barry et al., 2014). The government has presented a toolkit also for educating every individual of ways to prevent obesity. There is a strong push by the government also for an increase in physical activity. In China, the obesity rates have increased each year. After reviewing the standards for managing obesity in China, the treatment parallels with that of the US. Due to the prevalence of obesity in China and that Chinese are more prone to centralized obesity, the standards for management in relation to diagnosis represents a narrower satisfactory finding for the BMI. In the United States to be classified as obese, the BMI must be > 30; however, in China an individual is obese with a BMI of > 28. The prevalence of obesity could also have a link to the Chinese population considering Obesity as sign of happiness and abundance. The Chinese government has implemented different education programs to fight obesity (Huijun & Fangying, 2013).

A 4. Managed Disease Factors Various factors play a significant role in the management of obesity. These include financial resources available, level of access to healthcare services, and lack of medical insurance (Bray et al., 2016). The availability of financial resources makes it easy for an obese person to afford healthy foodstuffs. The patient can also find it easy to secure enough space for his or her physical activities. Sticking to healthy foods and engaging in regular physical activities help to bring about important lifestyle changes necessary for the management of obesity. The ability to access healthcare enables an obese patient to get the necessary treatment for the condition (Freedhoff & Sharma, 2010). It can also help him or her to get relevant

education for the management of the disease. An insured patient finds it easy to efficiently manage obesity (Freedhoff & Sharma, 2010). For instance, one who is covered with Medicaid is at liberty to explore the best treatment options for the condition since the cost of management is met by the federal government. A 4 a. Unmanaged Disease Factors Lack of the factors that influence the management of obesity usually tends to frustrate the efforts made by patients. For instance, lack of financial resources limits an obese patient’s ability to access proper healthcare services (Pickett-Blakely, 2016). This can be harmful to his or her health outcomes. Patients who live under extreme conditions of poverty tend to have negative healthcare outcomes as a result of lack of finance. If an obese patient is unable to access to healthcare services, it means that he or she is prevented from getting the relevant information and knowledge required for the management of his or her condition (Freedhoff & Sharma, 2010). For example, the patient can miss important information on what lifestyle change entail. On their part, obese patients who are not insured find it expensive to manage the condition (Freedhoff & Sharma, 2010). They have to meet the high cost of management. A 4 a i. Unmanaged Disease Characteristics Unmanaged obesity is associated with various characteristics among patients. A patient who has done nothing to improve his or her obese condition is likely to continue having excess weight. His or her BMI will probably remain high (O’Brien, Holubkov & Reis, 2004). It is also important to note that the patient can exhibit characteristics related to breathlessness, excessive sweating, sleep disturbances, joint and back pains, and emotional stress.

equipment for exercise (Chou, Grossman & Safffer, 2004). Obese patients find it expensive to manage their condition if it is associated with complications such as obesity and cancer. As far as Freedhoff and Sharma (2010) are concerned, the treatment of obesity related conditions costs over $147 billion per year. It has also been established that obese patients spend about 42% more on healthcare than persons with normal weights (Chou, Grossman & Safffer, 2004). A patient cannot afford the huge treatment cost of obesity. This makes it necessary for his or her family, and the community to get involved. For instance, the family and community members can make contributions for the clearance of hospital bills for a given obese patient. C. Best Practices Promotion Best practice promotion for the management of obesity involves putting in place appropriate pharmaceutical interventions and lifestyle changes. This depends on the effective assessment of the condition of the patient. As an advanced practice nurse, there is need to promote best practice in my current healthcare organization. Pharmaceutical intervention may involve the administration of anti-obesity drugs to an obese patient (Caveney et al., 2011). The drugs can play an important role in the reduction of body weight. However, the success of this intervention will basically depend on the compliance of the patient. On the part of lifestyle changes, there is need to focus on healthy eating habits and maintenance of physical fitness. It is important to provide nutritional training for the obese patient (O’Brien, Holubkov & Reis, 2004). This will help him or her to understand the importance of healthy foodstuffs in the management of his or her condition. It is also necessary to advise the patient to engage in various exercises and other physical activities (Bray et al., 2016). This will help to reduce weight.

C 1. Implementation Plan The best practices for the management of obesity need to be implemented effectively for them to succeed in the management of the disease. One of the most important strategies of implementation is to provide a scale to an obese patient (Bray et al., 2016). This scale will help them to track their weight daily. If any rapid weight gain is noticed, it is necessary for the patient to seek early treatment. The patient will be required to bring a journal of the daily weights to follow up appointments Another important intervention is the development of a support group for the patient. This group would have a counselor or therapist to lead the group to help the patient deal with the emotional issues that may come up during managing the disease. Development of education standards for newly diagnosed patients. The education program will be designed as an asynchronous, online learning module. The program will be updated annually to keep up with new standards. This can enable the patients to get important education and relevant information on obesity management. It is also necessary to ensure that patients understand how they can access their health records online (Bray et al., 2016). This will empower them and make them more involved in their various care plans.

C 2. Evaluation Method There is need to evaluate the success of the interventions used for the implementation of best practices for obesity. The best mode of evaluation can be one which is evidence-based (O’Brien, Holubkov & Reis, 2004). For example, the healthcare practitioner may collect all the important data pertaining to the application of the interventions among patients living with obesity. This data should be compared with other pieces of relevant data that derives from similar interventions. The data can be used to make important healthcare decisions for the

References Apovian, C., Aronne, L. and Powell, A. (2015). Clinical Management of Obesity. Professional Communications,Inc.

Barry, P., Batterham, R., Blakemore, A., Clare, K., Connell, C., Holt, R., … Wilding, J. (2014, November 27). Obesity: identification, assessment and management. National Institute for Health and Care Excellence. Retrieved from nice.org/guidance/cg

Bray, G. A., Fruhbeck, G., Ryan, D. H. and Wilding, P. H. (2016). Management of Obesity. The Lancet, 387 (10031): 1947-1956.

Caveney, E., Caveney, B. J., Somaratine R., Turner, J. R. and Gourgiotis, L. (2011). Pharmaceutical Interventions for Obesity: A Public Health Perspective. Diabetes Obes Metab., 13 (6):490-7. doi: 10.1111/j.1463-1326.2010.01353.

Chou, S., Grossman, M. and Safffer, H. (2004). An Economic Analysis of Adult Obesity: Results from the Behavioral Risk Factor Surveillance System. Journal of Health Economics, 23 (3): 565-587. doi/10.1016/j.jhealeco.2003.10.003.

Freedhoff, Y. and Sharma, A. M. (2010). Best Weight: A Practical Guide to Office-Based Obesity Management. Canadian Obesity Network.

Kennedy, C. A., Evans, E. M., and Laughlin, C. M. (2018). Fitness and wellness: A way of life. Champaign, IL: Human Kinetics.

Huijun, W., & Fangying, Z. (2013). Program and policy options for preventing obesity in China [Entire issue]. National Institute of Health Public Access, 14 (2). doi/10.1111/obr. Pickett-Blakely, O. (2016). Future Therapies in Obesity. Gastroenterology Clinics of North America, 45 (4), 705-714. O’Brien SH, Holubkov R, Reis EC. (2004) Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics, 114 154-

Nakaya, A. C. (2018). Thinking critically: Obesity Wellman NS, Friedberg B (2003). Causes and consequences of adult obesity: health, social and economic impacts in the United States. Asia Pacifc J Clin Nutr 11(Suppl):S705–9.
Strissel KJ, Stancheva Z, Miyoshi H, Perfield JW 2nd, DeFuria J, Jick Z et al.
(2007). Adipocyte death, adipose tissue remodeling, and obesity complications. Diabetes
56 : 2910–2918.
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PATHOPHARMACOLOGICAL FOUNDATIONS FOR ADVANCED 1
C 155 Pathpharmacological Foundations for Advanced Nursing Practice
Obesity
A. Investigation of Disease Process
Obesity is one of the major global health issues of the 21st century. About one-third of the
population of the world is either obese or overweight. In the United States, 34 percent of the
adults live with obesity (Nakaya, 2018). The prevalence of the condition tends to be higher
among women than among men. Obesity is a metabolic condition that is characterized by
excessive body fat. It develops when one’s caloric expenditure is lower than intake. This leads to
the conversion of the excess nutrients to fat. Obesity is measured using the body mass index
(BMI). When an individual’s BMI is over 30kg/m2, he or she is said to be obese.
It is important to note that obesity is a frustrating disorder which is not easy to manage.
Although the causes of the condition and its health implications are now fully understood by
many, nothing significant has been done in order to promote effective treatment and prevention.
(Strissel et al., 2007). This makes obesity a serious risk factor for death, morbidity, and high cost
of care. For instance, more than 300,000 people die every year in the United States because of
the complications associated with obesity (Strissel et al., 2007). Yet the condition is preventable.
Obesity can cause other serious illnesses. These include hypertension, type 2 diabetes, stroke,
and cardiovascular disease
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