See the CD-ROM for the Disease Summary for this case study.
PATIENT CASE
Patient's Chief Complaints
"I need to lose some weight and I can't do it by myself. I'm always tired and out of breath and my back and knees are killing me. I'd like to have stomach staples, if possible."
HPI
B.L. is a 57-year-old Hispanic woman of Puerto Rican heritage who states that she maintained her ideal weight, which she believes is about 115 lbs, until she was divorced 15 years ago. "I was in the military years ago and I was very trim at that time." She has been continually gaining weight, mostly through "comfort eating" after her divorce. She also admits to nibbling on snacks at work—mostly high-calorie foods like brownies and Twinkies. She has previously tried OTC diet pills, multiple fad diets (South Beach and Sugar Busters), meal replacement diets (Slim-Fast), "water pills," and most recently a combination of herbal products (chitosan and Garcinia). "I lose a bunch of weight over one or two months and then I gain it all back plus some." She is tearful as she talks about her weight struggles. "I realize that my weight is affecting my health and I want to finally get some help to lose some and then keep it off for good."
PMH
HTN times 8 years
Gallstones 5 years ago, treated with lithotripsy and ursodeoxycholic acid
Hypothyroidism times 5 years
Bilateral osteoarthritis of knees and lower back
Depression times 4 years
PSH
TAH 20 years ago
Carpal tunnel release surgery in both wrists 3 years ago
CASE STUDY 98= OBESITY $471
VS
See Patient Case Table 98.1
able[[Patient Case Table 98.1 Vital Signs],[BP, (138)/(88), T, 97.5°F, Waist, 48 in,],[P, 85 and regular, HT, 5 ft-1 in, Hips, 39 in,],[RR, 30, WT, 290 lbs, SaO2, 96%,]]
Skin
Warm with normal distribution of body hair
No rashes or moles noted
HEENT
Funduscopic exam normal
Ears, nose, and throat all WNL
Cardiac
RRR
S1 and S2 normal with no (m)/(r)/g
Lungs
CTA & P bilaterally
Breasts
Exam deferred
Abd
Severely obese with multiple striae
NT/ND
(+) BS
No palpable masses or bruits
(-) HSM
Hysterectomy scar well healed
Genit/Rect
Exam deferred
Ext
(+) for lower extremity varicosities
Palpation of knees reveals limited ROM, bony crepitus, and patient discomfort bilaterally
Pedal pulses 2+ bilaterally
Neuro
A&O times 3
CNs II-XII intact
Sensory and motor levels intact
DTRs 2+
(-) Babinski
Laboratory Blood Test Results
See Patient Case Table 98.2
able[[Patient Case Table 98.2 Laboratory Blood Test Results,],[Na, 140 meq/L, Ins, 190 μU/mL, PLT, 190,000/mm3, Neuro AOX3 CNs II-XII intact Sensory and motor levels intact DTRs2+ -Babinski, Laboratory Blood Test Results, Na 140 meq/L Ins 190 U/mL PLT K 3.9 meq/L AST 14 IU/L Cholesterol Cl 107 meq/L ALT 29 IU/L LDL HCO 29 meq/L Bilirubin, total 0.9 mg/dL HDL BUN 15 mg/dL Hct 49% Triglycerides Cr 0.8 mg/dL Hb 17.4 g/dL TSH Glu, fasting 118 mg/dL WBC 6,700/mm3 Uric acid 190,000/mm3 314 mg/dL 195 mg/dL 14 mg/dL 219 mg/dL 3.7 U/mL 1.7 mg/dL, Arterial Blood Gases, PaO= 90 mm Hg; PaCO=33 mm Hg; pH =7.35, Spirometry Tests, VC=4000 mL TLC=5000 mL ERV=1000 mL, Chest X-Ray WNL, Patient Case Question 2. Identify ten risk factors for obesity in this case study, Patient Case Question 3. Identify ten health consequences that may have developed in this patient from obesity. Patient Case Question 4. Does the patient have any signs of liver dysfunction?, Patient Case Question 5. Other than the patient's complaint of always being out of breath, does she have any signs of abnormal pulmonary function at this time? Patient Case Question 6. Does the patient's hypothyroid condition need a drug dosage adjustment at this time?, Patient Case Question 7. Into which class of obesity can this patient be categorized: I.IIorIII, Patient Case Question 8. What is the risk for this patient to develop disease if she continues at this weight?, Patient Case Question 9. Calculate the body fat percentage in this patient.
