Discussion: Week 3-Please complete prior to clinical

Discussion: Week 3-Please complete prior to clinical

6  6 unread replies.  6  6 replies.

Knee Pain and Obesity

Patient Profile

N.R., a 52-year-old woman, comes to the clinic for complaints of right knee pain. She had been hoping that the ""pain would just go away,"" but it continues to worsen, especially with activity. She currently takes no medications.

Subjective Data

Denies that her weight has any relationship to the knee pain

States that her mother is a large woman and accepts that it is normal for people in their family to be ""large""

Objective Data

Height 5'2"", weight 205 lb

Describes pain in knee as a 7 on a scale of 1-10

Questions

Question: Calculate the BMI (body mass index) for N.R. Is N.R. overweight or obese?

Question: Describe the additional history that needs to be collected specific to weight reduction.

Question: Based on the above data, what other assessment data do you need to perform on N.R?

Question: What nursing diagnoses are appropriate for N.R.?

Question: Outline a basic weight reduction plan appropriate for N.R.

Question: Would N.R. benefit from any referrals and why?"

Patient Profile: N. R. 52 years, female, primary complaint knee pain.

 Objective Data

 Height: 5’2” (62 inches)

 Weight: 205 lbs

 BMI Calculation:

 Formula: BMI = Affected weight in pounds divided by square of affected height in inches then multiplied by 703.

 BMI = (205 / (62 x 62)) x 703 = 37. 5

 Interpretation: A BMI of 37. 5 of them classify N. R. as an obese person.

 Questions and Answers

 By what percent is N. R a candidate for overweight or is N. R. obese using the Body Mass Index (BMI)?

 Currently, N. R. ’s BMI is 37. 5 which puts her into the obese bracket (BMI > 30).

 Explain what further history will be needed of concern to weight reduction.

 Dietary habits: Previous dietary habits, portion sizes, the frequency of meals and snacks as well as the consumption of high calorie or high fat foods and ready processed foods.

 Physical activity: Present exercise profile, the number of hours spent doing exercise (if any), the general active- living profile, and the challenges to integration of exercise into daily practice.

 Previous weight loss attempts: Knowledge about dieting in general, previous achievements, or failures in terms of diets.

 Psychosocial factors: Emotional eating habits , perceived stress levels and perceived behavioral readiness.

 Medical history: Screening for other diseases that may affect weight loss such as hypertension, diabetes or hyperlipidemia amongst others.

 From the above data the following assessment data are required to perform on N. R.

 Musculoskeletal assessment: Flexibility and extension of the knee joint, stability of the joint and presence of any oedema in the involved limb.

 Pain assessment: Type, time, and factors which worsen/ improve knee pain.

 Cardiovascular assessment: Such indices were blood pressure, frequency per minute, and certain indications of the cardiovascular load.

 Metabolic assessment: Look for features of metabolic syndrome, including hyperglycemia or hyperlipidemia.

 Psychosocial assessment: Self-serve on weight loss and intention to carry out behavior modifications.

 What nursing diagnoses are appropriate for N. R. ?

 People with obesity have complex chronic pain, particularly knee pain brought by stress on the joints based on the self-reported knee pain of 7/10.

 Imbalanced Nutrition: Other than Body Requirements concerning excessive caloric intake as is evidenced from the BMI of 37. 5.

 Activities: Limited Schleroderma Movement due to sensitivity to sunlight.   Pain: Impaired Physical Mobility related to knee pain and obesity: The patient report increased pain level with activity.

 Patient-Centeredness, a subcategory under Self-Care Readiness, namely Readiness for Enhanced Health Management in relation to patient’s concern as well as the requirement for pain relief.

 Provide usual and manageable weight loss plan that can fit NR.

 Dietary Modifications:

 Eat in moderation and it is recommended that you embark on a healthy eating plan, with an emphasis on low-fat fruits, vegetables, lean meat, whole grains, and the recommended portion size.

 Suggest that clients constrain the consumption of sweets, canned soda, and other fatty products.

 Physical Activity:

 Start a low impact exercise regimen like swimming, taking a walk or cycling for the improved effect on weight loss without necessarily putting a lot of pressure on the joints.

 Initially, the exercise should be moderate for 30 minutes on each of the 5 days but the duration and the intensity should be progressive.

 Behavioral Strategies:

 Promote the idea of giving realistic expectations on how much weight a woman can lose a week (1-2 pounds).

 Educate patients about proper eating behaviours, including taking time to eat, and listening to hunger and satiety signals.

 Support and Monitoring:

 Subsequently follow up on the patients periodically to check on their progress and to motivate them.

 Try writing down what he or she eats for a time period and then use the diary to analyze the common things that can be avoided.

 Would N. R. benefit from any of the referrals and why?

 Nutritionist/Dietitian: So that I can coach and educate the patient on how they should take and portion their recommended meals to take in per given time.

 Physical Therapist: Knee pain, joint health, weight training, flexibility, balance, aerobic fitness, walking/running for weight loss and osteoarthritis.

 Behavioral Therapist or Counselor: To tackle some of the issues that are likely to lead to eating disorders and to present ways for sustaining motivation.

 Orthopedic Specialist: For more assessment of knee pain and to discuss the prospects of joint management within the context of weight – primarily for the patient I luckily chose.