BNURS20 Nursing

Obesity ventilation syndrome is mainly characterized by the daytime hypercapnia, obesity and disordered in the breathing while sleep due to the absence of a vital lung or the disease related to the respiratory muscle (Leader et al., 2013). In the case of Michael Anderson, obesity is the reason for the increase in the type 2 diabetes mellitus. The obesity etiology is supplementary complex than merely an imbalance between energy output and energy intake. The most vital factor which influences the rate of the obesity is the changes in the consumption of food with the changes in the dietary habits (Leader et al., 2013).

The case history of the Michael clears that he is not only suffering from the physical issues but is also mentally disturbed and socially isolated himself from the society due to the increased weight which resulted in an increased hypertension and depression among him from the last three months (Leader et al., 2013).

To support Michael in such situations of  the poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea chronic illness factors such as the care, family relationships, technology, developmental level, beliefs, cultural values, economics need, and communication is to be measured. A thoughtful of how such factors affects the chronic illness can make possible the suitable development and commencement of options for the illness adaptation (Leader et al., 2013).

The chronic illness encounters the patients with the range of needs that is required by the patients to change the behavior and get involved in such activities that results in promoting the psychological and the physical well-being, to work together with the community healthcare providers and hold on to healing regimens, monitoring the status of health and to take the decisions associated with the care, and managing the illness impact on psychological, physical and social functioning with the coordination of the health care providers (You, Dunt, & Doyle, 2015).

The management related to the community care of the patients suffering from the OHS needs the multidisciplinary access which combines the various surgical and medical subspecialties.  The affected subjects need the contribution from endocrinologists and internists regarding diabetes mellitus, hyperlipidemia, hypertension, failure of the heart. In the case the main focus of the nursing care is to control the morbid obesity as this is the main cause of all the chronic diseases in the patient (You, Dunt, & Doyle, 2015).  Hence, nursing care priority in such case scenario is to implement the hypothyroidism therapy; a dietician is required for the planning the diet which will result in the weight reduction; a respirologist which will help in the management of the issues related to the respiratory failure and the surgeon is required at the time of need for the potential bariatric surgery (LAM, MAK and IP, 2012).

The community care services provides management for controlling the increased proportions of the risk related to the morbid obesity and also the advice related to the preventive lifestyle advice (Wilson, Ramelet, & Zuiderduyn, 2010). The focus of the community care providers is on the strategies of intervening in the lifestyle changes with increased healthy behavior in the patients and controlling all the physiological variables that are responsible for the onset of such chronic disease. In the case, reduction in the body weight may lead to the improvement in the functions and the pulmonary physiology which can be evidenced in the patient with the improved expiratory volume and vital capacity (Ramelet, & Gill, 2012). Weight loss will further results into the reduction of the desaturation severity and hypopnea or apnea index.  It is obvious that the care management related to the issues will be guided as per the severe conditions and acute presentation and hence the care management includes the need of different care such as the requirement of the reduction in the weight, positive pressure ventilation, oxygen therapy, tracheostomy, pharmacotherapy, and management of the complicated and comorbid illness (Wilson, Ramelet, & Zuiderduyn, 2010).

The plan for the dietary alteration which shall support the weight reduction including the emotional readiness in order to address such issues requires evaluation (Riha, 2009). Motivation to take part in the exercise as well as the activity in spite of returning to ordinary sedentary TV watching also shall be significant. The proper enhancement and development of the chart which allows to properly mapping of the plan in order to maintain recovery with the sense of timely progress may promote regular participation in developing his ability in order to support the ADLs individually again (Madigan, & Vanderboom, 2005). Proper and timely review of the efforts so as to enhance mobility should be regularly done.

The second strategy which is to be implemented by the community care is the multidisciplinary care and will normally involve the expansion of treatment plans customized to the psychosocial, medical and the financial requirements of the patients. The community care utilizes a wider range of the social and medical support personnel which includes the physicians, pharmacists, nurses, social workers, dieticians and others to facilitating transition from the inpatient acute care to the long term management of the disease (Blackwood, Albarran, & Latour, 2010). Sleep apnea is very harmful and dangerous as if it is untreated, may lead to very high blood pressure plus is also closely associated with an increased possibility of abnormal heart rhythms, heart attack, and also heart failures (LAM, MAK and IP, 2012).

The community care supported the treatment with the intravenous antibiotics, and was placed on the reduced salt with low-calorie diet; in support to this he was also given complete physical therapy. The community care will also focus on the social behavior, exercise with healthy diet and complete sleeps are considered as vital to lose weight (Hooper, 2010). As OHS may be brought into use for the treatment of the hilarious health problems, thus at times surgery is also required (e.g. gastric surgery) to assist with the weight loss. Serious obesity is also refractory to the flooding management with and also without the drug or the behavioral therapies; thus in such cases, the bariatric surgery has been considered to be the best and also the most effective modality of durable and reliable treatment refer the severe obesity (Dongelmans and Schultz, 2010). The main decision to referring the patients for proper bariatric surgery at times is not at all easy as such patients do suffer at the exact same time from the important comorbid illnesses thus keeping them at much comparative higher risk for any kind of general anesthesia plus the postoperative complications (Dongelmans and Schultz, 2010). As per the guidelines which have been issued by National Institutes of Health, all of the patients with a BMI that is comparatively higher than around 35kg/m² plus an obesity that is related to the comorbid condition or such patients having BMI even greater than 40kg/m² may be referred to some special kind of surgical treatment (Dongelmans and Schultz, 2010).

To properly treat the breathing disorder, one probably may require a (PAP) which stand for the positive airway pressure support that is explained in the ATS series on patient n the Obstructive Sleep Apnea refer grownups. The kinds of the positive airway pressure assistance include the (CPAP) that is Continuous PAP or the (BPAP) Bi-level PAP (Gylen, Anttalainen and Saaresranta, 2014).

These both are devices which deliver air to Michael through a mask which she wears anytime while sleeping or even at the time of napping. Continuous PAP delivers the air at a continuous pressure at times when you breathe out and also when you breathe in (Blackstone, 2006).

The BPAP, on the contrary, delivers much higher pressures when one breathes in, in comparison to when you breathes out. When the OSA is higher/severe, and is uncontrollable even with the PAP, a surgical hole in the back of the neck might be required to make sure that your sleep apnea is properly and completed treated (Gylen, Anttalainen and Saaresranta, 2014). In the health care of the Michael, the rationale is the continuous improvement with the long-term utilization of the PAP relics to be speculative and not active for acting via numerous mechanisms which ultimately leads to the daytime symptoms and improved nocturnal (Avram, 2002).

Michael for the successful treatment of the syndrome is with the bi-level PAP system with decrease in weight. As increased weight is one of the major reasons for diabetes and sleep apnoea and can be cared to the great extent with the weight loss. Hence the priority of the care system is to regulate the diet of Michael with intake of rich protein and fewer calories. He is to be motivated towards such diet and physical exercises with the regular watch. The community caretaker must weigh the Michael body weight at regular intervals and motivate him for the reduction (Avram, 2002). The other care which is to observe in Michael is to deal with the sleep apnea which results in the breathing issue and is treated with the CPAP and the bi-level PAP which will allow the independent adjustment of the expiratory and the aspiratory PAP and is proved to be equivalent effective to improve the daytime hypercapnia (Avram, 2002).  Hence, the proper care with routine medication will help Michael to improve his health and will result to live his routine life healthily.

Avram, A. (2002). Case Study: Necrotizing Fasciitis in a Patient With Obesity and Poorly Controlled Type 2 Diabetes. Clinical Diabetes, 20(4), 198-200.

Blackstone, R. (2006). Implications of the Medicare National Coverage Decision for Bariatric Surgery for Treatment of Morbid Obesity. Bariatric Nursing And Surgical Patient Care, 1(3), 151-155.

Blackwood, B., Albarran, J., & Latour, J. (2010). Research priorities of adult intensive care nurses in 20 European countries: a Delphi study. Journal Of Advanced Nursing, 67(3), 550-562.

Dongelmans, D., & Schultz, M. (2010). Adaptive Support Ventilation: An Inappropriate Mechanical Ventilation Strategy for Acute Respiratory Distress Syndrome?. Anesthesiology, 112(5), 1295.

Gylen, E., Anttalainen, U., & Saaresranta, T. (2014). Relationship between habitual sleep duration, obesity and depressive symptoms in patients with sleep apnoea. Obesity Research & Clinical Practice, 8(5), e459-e465.

Hooper, V. (2010). National Priorities Partnership: Palliative and End-of-Life Care. Journal Of Perianesthesia Nursing, 25(2), 135-136.

Lam, j., Mak, j., & Ip, M. (2012). Obesity, obstructive sleep apnoea and metabolic syndrome. Respirology, 17(2), 223-236.

Leader, N., Ryan, L., Molyneaux, L., & Yue, D. (2013). How best to use partial meal replacement in managing overweight or obese patients with poorly controlled type 2 diabetes. Obesity, 21(2), 251-253.

Madigan, E., & Vanderboom, C. (2005). Home health care nursing research priorities. Applied Nursing Research, 18(4), 221-225.

Ramelet, A., & Gill, F. (2012). A Delphi study on National PICU nursing research priorities in Australia and New Zealand. Australian Critical Care, 25(1), 41-57.

Rhodes, E., & Fleischman,. (2009). Management of obesity, insulin resistance and type 2 diabetes in children: consensus and controversy. Diabetes, Metabolic Syndrome And Obesity: Targets And Therapy, 185.

Riha, R. (2009). Genetic Aspects of the Obstructive Sleep Apnoea/Hypopnoea Syndrome – Is There a Common Link with Obesity?. Respiration, 78(1), 5-17.

Wilson, S., Ramelet, A., & Zuiderduyn, S. (2010). Research priorities for nursing care of infants, children and adolescents: a West Australian Delphi study. Journal Of Clinical Nursing, 19(13-14), 1919-1928.

You, E., Dunt, D., & Doyle, C. (2015). How would case managers’ practice change in a consumer-directed care environment in Australia?. Health & Social Care In The Community, 25(1), 255-265.

You, E., Dunt, D., & Doyle, C. (2015). What is the role of a case manager in community aged care? A qualitative study in Australia. Health & Social Care In The Community, 24(4), 495-506.