Case Study: Mr. C.
Describe the Clinical Manifestations Present In Mr. C
Mr. C presented with complaints of increasing shortness of breath on exertion, swollen ankles, and pruritus for 6 months. He also complained of sleep apnea and increased blood pressure, which he reports he tries controlling by restricting dietary sodium intake. Additionally, he complains of unintentional and worrying weight gain, having gained around 100 pounds over the last 2 to 3 years. The obesity is worrying, which forces him to present to the clinic to inquire about bariatric surgery as an intervention for his obesity.
Potential Health Risks for Obesity That Are Of Concern for Mr. C
Obesity most often is regarded as a serious health concern since it predisposes one to increased risks of developing other potentially life-threatening conditions (Upadhyay et al., 2018). Mr. C is typically obese, which could pose significant risks to his health, some of which are currently present in his clinical presentation. He is currently experiencing sleep apnea, which is a result of obesity. Additionally, he reports having been diagnosed with hypertension, which obesity increases the risk of its development. The other health risk that is of concern to Mr. C is the development of diabetes, with the current sugar levels indicating an increased glucose level in the blood. There is also the risk of hypercholesterolemia and elevated triglycerides increased risks of developing heart problems, some types of cancers, psychological issues, low quality of life, and generally, an increased mortality rate.
Bariatric surgery is a medical procedure used in the treatment of obesity. It involves reducing the stomach size by removing a part of it, reducing food consumption, and subsequent weight loss (Upadhyay et al., 2018). This procedure is indicated for 80-100 pounds patients, overweight or obese, or those with a BMI greater than 35. This indication applies to Mr. C, thus making him an appropriate candidate for this procedure. The other indication is the age range between 14 to 75 years, which Mr. C falls within. The remaining criteria are to perform a mental assessment to ensure that the patient is motivated, has realistic expectations, and is mentally capable of making such decisions. He also needs to be informed more regarding the procedure to understand both the benefits and the risks involved with the surgery.
Discuss At Least Five Actual or Potential Problems Can You Identify From the Functional Health Patterns and Provide the Rationale for Each
According to Mr. C’s health information, various functional health patterns can be derived and used to plan the patient’s management to help him achieve better health outcomes. Some of the actual problems that can be identified include; elevated blood pressure or hypertension. His blood pressure is 172/98mmHg, higher than the upper limit of 140/90mmHg, above which one is considered hypertensive. The other health problem is elevated blood sugars since the patient’s fasting blood glucose is 146 mg/dL, above the normal range. A diagnosis of diabetes is made when an individual’s fasting blood glucose is above 126 mg/dL. The results for Mr. C could suggest that he is diabetic or prediabetic. Diabetes increases one’s risk of developing potential health problems such as kidney diseases (Fikriana & Devy, 2018). However, further tests and investigations are required to make a definitive diagnosis.
The other health problem is the elevated cholesterol and triglyceride levels obtained. His total cholesterol is at 250mg/dl, which is higher than the normal range, a maximum of 200mg/dL, thereby indicating that the patient is also having issues with his cholesterol levels. His triglyceride level is 312mg/dL, which is high above the recommended range of 150mg/dL, indicating that the patient has abnormal cholesterol levels. The latter two predispose the patient to other potential health problems such as heart attack, stroke, and coronary artery diseases (Fikriana & Devy, 2018). Lastly, the other problem identified from Mr. C’s functional health pattern is sleep apnea, which is highly likely to occur in obese patients.
It is essential to consider various aspects while assessing Mr. C’s functional health patterns. These include Health – Perception – Health – Management, which helps identify the potential risks of the condition on the patient’s health and then develops a management plan such as education on lifestyle modification to help prevent such potential risks (Fikriana & Devy, 2018). The other crucial aspect of being considered is the nutritional-metabolic, which ensures that he takes a healthy diet that helps in weight control. Considering the elimination aspect would enable the patient to understand the type of food and drinks necessary to enhance bowel movement to promote elimination. Other aspects necessary during the assessment include; activity and exercise, sleep-rest, cognitive-perceptual, self-perception, role-relationship, sexuality, and coping-stress tolerance.
Staging Of End-Stage Renal Disease (ESRD) and Contributing Factors to Consider
Chronic kidney disease refers to the gradual loss of kidney function, which progresses to ESRD which often requires regular dialysis or kidney transplant. Kidney disease occurs in five stages, categorized based on the glomerular filtration rate (GFR). ESRD occurs when the kidney function falls below 10% of its normal functioning, with a significant decline in the GFR (Kelly et al., 2017). Various contributing faces increase one’s risk of developing ESRD, including hypertension, diabetes, smoking, drug use, weight, age, gender, race, and proteinuria, among others.
ESRD Prevention and Health Promotion Opportunities
There is no definitive cure for ESRD. The management often involves dialysis or kidney transplant, as aforementioned. ESRD prevention in a high-risk patient involves proper control of the preexisting conditions, for instance, diabetes or hypertension, to prevent its progression to the development of ESRD (Kelly et al., 2017). Mr. C is at a high risk of developing kidney issues; thus, he should be advised to avert this. He should be advised to adhere to the prescribed medications and any procedures such as dialysis to prevent the accumulation of metabolic wastes, which may pose a significant risk to his health. Additionally, he should be advised on an appropriate and healthy diet and the need to exercise regularly, as these will help prevent the development of complications and even death.
Type of Resources Available For ESRD Patients for Non-acute Care and the Type of Multidisciplinary Approach
Various resources are available for ESRD patients. These include; support groups and multidisciplinary care with physicians and other healthcare providers such as dieticians, emergency resources, and nephrologists. These professionals are crucial in care provision to promote better patient health outcomes (Kelly et al., 2017). Other resources such as transportation, devices, and living conditions for these patients can be provided through the collaboration with the social workers who will ensure that patients have access to various community services and address any barriers that may hinder such accessibility.
References
Fikriana, R., & Devy, S. R. (2018). The Effects of Age and Body Mass Index on Blood Glucose, Blood Cholesterol, and Blood Pressure in Adult Women. Indian Journal of Public Health Research & Development, 9(11), 1697-1702. http://repository.unair.ac.id/105482/
Kelly, J. T., Palmer, S. C., Wai, S. N., Ruospo, M., Carrero, J. J., Campbell, K. L., & Strippoli, G. F. (2017). Healthy dietary patterns and risk of mortality and ESRD in CKD: a meta-analysis of cohort studies. Clinical Journal of the American Society of Nephrology, 12(2), 272-279. https://cjasn.asnjournals.org/content/12/2/272?utm_campaign=TMDPC&WT.MC_ID=TMDPC&utm_medium=cpc&utm_source=TrendMD
Upadhyay, J., Farr, O., Perakakis, N., Ghaly, W., & Mantzoros, C. (2018). Obesity is a disease. Medical Clinics, 102(1), 13-33. https://www.medical.theclinics.com/article/S0025-7125(17)30128-1/abstract
question:
An RN-BSN-prepared nurse must demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mr. C., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. C., a 32-year-old single male, is seeking the information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.
Objective Data:
Height: 68 inches; weight 134.5 kg
BP: 172/98, HR 88, RR 26
3+ pitting edema bilateral feet and ankles
Fasting blood glucose: 146 mg/dL
Total cholesterol: 250 mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Serum creatinine 1.8 mg/dL
BUN 32 mg/dl
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:
Describe the clinical manifestations present in Mr. C.
Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric before beginning the assignment to become familiar with the expectations for successful completion.
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