Nursing

It is necessary for an RN-BSN-prepared nurse to 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 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 to 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 prior to beginning the assignment to become familiar with the expectations for successful completion.

ANSWER

Mr. C Case Study

Introduction

Disease prevention and health promotion relies on understanding the psychological and biological abnormalities and physical result of some kind of infection or illness.  The clinicians rely on clinical manifestations, pathophysiological processes of a disease to interpret the condition of the patient before they can completely describe the signs and symptoms as well as the treatment.  This paper will evaluate the medical information and health history for Mr. Critically evaluate potential diagnosis and interventions for his condition.

Clinical manifestations

Mr. C is a 32 year old single male who has been enquiring about bariatric surgery for his obesity. He is currently working at a catalog telephone center. He says that since his childhood, he has been heavy and has gained approximately 100 pounds for the last 2-3 years. His past medical examinations have not presented any metabolic diseases but has high blood pressure and sleep apnea. Mr. C complains of swollen ankles, increased shortness of breath while doing activities and pruritus over the last six months.

The objective records show that Mr. C is 134.5 kg, 68 inches, HR 88, RR 26, triglycerides of 312 mg/dL, serum creatinine 1.8 mg/dL, fasting blood glucose is 146 mg/dL, HDL 30 mg/dL, and a BUN of 32 mg/dL, total cholesterol of 250 mg/dL, and 3+ pitting edema bilateral feet and ankles. Mr. C BMI is 47.9 which puts him at a greater risk of coronary disease, hypertension, and type 2 diabetes. The vital signs have indicate increased heart rate, blood pressure and respirations which means that he is at the second stage of hypertension. However, he claims to control it through sodium dietary restriction.

Potential Health Risks of Obesity and Bariatric Surgery Intervention

Obesity is a combination of different individual factors such as genetics, and behavior. (Manna and Jain, 2015). An individual with obesity is at a higher risk of various health condition and many serious diseases. Mr. C’s condition puts him at potential health risk of sleep apnea high blood pressure, coronary heart disease, Type 2 diabetes and stroke. Bariatric surgery also considered as weight loss surgery is sometimes considered effective treatment for individuals with obesity (Arterburn, Telem, Kushner and Courcoulas, 2020). This entails significant weight loss and helping an individual to improve on their obesity linked health situations such as type 2 diabetes and high blood pressure.

A patient may qualify for bariatric surgery if the meet the following conditions inability to lose weight in the past, BMI above 35, two or more health risks such as hypertension, diabetes, heart disease or sleep apnea. BMI of 40 and above can lead to bariatric surgery with or without the health risks. Mr. C presents conditions that demand bariatric surgery such as high blood pressure, sleep apnea and BMI of 47.9.  Mr. C is psychologically prepared to undergo bariatric surgery to lose weight. He has obesity related condition and proves incapability to lose weight since he has gained a 100 pounds in the last 2-3 years. Considerably, bariatric surgery is aimed at reducing weight which will have a great impact on controlling the risks factors of hypertensions, sleep apnea, type 2 diabetes, and high blood pressure. Therefore, bariatric surgery will be an effective intervention to change Mr. C obese condition.

Potential and Actual Problems

The functional health patterns offer a holistic model for health assessment. These include health management, sleep/rest, cognitive-perception, metabolic, elimination, activity/exercise, nutritional, role relationship, self-perception, cognitive-perceptual, coping stress tolerance and sexuality. For his health perception, the wellbeing and pattern of Mr. C has many risk factors and serious complications linked to his disease process. For his nutritional-metabolic pattern, Mr. C needs a healthier diet which includes eliminating much sugar and sodium intake, eating foods rich in grains and fiber, high protein foods and vegetables to maintain his weight.

For the elimination functional health pattern, Mr. C needs to increase fiber and water intake to promote his voiding pattern. For his sleep/rest pattern, Mr. C has a sleeping disorder which is caused by obesity and excess weight. Eating health and more physical activities will help address the problem of sleep apnea. For his cognitive-perceptual pattern, he has been able to comprehend and rely on the sensory function and information. Therefore, he seeks to change his life through bariatric surgery which will reduce his weight.

For his self-perception, Mr. C is not reasonably satisfied with his current condition and demonstrates issues of physical dissatisfaction due to obesity. He clearly states that he needs bariatric surgery since her weight issues affect his social activities. For his relationship pattern, Mr. C does not show any significant support from friends, family or significant other. For sexuality, Mr. C has always perceived himself as being obese and overweight. For his coping stress tolerance, Mr. C has poor coping skills since he has been overweight since childhood.

Staging of end-stage renal disease (ESRD)

The end stage of the renal disease is considered as an irreversible condition where the kidney totally fails to work and toxins remain confined in the body (Dai, Golembiewska, Lindholm and Stenvinkel, 2017). The process begins with gradual loss of kidney function over time which then lead to permanent loss. The kidneys are unable to function at normal levels for the day to day activities which leads to the end stage renal disease. High blood pressure, Type 2 diabetes, kidney inflammation and kidney tubules, long obstruction of the urinary tract, and conditions such as kidney stones, Vesicoureteral reflux are some of the contributing factors that lead to the increase of the chronic kidney disease and likelihood of the end stage renal disease.

The end stage renal disease has no cure which means that Mr. C needs to consider health promotion and prevention. Healthy lifestyle education needs to be introduced to Mr. C since he has been struggling with blood pressure and body weight. Healthier diet, moderate physical exercise and weight reduction intervention will play an essential role in health restoration and prevent deterioration of to the end stage.

Resources of ESRD Patients for Nonacute Care and Multidisciplinary Approach

The resources available for patients include multidisciplinary approaches with dietitian, physician and other support groups. The support groups will enable the patient to interact with peer mentors who have a positive role model. Nephrologists and physicians will offer education about risk factors and ways to promote health. Dietitians can offer essential information about healthier eating and kidney friendly diet. The social workers for the patient will offer a person centered approach through improving the patient’s living condition and offering resources that meet the patients’ social, emotional and physical needs.

Conclusion

Mr. C’s case study has offered an overview of various disease process that are linked to his condition. Mr. C is seeking bariatric surgery but can start with exercise and weight management program before being eligible for bariatric surgery. There is need to manage his condition to prevent complications. Considerably, End Stage Renal Disease has no cure thus there need to manage the renal disease condition before it progress to Chronic kidney disease.

References

Arterburn, D. E., Telem, D. A., Kushner, R. F., & Courcoulas, A. P. (2020). Benefits and risks of bariatric surgery in adults: a review. Jama, 324(9), 879-887.

Dai, L., Golembiewska, E., Lindholm, B., & Stenvinkel, P. (2017). End-stage renal disease, inflammation and cardiovascular outcomes. Expanded Hemodialysis, 191, 32-43.

Manna, P., & Jain, S. K. (2015). Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: causes and therapeutic strategies. Metabolic syndrome and related disorders, 13(10), 423-444.