Assignment Prompt
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: 1. Height: 68 inches; weight 134.5 kg 2. BP: 172/98, HR 88, RR 26 3. 3+ pitting edema bilateral feet and ankles 4. Fasting blood glucose: 146 mg/dL 5. Total cholesterol: 250 mg/dL 6. Triglycerides: 312 mg/dL 7. HDL: 30 mg/dL 8. Serum creatinine 1.8 mg/dL 9. 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: 1. Describe the subjective and objective clinical manifestations present in Mr. C. 2. Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention. 3. Assess each of Mr. C.'s functional health patterns using the information given. Discuss at least five actual or potential problems you can 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.) 4. Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C's ESRD? 5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status. 6. 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. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
Introduction
The patient in question is a 32-year-old single male who works at the catalog telephone center. He reports having extra weight since he was a child and in the past 2 to 3 years, he has gained approximately 100 pounds. This paper discusses the clinical manifestation of the patent potential health risks of obesity and the need for bariatric surgery, functional health patterns, staging of ESRD, health promotion, and resources for ESRD patients.
Clinical Manifestations Present in Mr. C
Subjective clinical manifestations are reported by the patients and the objective data is derived from the objective data. On reporting to the facility, Mr. C reports a history of obesity and gives previous reports on medical evaluations in the past. He reports sleep apnea and hypertension that he controls by restricting their intake of sodium. The patient also reports an increase in shortness of breath when participating in physical activity, pruritus, and swollen ankles in the past 6 months. Laboratory examination reveals that he has 3+ bilateral pitting edema, a fasting blood sugar of 146 mg/dL this is an indication of diabetes, elevated cholesterol of 250 mg/dL, triglycerides level at 312 mg/dL, Serum creatinine of 1.8 mg/dL, BUN 32 mg/dl and HDL of 30 mg/dL.
Potential Health Risks for Obesity and Bariatric Surgery
There are various risk factors for obesity that are present in Mr. C. The risk factors include sleep apnea, hypertension, diabetes, and high levels of lipids. The patient works at a catalog telephone center and he engages in minimal physical activities. Obesity increases the risk of cardiovascular diseases, gall bladder disease, stroke, and psychological issues such as anxiety and depression (Piché et al., 2020). Bariatric surgery is necessary for the patient to reduce his body farts and reduce the symptoms of sleep apnea. He is also experiencing a high BMI and hypertension and this makes him a viable candidate for the surgery.
Functional Health Patterns
There are various problems that I can identify from the functional health patterns of the patient. He is experiencing a problem with his health perception due to his weight as since he was a child, he was a heavy child. Currently, he has gained over 100 pounds and this can be attributed to his sedentary lifestyle. Mr. C. is experiencing problems with his nutrition and this is evidenced by the patient's high cholesterol levels. The patient is experiencing a problem in the functional health pattern of sleep. He is experiencing sleep apnea due to his shortness of breath. Another problem that the patient is experiencing with the activity exercise is that the patient is not engaging in any physical activity due to his place of work. The patient is likely to have a problem in his elimination due to his BUN and creatinine levels.
Staging and Contributing Factors of End-Stage Renal Disease (ESRD)
ESRD results from the loss of functioning of the kidneys. Some of the contributing factors to ESRD are; hypertension, diabetes, and obesity. The first stage of ESRD is characterized by damaged lungs and a GFR of more than 90ml/min (Hashmi et al., 2023). The second stage is evidenced by a mild reduction in GFR to 60-19 ml/min and in stage 3, there is a moderate reduction of the GFR from 30 to 44 ml/min. Stage 4 of ESRD is exhibited by a severe reduction of GFR that ranges from 15 to 29 ml/min and stage 5 is characterized by complete renal failure to less than 15 ml/min/ (Hashmi et al., 2023).
Health Promotion and Prevention Opportunities for ESRD
Health promotion of ESRD would involve engaging in physical activities, reducing weight, control of hypertension, and consumption of high nutritious foods. It is also essential to seek medical interventions that are necessary for reducing serum creatinine and BUN levels that are leading contributors to damage to kidneys. It will be necessary for the patient to engage in activities necessary to maintain a healthy weight even after undergoing bariatric surgery.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
There are various resources that improve social functioning and the quality of life for patients living with ESRD. There are transportation resources available for ESRD patients as they need to attend dialysis as often as three times a week (Varghese, 2020). The financing of the care of ESRD patients is done through resources such as state and federal programs, private organizations, federal government health insurance, and private organizations among other resources.
Conclusion
Mr. C. is experiencing problems in weight and he is experiencing problems in the functional health patterns. He has a problem with his nutrition as his diet is contributing to high cholesterol levels in the body, he engages in little physical activity, is experiencing sleep apnea, is likely to experience problems in elimination, and is experiencing weight gain. The patient would require bariatric surgery to maintain his weight.
References
- Hashmi, M. F., Benjamin, O., & Lappin, S. L. (2023). End-stage renal disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499861/
- Piché, M. E., Tchernof, A., & Després, J. P. (2020). Obesity phenotypes, diabetes, and cardiovascular diseases. Circulation research, 126(11), 1477-1500. https://www.ahajournals.org/doi/abs/10.1161/CIRCRESAHA.120.316101
- Varghese, S. A. (2020). Barriers to Transportation: A Study on Patients with End-Stage Renal Disease Receiving in-Center Hemodialysis. Journal of Social Service Research, 46(6), 801-812. https://www.tandfonline.com/doi/abs/10.1080/01488376.2019.1666080