Case Study: Mr. C.
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
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.
- 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.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Case Study of Mr. C
Chronic diseases constitute the biggest causes of death for ageing individuals in the US and in the rest of the world. According to Textor (2017), they not only cause disability and death, but also lead to high expenditures in healthcare amounting to $3.8 trillion every year. In the case of Mr. C, a 32-year-old male patient who is single, he shows symptoms that suggest the presence of hypertension and obesity. A journey through the management of the condition helps to suggest the best action for any patient faced with a situation similar to that of Mr. C.
The objective data for Mr. C shows he has a moderately high bp, 3+ pitting edema in ankles and bilateral feet, cholesterol of 250,,/dL which is above the normal range of 200-239, BUN of 32mg/dl, which is also above the normal range of 7-20, and elevated serum creatinine of 1.8mg/dl (normal range is 0.74-1.35) (Textor, 2017). The client also showed the presence of weight management problems, and he has gained 100 pounds in 2-3 years and has always been heavy even as a child. Besides, he has shortness of breath when he does activities, sleep apnea, and has been trying to manage pruritus for the past six months. The VS include Height: 68 inches; weight 134.5 kg, BP: 172/98, and HR 88, RR 26. The fasting blood glugose is 146mg/dl, the total cholesterol 250mg/dl, and the triglycerides amount to 312mg/dl.
Obesity Potential Health Risk
The presence of unstable levels of blood sugar is one of the key potential risks of obesity. For Mr. C, the primary risk factors is having too high levels of LDL, which shows that the body is not able to metabolize fat efficiently, and storage in the adipose tissues may result in excesses that cause obesity. Being overweight or obese can then serve as a primary cause of other conditions including but not limited to cardiovascular disorders, arthritis, and anxiety (Celano et al., 2018).
Functional Health Patterns
The occupation of Mr. C as a telephone attendant may be one of the causes of his obesity, because it is likely that he spends much of his work time dormant, and he does not exercise at all to keep fit. It could also be due to genetic factors as Mr. C says that he has been feeling overweight since a young age. Another potential problem that may account for the health behavior and characteristics of Mr. C. is the presence of poor nutrition, which could result in defective metabolism. Also, at 32, he should possibly be having a girlfriend or a partner who would provide him with the necessary support when he encounters problems managing his illness. A partner could also help him become consistent in the medication by reminding him about some of the dosages that he could forget. Lastly, with a partner, he is more likely to efficiently cope with stress that is associated with the overweight problem, reducing the chances of other conditions.
The subjective data shows that Mr. C. is fully aware of his overweight problem and he asks if it is possible for him to have bariatric surgery. This option is always a hard one for the obese patients as it entails sacrificing a lot including behavior wise, health wise, and financial wise. Mr.’ C’s suffering from hypertension requires him to adjust his dietary consumption so as to include less sodium rich foods (Benjamin et al., 2019). A major challenge that he encounters is the fact that he is not well informed about his metabolic disease, whether it is diarrhea or constipation that is troubling him, and this also creates a challenge for him when deciding about dietary modification.
Mr. C should go for bariatric surgery at this time because it is likely to health him recover some of the primary symptoms of obesity. There are other interventions that could be applied to minimize the side effects of bariatric surgery, but the fact that the condition has already spread extensively means that the most appropriate intervention is the surgery (English et al., 2018).
End Stage Renal Disease, ESRD, is the last of the five stages of chronic kidney disease. At this point, the functioning of the kidney is 10-15%. Patients at this stage could encounter hard time removing waste in form of urine.
ESRD Contributing Factors and Prevention
The main contributing factor for ESRD is too low glucose levels. Patients who have abnormal blood pressure could also have ESRD because the blood is not able to filter efficiently in the glomerulus at the normal pressure (McCullough et al., 2019). The prevention of this condition is through early detection through screening and providing timely treatment.
Resources for ESRD
The patients of ESRD could opt for kidney dialysis where they improve the functioning of the kidney, and the process of filtration of blood is aided by machines. Unfortunately, there are diverse negative impacts of dialysis (Bowe et al., 2018). Other resources include the American Kidney Fund and Life rehabilitation options.
The management of Mr. C’s condition is best done by using bariatric surgery, which would be faster and more effective than other methods such as dietary change. Hypertension and high blood sugars are among the potential health risks that could make him have ESRD. However, proper utilization of the available resources could help promote his smooth recovery.
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528. https://doi.org/10.1161/CIR.0000000000000659
Bowe, B., Xie, Y., Li, T., Yan, Y., Xian, H., & Al-Aly, Z. (2018). Particulate matter air pollution and the risk of incident CKD and progression to ESRD. Journal of the American Society of Nephrology, 29(1), 218-230. https://www.medical.theclinics.com/article/S0025-7125(16)37329-1/fulltext
Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018). Depression and anxiety in heart failure: a review. Harvard review of psychiatry, 26(4), 175. DOI: 10.1097/HRP.0000000000000162
English, W. J., DeMaria, E. J., Brethauer, S. A., Mattar, S. G., Rosenthal, R. J., & Morton, J. M. (2018). American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surgery for Obesity and Related Diseases, 14(3), 259-263. https://doi.org/10.1016/j.soard.2017.12.013
McCullough, K. P., Morgenstern, H., Saran, R., Herman, W. H., & Robinson, B. M. (2019). Projecting ESRD incidence and prevalence in the United States through 2030. Journal of the American Society of Nephrology, 30(1), 127-135. https://doi.org/10.1681/ASN.2018050531
Textor, S. C. (2017). Renal arterial disease and hypertension. Medical Clinics, 101(1), 65-79. https://www.medical.theclinics.com/article/S0025-7125(16)37329-1/fulltext