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.
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Expert Answer and Explanation
Pathophysiological Process of Obesity and End-Stage Renal Disease
Understanding the pathophysiology of diseases can help advanced practice nurses provide quality and safe care to their patients. Pathophysiology studies how a disease or abnormal condition has caused disturbance of normal physical, biochemical, or mechanical functions. In other words, the pathophysiology of the body is the abnormal changes in the body functions caused by a disease (Wishart, 2019). An advanced care nurse can understand the causes, symptoms, and risk factors by studying its pathophysiology. In this paper, an understanding of the pathophysiological processes of a disease has been used to evaluate the medical and health history data of Mr. C, and a plan of care has been developed based on this information.
Clinical manifestations are presenting symptoms and signs of disease. The clinical manifestations present in the patient include obesity, increasing body weight, high blood pressure, sleep apnea, swollen ankles, increasing shortness of breath after engaging in an activity, and pruritus in the last six months. Inspection shows that the patient’s feet and ankles are swollen. The patient’s fasting blood glucose is also high.
Health Risks for Obesity and Appropriateness of Bariatric Surgery
Obesity is a risk factor for many health problems. One of the potential health risks of obesity is strokes and heart disease. Obesity puts the patient at risk of developing heart problems such as arrhythmias, stroke, coronary heart disease, and heart attacks (Powell-Wiley et al., 2021). The patient already has hypertension, a problem that can lead to heart attacks. He also risks developing type two diabetes by affecting how insulin is used or produced in the body. Third, obesity puts the patient at risk of developing cancers such as rectum, colon, breast, kidney, or pancreatic cancers (Arterburn et al., 2020). The patient also risks developing digestive problems. The patient already has sleep apnea which is caused by obesity. Obesity puts excess weight on the patient’s joints, making him more vulnerable to osteoarthritis. Lastly, if the patient contracts Covid-19 while obese, he risks suffering severe covid-19 symptoms. Bariatric surgery is appropriate for this patient. His BMI is 45, and hospital equipment can accommodate his weight. His BMI puts him at high risk of suffering the mentioned diseases.
Functional Health Patterns
The patient has sleep apnea. This problem has been identified using a sleep-rest pattern. The patient describes that he has a problem sleeping. Second, the patient has an activity-exercise problem. He says that she experiences shortness of breath during physical activity. Third, he also has a swollen ankle that can prevent him from engaging in physical exercises. Fourth, using a health-perception-health-management pattern, it has been found that the patient has been having weight problems. For instance, he gained 100 pounds in 2-3 years. Fifth, the potential problem I can identify using self-perception/self-concept is that the patient has problems with his image. Most patients with obesity often have a negative image of themselves are often ashamed of their body shape.
Staging of End-Stage Renal Disease (ESRD) and Contributing Factors
End-stage renal disease (ESRD) is the permanent and final stage of chronic kidney disease (CKD), where the kidneys cannot function or have declined. Individuals with ESRD must undergo dialysis to help remove waste from their blood or kidney transplant. Many factors can lead to ESRD. The factors include drug abuse, heart diseases such as vesicoureteral disease, high blood pressure, kidney infections, diabetes, family history of the disease, blockages in the urinary tract, old age, tobacco use, being black, Pacific Islander, American Indian, Hispanic, or Hispanic, some genetic disorders, and inflammation. Patients with CKD who are not managing it properly also risk developing ESRD.
ESRD Prevention and Health Promotion
One of the ways to prevent ESRD is a healthy weight. One should ensure that they have a healthy weight to prevent the disease. The second way is engaging in physical activities for most of the days (Oliveira et al., 2020). Third, ESRD can be prevented by eating a balanced diet with low sodium foods. The fourth way of preventing the disease is controlling blood sugar. A person with kidney problems should take medications as directed by their physician to prevent ESRD. Other ways to prevent the disease include getting regular checkups, smoking, and checking cholesterol levels and blood sugar. Mr. C should engage in activities to achieve a healthy weight, such as eating healthy food and engaging in physical exercises.
One of the resources available for people with ESRD is Free Prescription Discount Card by the National Kidney Foundation. This card helps patients with the disease receive medications at an affordable price. The National Kidney Foundation also provides education and resources to help improve people’s health with ESRD. Patients with ESRD can also benefit from low housing rates. Low housing can help them save and use the money for kidney care (Novick et al., 2020). Patients with ESRD can also benefit from available and affordable ambulance services because they risk experiencing health emergencies. Hospitals should avail dialysis devices for these patients because they always need one. Their employers can support them by having a policy that protects them from being fired for frequent sickness.
Mr. C should go for bariatric surgery to help him achieve a healthy weight. At the moment, he risks suffering many diseases due to obesity. After the surgery, he should engage in physical activity and healthy eating to maintain his weight.
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. https://jamanetwork.com/journals/jama/article-abstract/2770015
Novick, T. K., Omenyi, C., Han, D., Zonderman, A. B., Evans, M. K., & Crews, D. C. (2020). Housing insecurity and risk of adverse kidney outcomes. Kidney360, 10-34067. https://doi.org/10.34067/KID.0000032019
Oliveira, L. M., Sari, D., Schöffer, C., Santi, S. S., Antoniazzi, R. P., & Zanatta, F. B. (2020). Periodontitis is associated with oral health‐related quality of life in individuals with end‐stage renal disease. Journal of Clinical Periodontology, 47(3), 319-329. https://doi.org/10.1111/jcpe.13233
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J. P., Gordon-Larsen, P., Lavie, C. J., … & American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. (2021). Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 143(21), e984-e1010. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000973
Wishart, D. S. (2019). Metabolomics for investigating physiological and pathophysiological processes. Physiological Reviews, 99(4), 1819-1875. https://doi.org/10.1152/physrev.00035.2018
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