Describe the clinical manifestations present in Mr. C.
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.
Expert Answer and Explanation
Assessment of Elimination Complexities
Elimination is an important physiological process in which one eliminates wastes from their body system through urination, sweating or excretion. The process helps ensure that the harmful waste products are discharged from the body to prevent these products from interfering with the normal function of the body. The accumulation of the toxins in the body can alter the way the body functions and make one more susceptible to certain kinds of diseases including cancer. This is because it causes the energy production to fail by limiting the manufacturer of hemoglobin (Khatiban, Tohidi, & Shahdoust, 2019). When working with a patient with elimination problems, RN-BSN prepared nurse should conduct comprehensive clinical assessment to understand the underlying cause of such problems, and the impact of the same on the patient’s wellbeing as explored in this study.
Clinical Manifestation seen in Mr. C.
There are a number of clinical manifestations seen with Mr. C. Swollen ankles is an example of such symptoms, and this is possibly due to edema. In addition, he has breathing problems, and this could be a sign of an underlying cardiorespiratory issue. The blood pressure reading for Mr. C. is 172/98. This is above the normal range, and he is therefore hypertensive (Narva, Norton, & Boulware, 2016). Other manifestations for the patient include itching of the skin and elimination challenges.
Potential Health Risks for Obesity which are of Concern for Mr. C.
Mr. C., based on his weight and height, is obese, and because of his excessive weight, he is at risk of developing various illnesses. Because of his weight, he is pre-diabetic, and this puts him risk of type-2 diabetes. Stroke is another risk linked to obesity, and if Mr. C. does not manage his weight, he may be affected by stroke. The risk of elevated blood pressure is equally high for this patient. When one is overweight, their heart does much more work, and the increase in the heart’s workload is what may cause the patient to become hypertensive (Queeley & Campbell, 2018).
Whether Bariatric Surgery is Appropriate for Mr. C.
Bariatric surgery is the appropriate intervention for Mr. C. given his weight. This procedure involves performing a surgical operation on the patient’s gastrointestinal tract to help change his energy balance by increasing the metabolism of fat. This intervention is usually used where the patient has limited chances of reducing their weight through the normal process of exercise and diet (Queeley & Campbell, 2018).
Assessment of Functional Health Patterns
Mr. C., tries to limit the amount of salt he takes, and this is because he understands the link between salt intake and hypertension. He is cognitively aware considering that he is sound in terms of the way he answers questions. His relationship status seems to have negative impact on his functional health, and given his ESRD, he has elimination issues. Being alone means he has no one to share his problems with, and the stressors can psychologically affect him emotionally and psychologically (Richards et al., 2018). Furthermore, he scores poorly when it comes to activity-exercise considering the nature of his job.
Staging of End-Stage Renal Disease and Contributing Factors
A normal kidney is expected to perform a certain amount of work, and when measuring the amount of work the kidney can perform, providers usually employ the Glomerular Filtration Rate (GER). This method can be used during the staging of the ESRD to help gain insight into how much the disease has affected the kidney. During the 4th stage of the disease, the GFR is within the range 15%-30%, and it is when one’s hands of feet may swell. They may also experience back pain, and reduced frequency of urination. Vomiting is another symptom linked to stage four of the disease (Carbone et al., 2019).
Health Education for Mr. C.
Health education can provide significant benefits to the patient, and the goal of educating him is to empower him with information on how he can attain and sustain optimal health. When educating Mr. C., diet and physical activity should be emphasized. The goal is to help him be aware of the foods which if he eats, can help him manage his weight. Health education should also focus on educating the patient about physical activity with focus on the different types of physical exercise, and frequency of the exercise. Besides education, the patient may benefit from kidney replacement in which he receives a healthy kidney (Fraser & Blakeman, 2016).
The Type of Resources which are available for ESRD Patients
Mr. C. and ESRD patients in general can benefit from various resources. The American Diabetes Association publishes articles on its website platform. These resources can help inform ESRD patients about the foods which are good for kidney health, and those that can affect the health of the kidney. The American Heart Association’s website equally has resources which can benefit people who need to understand the risks of ESRD, and how such risks can be managed (Fraser & Blakeman, 2016). Besides these resources, library resources can be a source of information for those who want to learn about ESRD.
In conclusion, the elimination complexities linked to ESRD can have physiological and psychological health of the patient, and it is imperative that the provider assess the needs of the patient, and come up with appropriate intervention to holistically address the needs of these patients. Clinical assessment for a patient with ESRD should include determining the stage of the disease to help inform treatment decisions.
Carbone, S., Canada, J. M., Billingsley, H. E., Siddiqui, M. S., Elagizi, A., & Lavie, C. J. (2019). Obesity paradox in cardiovascular disease: where do we stand?. Vascular health and risk management, 15, 89–100.Doi: https://doi.org/10.2147/VHRM.S168946.
Fraser, S. D., & Blakeman, T. (2016). Chronic kidney disease: identification and management in primary care. Pragmatic and observational research, 7, 21–32.Doi: https://doi.org/10.2147/POR.S97310.
Khatiban, M., Tohidi, S., & Shahdoust, M. (2019). The effects of applying an assessment form based on the health functional patterns on nursing student’s attitude and skills in developing the nursing process. International journal of nursing sciences, 6(3), 329–333. Doi:https://doi.org/10.1016/j.ijnss.2019.06.004.
Narva, A. S., Norton, J. M., & Boulware, L. E. (2016). Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care. Clinical journal of the American Society of Nephrology : CJASN, 11(4), 694–703. Doi:https://doi.org/10.2215/CJN.07680715.
Queeley, G. L., & Campbell, E. S. (2018). Comparing Treatment Modalities for End-Stage Renal Disease: A Meta-Analysis. American health & drug benefits, 11(3), 118–127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973249/.
Richards, D. A., Hilli, A., Pentecost, C., Goodwin, V. A., & Frost, J. (2018). Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene. Journal of clinical nursing, 27(11-12), 2179–2188. Doi: https://doi.org/10.1111/jocn.14150.
[ANSWERED] Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable).