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.
Expert Solution Preview
Based on the information provided, Mr. C., a 32-year-old single male, is considering bariatric surgery for obesity. He has a history of gaining significant weight in the past few years and is currently experiencing symptoms such as shortness of breath with activity, swollen ankles, and pruritus. Objective data reveals a high body weight, elevated blood pressure, edema, high fasting blood glucose, high cholesterol, and impaired kidney function. In this critical thinking essay, we will evaluate Mr. C’s potential diagnosis and interventions, discuss the health risks associated with obesity, assess his functional health patterns, explain the staging of end-stage renal disease (ESRD), consider ESRD prevention and health promotion opportunities, and describe the resources available for ESRD patients.
1. Describe the clinical manifestations present in Mr. C.
Mr. C. presents with several clinical manifestations, including obesity, shortness of breath with activity, swollen ankles, pruritus, elevated blood pressure, and impaired kidney function. These manifestations may indicate underlying health conditions related to obesity, such as cardiovascular disease, sleep apnea, and renal dysfunction.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
The potential health risks for obesity that concern Mr. C. include cardiovascular disease, diabetes, sleep apnea, and renal dysfunction. Bariatric surgery may be an appropriate intervention for Mr. C. given his significant weight gain, inability to control his obesity-related health conditions through dietary restrictions, and the presence of obesity-related complications. However, a thorough evaluation of his overall health status, psychological readiness, and adherence to post-surgery lifestyle changes is necessary to determine the appropriateness of bariatric surgery as an 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.
a. Health-perception: Mr. C. may lack awareness of the negative consequences of his obesity on his overall health, as evidenced by a history of weight gain and previous evaluations not indicating any metabolic diseases. This can lead to delayed or inadequate health-seeking behaviors.
b. Nutritional: Mr. C.’s nutritional pattern is likely characterized by overeating, poor dietary choices, and excessive calorie intake, which contribute to obesity and associated complications such as diabetes and dyslipidemia.
c. Metabolic: Mr. C.’s metabolic pattern is disrupted, as indicated by elevated fasting blood glucose, high cholesterol, and impaired kidney function. These abnormalities are commonly observed in individuals with obesity and can lead to further health complications.
d. Activity-exercise: Mr. C.’s shortness of breath with activity suggests reduced exercise tolerance, potentially due to the excess body weight and associated cardiovascular strain. This can limit his physical activity, further contributing to weight gain and overall health decline.
e. Sleep-rest: Mr. C.’s symptoms of sleep apnea and pruritus indicate disrupted sleep patterns, which may be related to his obesity. Poor sleep quality can negatively impact overall functioning and exacerbate obesity-related health issues.
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
End-stage renal disease (ESRD) is the final stage of chronic kidney disease, characterized by permanent loss of kidney function. The staging of ESRD is based on the glomerular filtration rate (GFR) and ranges from stage 1 (mild kidney damage) to stage 5 (kidney failure). Contributing factors to consider in ESRD include the presence of underlying conditions such as diabetes, hypertension, and obesity, as well as genetic factors, lifestyle choices, and medication use.
5. 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.
ESRD prevention and health promotion opportunities for Mr. C. include lifestyle modifications, medication adherence, blood pressure and blood sugar control, and regular monitoring of kidney function. Patient education should focus on the importance of maintaining a healthy weight, following a balanced and low-sodium diet, engaging in regular physical activity, managing comorbid conditions, and adhering to prescribed medications. Additionally, Mr. C. should be educated about the significance of routine check-ups and monitoring kidney function to detect any deterioration early on.
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. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.
ESRD patients have access to various resources for nonacute care, including renal dieticians, social workers, support groups, and home health services. These resources can provide assistance in managing dietary restrictions, emotional support, financial counseling, and education regarding treatment options. A multidisciplinary approach involving nephrologists, dieticians, nurses, social workers, and psychologists is beneficial for addressing the complex needs of ESRD patients. This approach ensures comprehensive medical care, emotional support, and social services. Considering aspects such as assistive devices, transportation assistance, housing accommodations, and employment support is crucial in enhancing the overall well-being and quality of life for ESRD patients.
In conclusion, based on the evaluation of Mr. C.’s health history and medical information, it is evident that his obesity is associated with several health risks and complications. Bariatric surgery may be a suitable intervention for him, provided a comprehensive assessment is conducted. Mr. C. demonstrates functional health pattern disruptions, including inadequate health perception, poor nutritional habits, metabolic abnormalities, reduced activity tolerance, and disrupted sleep patterns. Early recognition and intervention are necessary to prevent further deterioration of renal function. ESRD prevention strategies and patient education should focus on lifestyle modifications, medication adherence, and regular monitoring. A multidisciplinary approach, coupled with available resources, can greatly contribute to the overall management and well-being of ESRD patients.