NRS 410 Case Study: Mr. C. BERNIE Essay
NRS 410 Case Study: Mr. C. BERNIE Essay
Case Study
Health problems such as obesity have immense health impacts on the affected populations. Nurses and other healthcare providers utilize patient-centered evidence-based interventions that enable patients to overcome obesity and its associated complications. Therefore, this paper explores a case study involving an obese patient. It explores health risks, prevention, health issues, and resources available for the patient.
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Subjective and Objective Clinical Manifestations
Subjective clinical manifestations refer to the patient’s information about experience with a health problem. The subjective clinical manifestations in the case study include being always heavy even when he was a child, gaining about 100 pounds in the last 2-3 years, sleep apnea, high blood pressure, swollen ankles, shortness of breath with activity, and pruritus over the last six months. Objective clinical manifestations refer to the data that healthcare providers obtain during patient assessment. The objective clinical manifestations in the case study include obesity, hypertension, 3+ pitting edema on ankles and bilateral feet, hyperglycemia, hypercholesteremia, elevated triglyceride levels, and serum creatinine and BUN.
Health Risks
Mr. C is increasingly predisposed to health risks for obesity. One of them is diabetes. The client’s fasting blood sugar level is elevated, translating into either hm being diabetic or prediabetic. The other risk identified from the objective data is hypertension. The patient currently has elevated blood pressure. Obesity causes the deposition of fats in the arteries and other small blood vessels, which increase the risk of other cardiovascular complications such as atherosclerosis (Cercato & Fonseca, 2019). Mr. C is also at a high risk of developing stroke as a complication of cardiovascular events such as hypertension. The patient is also at a risk of kidney failure. His serum BUN and creatine levels are currently elevated, which imply that he has reduced renal functions (Stahl & Malhotra, 2022). The additional health risks that Mr. C is predisposed include obstructive sleep apnea and non-alcohol fatty liver disease.
Bariatric surgery is appropriate for Mr. C. Accordingly, obese patients with commodities are the ideal candidates for bariatric surgery. In addition, patients with a BMI of 40 kg/m2 or above without any medical problems and no excessive risk of bariatric surgery are also ideal candidates for the procedure. The other conditions that influence if a patient can undergo bariatric surgery include the presence of other conditions such as hyperlipidemia, hypertension, type 2 diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, asthma, severe urinary incontinence, venous stasis disease, and impaired quality of life would qualify to undergo bariatric surgery (Stahl & Malhotra, 2022). Mr. C meets most of these conditions, hence, bariatric surgery is ideal for him.
Functional Health Patterns
Mr. C has actual and potential health problems that should be prioritized in the nursing care plan. One of the actual health problems is activity intolerance related to excessive body weight gain as evidenced by his shortness of breath with activity. The implication is that his quality of life is lowered since he cannot engage independently in most activities of daily living such as exercising. The second actual health problem is impaired blood glucose control as evidenced by elevated blood glucose level. The elevated blood glucose levels predispose the patient to complications such as renal disease, hypoglycemia, and diabetic retinopathy and neuropathy. The third actual health problem from functional health patterns is impaired renal function as evidenced by elevated BUN and creatinine levels. The impairment could be attributed to hypertension and diabetes, which are due to obesity. This makes it necessary to implement interventions that aim at preserving optimum renal functioning. The fourth actual health problem is impaired cardiac function as evidenced by elevated blood pressure and other markers such as triglyceride and total cholesterol levels. Interventions that ensure optimum cardiac functioning should be adopted (Blüher, 2020). The last actual problem is altered sleep pattern as evidenced by the patient reporting obstructive sleep apnea. Cumulatively, these health problems affect Mr. C’s health and wellbeing.
Stages of Renal Disease
Renal disease occurs in stages that ultimately results in end-stage renal disease (ESRD). The first stage, stage 1 is characterized by glomerular filtration rate of above 90. This stage is asymptomatic but the kidneys may not be functioning optimally as expected. Stage 2 is characterized by glomerular filtration rate of 60-89. This stage is also asymptomatic and often diagnosed when patients come to the hospital for other health problems such as diabetes and hypertension. Stage 3 is characterized by glomerular filtration rate of 30-59. Patients experience symptoms such as fluid retention, fatigue, and alterations in urinary patterns. Stage 4 is when glomerular filtration rate is severe and ranges between 15 and 29. The symptoms experienced in this stage include vomiting, nausea, edema of the extremities, and impaired cognitive function. A glomerular filtration rate of less than 15 is the fifth stage of kidney failure, also known as ESRD (Ammirati, 2020). The factors that contributed to Mr. C developing ESRD include obesity, hypercholesteremia, elevated triglycerides, hypertension, and diabetes.
ESRD Prevention and Health Promotion Opportunities
The health education offered to Mr. C on ESRD prevention should focus on several aspects. One of them is the need for weight loss. Weight loss should be a priority to reverse additional complications such as hypertension and diabetes mellitus type 2. The other aspect of health education that should be of focus is dietary modification. Mr. C she be educated about the importance of avoiding diets rich in sodium. Sodium increases fluid retention, worsening the complications of renal disease and cardiac system. The other aspect of health education is avoiding over the counter medications. Over the counter medications such as acetaminophen are nephrotoxic. As a result, the patient should be educated on the importance of avoiding any medications that may damage the kidneys further. Mr. C should also be educated about the importance of maintaining active physical activity. Accordingly, physical activity should be encouraged, as it promotes weight loss, cardiac functioning, and glycemic control (Gonsalez et al., 2019; Lv & Zhang, 2019). Lastly, Mr. C should avoid alcohol intake or abuse of any substance, which may alter the normal kidney functioning.
Resources for ESRD Patients
Patients with ESRD have access to a wide range of resources they can utilize for their health. They include social support groups, hospice care, home health, and clinical toolkits that have been developed to guide clinicians in providing the care that the affected patients need. The other resource is the ESRD networks that help patients to access their needed services such as dialysis and kidney transplant services.
Conclusion
This paper has explored Mr. C’s case study. It has examined his clinical manifestations and health risks associated with obesity. The paper has also explored the prevention strategies for ESRD and its stages as well as resources available for the patient. Mr. C should implement interventions that minimize the risk of obesity complications. Nurses should also link him with the available community resources.
References
Ammirati, A. L. (2020). Chronic Kidney Disease. Revista Da Associação Médica Brasileira, 66, s03–s09. https://doi.org/10.1590/1806-9282.66.S1.3
Blüher, M. (2020). Metabolically Healthy Obesity. Endocrine Reviews, 41(3), bnaa004. https://doi.org/10.1210/endrev/bnaa004
Cercato, C., & Fonseca, F. A. (2019). Cardiovascular risk and obesity. Diabetology & Metabolic Syndrome, 11(1), 74. https://doi.org/10.1186/s13098-019-0468-0
Gonsalez, S. R., Cortês, A. L., Silva, R. C. da, Lowe, J., Prieto, M. C., & Silva Lara, L. da. (2019). Acute kidney injury overview: From basic findings to new prevention and therapy strategies. Pharmacology & Therapeutics, 200, 1–12. https://doi.org/10.1016/j.pharmthera.2019.04.001
Lv, J.-C., & Zhang, L.-X. (2019). Prevalence and Disease Burden of Chronic Kidney Disease. In B.-C. Liu, H.-Y. Lan, & L.-L. Lv (Eds.), Renal Fibrosis: Mechanisms and Therapies (pp. 3–15). Springer. https://doi.org/10.1007/978-981-13-8871-2_1
Stahl, J. M., & Malhotra, S. (2022). Obesity Surgery Indications And Contraindications. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK513285/
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Assessment Description
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:
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 subjective and objective clinical manifestations present in Mr. C.
Describe the potential health risks for obesity that are of concern for Mr. C. Explain 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 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.)
Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
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.
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.
You are required to cite a minimum of three 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.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Rubric Criteria
Total
120 points
Criterion
1. Unsatisfactory
2. Insufficient
3. Approaching
4. Acceptable
5. Target
Staging and Contributing Factors of End-Stage Renal Disease (ESRD)
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD.
0 points
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and/or what factors contributed to the patient’s ESRD are omitted.
9 points
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and/or what factors contributed to the patient’s ESRD are present, but lack detail or are incomplete.
9.48 points
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD are present.
10.68 points
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD are detailed.
12 points
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD are thorough.
Potential Health Risks for Obesity and Bariatric Surgery
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention.
0 points
Discussion of the potential health risks for obesity and/or the appropriateness of bariatric surgery as an intervention are omitted.
9 points
Discussion of the potential health risks for obesity and/or the appropriateness of bariatric surgery as an intervention are present but lack detail or are incomplete.
9.48 points
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention are present.
10.68 points
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention are detailed.
12 points
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention are thorough.
Thesis, Position, or Purpose
Communicates reason for writing and demonstrates awareness of audience.
0 points
The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.
4.5 points
The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.
4.74 points
The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.
5.34 points
The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.
6 points
The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.
Functional Health Patterns
Discussion of at least five actual or potential problems identified from the functional health patterns assessment, and rationale for each.
0 points
Discussion of at least five actual or potential problems identified from the functional health patterns assessment and/or rationale are omitted.
13.5 points
Discussion of at least five actual or potential problems identified from the functional health patterns assessment and/or rationale are present, but lack detail or are incomplete.
14.22 points
Discussion of at least five actual or potential problems identified from the functional health patterns assessment, rationale for each are present.
16.02 points
Discussion of at least five actual or potential problems identified from the functional health patterns assessment and rationale for each are detailed.
18 points
Discussion of at least five actual or potential problems identified from the functional health patterns assessment and rationale for each are thorough.
Format/Documentation
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
0 points
Appropriate format is not used. No documentation of sources is provided.
1.8 points
Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.
1.9 points
Appropriate format and documentation are used, although there are some obvious errors.
2.14 points
Appropriate format and documentation are used with only minor errors.
2.4 points
No errors in formatting or documentation are present.
Evidence
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
0 points
Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.
4.5 points
Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.
4.74 points
Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.
5.34 points
Relevant evidence that includes other perspectives is used.
6 points
Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues.
0 points
Explanation of the types of resources available for ESRD patients for nonacute care, and/or the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues are omitted.
13.5 points
Explanation of the types of resources available for ESRD patients for nonacute care, and/or the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues are present, but lack detail or are incomplete.
14.22 points
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues are present.
16.02 points
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues are detailed.
18 points
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues is thorough.
Mechanics of Writing
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
0 points
Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.
2.7 points
Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.
2.84 points
Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.
3.2 points
Few mechanical errors are present. Suitable language choice and sentence structure are used.
3.6 points
No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Health Promotion and Prevention Opportunities for ESRD
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status.
0 points
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status is omitted.
18 points
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status is present, but lack detail or are incomplete.
18.96 points
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status is present.
21.36 points
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status is detailed.
24 points
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status is thorough.
Clinical Manifestations of Mr. C.
Detail of subjective and objective clinical manifestations.
0 points
Subjective and objective clinical manifestations are omitted.
9 points
Subjective and objective clinical manifestations are present but lack detail or are incomplete.
9.48 points
Subjective and objective clinical manifestations are present.
10.68 points
Subjective and objective clinical manifestations are detailed.
12 points
Subjective and objective clinical manifestations are thorough.
Development, Structure, and Conclusion
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
0 points
No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.
4.5 points
Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.
4.74 points
Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.
5.34 points
The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.
6 points
The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.