Case Study: Mr. C. RN-BSN-prepared Nurse

Case Study: Mr. C

Introduction

Understanding the pathophysiology of different disease processes enables the registered nurse to understand the clinical manifestations and treatment approaches. The presented case scenario presents an obese man who seeks more information about bariatric surgery as a treatment approach for obesity. In this paper, I will review his clinical manifestations, assess him using the functional health patterns, explain the staging of end-stage renal disease, discuss health promotion and prevention of ESRD, and identify various nonacute resources and multidisciplinary approach strategies from which ESRD patients can sap limitless benefits.

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Clinical Manifestations

Mr. C is a 32-year-old male client who has been obese since childhood, gaining about 100 pounds within 2-3 years. Currently, he is working at a catalog phone center. He has visited the hospital to enquire more details about possible bariatric surgery due to his obesity. Over the last six months, Mr. C has experienced pruritus, swollen ankles, and increased shortness of breath when carrying out physical activities. Previous medical evaluations have not revealed any metabolic diseases. However, he reports that he has high blood pressure and sleep apnea. He restricts his dietary sodium intake to control the two conditions.

On physical assessment, Mr. C has pitting bilateral edema (3+) on the ankles and feet, blood pressure of 172/98 mmHg, total cholesterol levels of 250 mg/dl, and fasting blood sugar levels of 146mg/dl. His serum creatinine levels are at 1.8mg/dl, triglycerides at 312 mg/dl, high density lipoproteins at 30 mg/dl, and he weighs 134.5 kgs.

Potential Health Risks for Obesity

Obesity is a global health issue associated with several comorbidities. Genetics and behaviors such as dietary patterns, medication use, physical inactivity lead to obesity. Obesity is associated with reduced quality of life, poor mental health outcomes and is the leading cause of deaths globally and in the United States (CDC, 2021). Fruh (2017) asserts that obese individuals have a significant risk for developing several comorbid conditions, including obstructive sleep apnea and other respiratory conditions, type 2 diabetes, hypertension, cardiovascular diseases, muscular and joint disorders, and psychological and mental health issues. Mr. C has a risk of developing the stated conditions.

Mr. C has a history of hypertension and elevated blood pressure (172/98 mmHg). Additionally, he is at risk of developing type 2 diabetes, more prevalent in hypertensive and obese patients. He has an elevated blood sugar level (146mg/dl) against the normal values, which should not exceed 108 mg/dl (Mathew & Tadi, 2020). Besides, he has elevated cholesterol levels reflected in the high triglycerides and HDL levels, increasing patients’ risk of developing insulin resistance (Fruh, 2017). Obesity also causes obstructive sleep apnea and respiratory problems (Safaei et al., 2021). Mr. C has increased shortness of breath with physical activities and sleep apnea. Obesity reduces chest wall compliance, decreasing the functional residue capacity and total lung compliance (Fruh, 2017). Besides, obesity leads to cardiac failure, evidenced by bilateral pitting edema in the ankles and feet (3+) and dyspnea on exertion. Furthermore, hypertension and diabetes are significant health risk factors for kidney failure. This is reflected in Mr. C’s elevated BUN and serum creatinine levels.

Bariatric Surgery

Bariatric surgery is intended to accomplish weight loss in severely obese patients. The surgery promotes weight loss, improves the quality of life, and improves comorbidities related to obesity (Kang & Le, 2017). Requirements for the surgery include a BMI above 40 or a BMI above 35 with at least one comorbid condition, either type 2 diabetes, hypertension, GERD, asthma, obstructive sleep apnea, asthma, or hyperlipidemia (Kizy et al., 2017). A patient must also give informed consent. Bariatric surgery is appropriate for Mr. C, who has a BMI of 46.4 and comorbid conditions such as hyperlipidemia, elevated blood sugar levels, sleep apnea, and hypertension. The surgery may help improve his overall health condition.

Functional Health Patterns

Activity-exercise pattern

Mr. C has increased dyspnea on exertion. This is associated with reduced chest wall compliance, total lung compliance, and functional residue capacity (Fruh, 2017).

Sleep-rest apnea

The client has sleep apnea which interrupts his sleep and resting patterns. Sleep apnea in obese patients occurs from the deposition of excess fat in the upper respiratory tract, narrowing the airways (Jehan et al., 2017).

Elimination pattern

Mr. C is at risk of impaired excretion following renal failure. The elevated BUN and creatinine levels reflect impaired kidney function, following complications of high blood pressure and blood sugar levels. If not corrected, it can progress to end-stage renal disease, depriving the patient of his renal excretory capabilities.

Coping-stress tolerance pattern

Mr. C is at risk of psychological issues such as stress due to his health conditions. Obesity and comorbidities reduce the quality of life (Safaei et al., 2021), which causes psychological burdens. Additionally, the client is single, indicating a potential lack of sufficient support systems by a spouse.

Health perception-health management pattern

Mr. C perceives his condition as severe and affecting his ability to function. He believes that taking action, in this case, bariatric surgery, will improve his health outcome. He believes that taking action will make a difference. This is reflected by him going to the hospital to inquire about bariatric surgery.

Staging of End-Stage Renal Disease (ESRD)

ESRD is the result of longstanding kidney conditions. Chronic kidney disease is a debilitating condition, and its progression to the terminal state (ESRD) is a significant source of premature mortality and reduced life quality. CKD is classified into five stages depending on the level of the glomerular filtration rate (Benjamin & Lappin, 2021). These are stage 1 in which the kidneys are damaged but with a normal GFR above 90 ml/min, stage 2 with a mild reduction in GFR between 60-89 ml/min, and stage 3a and 3b with a moderate decrease in GFR between 40-59 ml/min and 30-44 ml/min, respectively. In stage 4, patients have a severe reduction in GFR ranging between 15-29 ml/min. Lastly, stage 5 renal failure is characterized by GFR below 15 ml/min.

Type 2 diabetes is a leading cause of renal failure (Clements et al., 2020). Other causes of CKD include heart disease, hypertension, vascular disease, and certain medications. Mr. C’s health state puts him at significant risks of these conditions, which are strongly implicated in the pathophysiology of ESRD.

ESRD Health Promotion and Prevention Strategies

Mr. C is at significant risk of deteriorating kidney function, which may ultimately result in ESRD. Therefore, patient education on health promotion and prevention strategy is vital in managing Mr. C. Patient education improves outcomes and reduces the patients’ concerns. Strategies for promoting healthy kidneys for Mr. C include losing weight, taking medications (blood pressure and diabetes drugs) as instructed, reducing salt intake, taking more fruits and vegetables, and staying in the targeted cholesterol level (Centers for Disease Control and Prevention, 2020). The education strategies will enable Mr. C to be more actively involved in managing his health condition to prevent ESRD.

Resources for ESRD Patients and Multidisciplinary Approach

ESRD is a substantial health burden associated with premature deaths, high hospital costs, and increased hospitalization rates. An interdisciplinary team approach to care promotes effective care, which improves outcomes (Fluck & Taal, 2018). The multidisciplinary team should include a nephrologist, advanced practitioner, pharmacists, dietician, palliative care personnel, general surgery, and a transplant team. Each member plays a unique role that promotes the safety and quality of life for patients with ESRD.

Nonacute care is meant for patients who suffer from chronic conditions to promote their quality of life, prevent complications and death. Baker and Fatoye (2019) observe that several community-based resources assist patients requiring critical care and those managing long-term illnesses. These include funds, personnel, appropriate medical equipment, education, and facilities. The patient also benefits from dialysis and transport services. These enable patients to access high-quality care that promotes their well-being and satisfaction, improving their holistic quality of life.

Conclusion

Mr. C is obese with a BMI of 46.4. He has other comorbid conditions related to obesity. He seeks more information about bariatric surgery, which will be appropriate as a weight reduction strategy. Mr. C has elevated blood pressure and blood sugar levels, associated with kidney disease reflected in the patient’s altered lab values. Patients with renal failure, including ESRD, benefit from various resources. These include health education, health facilities, medication, dietary modifications, and physical activities. A multidisciplinary approach in managing patients with ESRD promotes effective and safe care, improving clinical outcomes.

References

Baker, E., & Fatoye, F. (2019). Patient perceived impact of nurse-led self-management interventions for COPD: A systematic review of qualitative research. International Journal of Nursing Studies, 91, 22–34. https://doi.org/10.1016/j.ijnurstu.2018.12.004

Benjamin, O., & Lappin, S. L. (2021). End-Stage Renal Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499861/

CDC. (2021). Adult Obesity Causes & Consequences. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/adult/causes.html

Centers for Disease Control and Prevention. (2020). Chronic Kidney Disease Initiative: Prevention & Risk Management. Centers for Disease Control and Prevention. https://www.cdc.gov/kidneydisease/prevention-risk.html

Clements, J. M., Rosca, M., Cavallin, C., Falkenhagen, S., Ittoop, T., Jung, C. K., Mazzella, M., Reed, J. A., Schluentz, M., & VanDyke, C. (2020). Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan. The American Journal of the Medical Sciences, 359(4), 218–225. https://doi.org/10.1016/j.amjms.2020.01.013

Fluck, R. J., & Taal, M. W. (2018). What is the value of multidisciplinary care for chronic kidney disease? PLOS Medicine, 15(3), e1002533. https://doi.org/10.1371/journal.pmed.1002533

Fruh, S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. Journal of the American Association of Nurse Practitioners, 29(1), S3–S14. https://doi.org/10.1002/2327-6924.12510

Jehan, S., Zizi, F., Pandi-Perumal, S. R., Wall, S., Auguste, E., Myers, A. K., Jean-Louis, G., & McFarlane, S. I. (2017). Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Medicine and Disorders: International Journal, 1(4), 00019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836788/#:~:text=In%20obese%20people%2C%20fat%20deposits

Kang, J. H., & Le, Q. A. (2017). Effectiveness of bariatric surgical procedures. Medicine, 96(46), e8632. https://doi.org/10.1097/md.0000000000008632

Kizy, S., Jahansouz, C., Wirth, K., Ikramuddin, S., & Leslie, D. (2017). Bariatric Surgery: A Perspective for Primary Care. Diabetes Spectrum, 30(4), 265–276. https://doi.org/10.2337/ds17-0034

Mathew, T., & Tadi, P. (2020). Blood Glucose Monitoring. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/18394

Safaei, M., Sundararajan, E. A., Driss, M., Boulila, W., & Shapi’i, A. (2021). A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Computers in Biology and Medicine, 136, 104754. https://doi.org/10.1016/j.compbiomed.2021.104754

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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

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 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.