NRS 410 Assignment: Case Study: Mr. C.

NRS 410 Assignment: Case Study: Mr. C.

Grand Canyon University NRS 410 Assignment: Case Study: Mr. C.-Step-By-Step Guide

 

This guide will demonstrate how to complete the NRS 410 Assignment: Case Study: Mr. C. assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for NRS 410 Assignment: Case Study: Mr. C.                                   

 

Whether one passes or fails an academic assignment such as the Grand Canyon University   NRS 410 Assignment: Case Study: Mr. C. depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for NRS 410 Assignment: Case Study: Mr. C.                                   

 

The introduction for the Grand Canyon University   NRS 410 Assignment: Case Study: Mr. C. is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for NRS 410 Assignment: Case Study: Mr. C.                                   

 

After the introduction, move into the main part of the NRS 410 Assignment: Case Study: Mr. C. assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for NRS 410 Assignment: Case Study: Mr. C.                                   

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for NRS 410 Assignment: Case Study: Mr. C.                                   

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NRS 410 Assignment: Case Study: Mr. C.

One of the clinical manifestations that Mr. C presented to the outpatient center is being always heavy. He reports that he gained approximately 100 pounds in the last 2-3 years. The other clinical manifestation is sleep apnea and high blood pressure. He also reports increasing shortness of breath in engaging in activity, pruritus over the last six months, and swollen ankles.

Potential Health Risks for Obesity

One of the potential health risks for obesity in the patient is type 2 diabetes. Obesity increases the risk of type 2 diabetes due to high insulin resistance. As a result, there is an increased risk of developing the disease due to obesity. The other health risk is elevated blood pressure. The patient is at a risk of hypertension due to the thickening of the blood vessels and increased cardiac workload for the heart. This is likely to increase the patient’s risk for cerebrovascular accidents and heart disease. These complications arise from the worsening situation of the cardiac muscles. There is also the increased risk for coronary artery disease. This is likely to result from the deposition of fatty streaks on the blood vessels. The consequences including the thickening of the vessels, increased resistance in the blood vessels, and occlusion of blood supply to tissues. The other potential health risk for the patient is cancer. The patient is also at a risk of developing kidney disease. This is likely to arise from the complications of diabetes type 2 and heart disease. The patient is also at a risk of bone problems such as fractures and osteoarthritis (Shekar & Popkin, 2020). Bone fractures are likely to occur due to large body weight that the bones cannot bear.

Family Health Assessment is crucial in identifying the family’s strength and weakness in terms of access to quality and affordable care. The assessment also provides crucial information to the healthcare practitioners on the threats to achieving comprehensive health and general wellness for the whole population. Furthermore, the family assessment prepares nurses especially the Family Nurse Practitioners with the relevant skills required in the assessment of the family health patterns and be able to offer family-based solutions (Peterson-Burch, 2018). The concept has also proved to be instrumental in advancement of genetic interventions in some of the complex conditions.

Bariatric surgery is appropriate for the patient. He meets all the indications that should be considered for this management approach. Firstly, the patient weighs more than 100 pounds. Besides the BMI, he also has other co-morbidities such as sleep apnea and hypertension. The patient reports that he has tried weight management approach that has been unsuccessful. These conditions are the indications for bariatric surgery, hence, its appropriateness for the patient (Gordeladze, 2017).

Functional Health Patterns

Functional health patterns allows for the accurate assessment of the patient’s problems in nursing. The patient’s health perception pattern is unaltered since he understands his problems and ways of managing it. His nutrition metabolic health pattern is unaltered since food and fluid intake is normal. However, there is an increased risk for metabolic disorders such as diabetes type 2. The patient’s elimination pattern is unaltered. The patient’s activity exercise pattern is altered as evidenced by his difficulty in breathing while engaging in activity. The sleep-rest pattern is altered as evidenced by sleep apnea. The self-perception pattern is also altered since being obese has affected patient’s perception of self. The coping-stress pattern has also been altered as evidenced by patient’s need for additional care due to failure of his adopted weight management interventions.

Actual or Potential Health Problems from the Functional Health Patterns

One of the actual problems facing the patient is negative perception of self. The obesity has significantly altered patient’s perception of self. He is at a risk of developing low self-esteem due to his physical appearance. The other actual health problem is altered sleep-rest pattern as evidenced by sleep apnea. The patient’s ability to get adequate sleep is likely to be altered if the current health problem is not addressed. The third actual health problem that the patient faces is activity intolerance. The patient reports that he experiences shortness of breath in engaging in activity. This is likely to limit his ability to live a healthy lifestyle. The fourth potential health problem he faces is the increased risk for metabolic disorders such as type 2 diabetes. This is likely to occur due to high insulin resistance. The last health problem that the patient is at a risk of developing is poor coping with the stressful health needs due to his condition. The patient has tried sodium diet restriction as part of managing his weight gain but unsuccessful (Gordeladze, 2017). He is therefore at a risk of developing poor coping skills with his stress should the adopted interventions prove ineffective.

Staging of End Stage Renal Failure and Factors to Consider

End stage renal disease is classified into five stages. The staging takes into consideration the glomerular filtration rate, which reflects the level of kidney function. Stage 1 end stage kidney disease is characterized by glomerular filtration rate (GFR) of 90 and above with normal or almost normal kidney function. Stage 2 is characterized by GFR of 60-89 with mild loss of the desired kidney function. Stage 3 is characterized by GFR of 30 to 59 with mild to moderate loss of the kidney function. Stage 4 is GRL of 15-29 with severe loss of the kidney function. Stage 5 is GFR less than 15 with kidney failure.

Patient Education

The patient should be educated on the causes and risk factors for end stage renal failure. This will help him come up with ways of minimizing them in his life. He should also be educated on the signs and symptoms of end stage renal disease and the need for reporting them to the physician. He should also be educated on lifestyle and behavioral changes that he needs to adopt. This includes dietary modifications and engaging in physical activity to reduce the risk of obesity and its associated complications. He should also be educated on the importance of medication adherence to prevent deterioration of the kidney function (Stanhope et al., 2019).

Resources

Non-acute patients suffering from end stage renal disease require a number of resources for their health and wellbeing. One of them is the social support from the family and the community. The family and community should provide the patient with the physical, social, and emotional support he needs. The community should support his needs by incorporating him into the existing social support systems for patients with chronic illnesses. The community should also be supportive by discouraging discrimination of patients with chronic illnesses. The patient also requires multidisciplinary interventions. They include active collaboration between physicians, nutritionist, physiotherapist, counselors, and nephrologist. Active collaboration is needed to optimize the health outcomes of care for the patient (Stanhope et al., 2019). The patient should be educated on delayed return to his normal activities such as resumption of job and normal activities of the daily living.

References

Gordeladze, J. (Ed.). (2017). Adiposity: Epidemiology and Treatment Modalities. BoD–Books on Demand.

Shekar, M., & Popkin, B. (Eds.). (2020). Obesity: Health and Economic Consequences of an Impending Global Challenge.

Stanhope, M., Faan, R. D., Lancaster, J., & Faan, R. P. (2019). Public Health Nursing E-Book: Population-Centered Health Care in the Community. Elsevier Health Sciences.

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:

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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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Sample Answer 2 for NRS 410 Assignment: Case Study: Mr. C.

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.

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/

Sample Answer 3 for NRS 410 Assignment: Case Study: Mr. C.

Obesity signifies a state of excess body fat in the visceral and subcutaneous tissues of the body. It occurs when energy intake exceeds energy output due to excessive caloric intake and a sedentary lifestyle. Obesity in adults is characterized mainly by adipocyte hypertrophy, which occurs when adipocytes increase their volume several thousand-fold to accommodate an increase in lipid storage. Regarding obesity, this essay will analyze the case of Mr. C, a 32-year-old male patient with a history of obesity, including his health risks and health promotion opportunities. The essay will also discuss end-stage renal disease, including health promotion, resources, and multidisciplinary care for patients with the condition.

Clinical Manifestations Present in Mr. C

Mr. C has a history of obesity and has been overweight since childhood. He reports gaining about 100 pounds in the past 2-3 years. He presents with complaints of sleep apnea and high blood pressure as well as exertional dyspnea, pruritus, and swollen ankles over the past six months. Positive objective findings include a BMI of 46.4, defined as obesity, high blood pressure, tachypnea, 3+ pitting edema on bilateral lower limbs. Diagnostic tests reveal hyperglycemia and hyperlipidemia. Besides, the patient has elevated serum creatinine and BUN levels, which indicate an impaired kidney function.

Potential Health Risks for Obesity That Are of Concern for Mr. C

Mr. C is at risk of various obesity comorbidities in the cardiovascular, respiratory, metabolic, and renal systems. In the cardiovascular system, Mr. C is at risk of hypertension, which is evident by the history of high blood pressure and positive finding of a BP of 177/98. In addition, he has a health concern of congestive heart failure based on positive pertinent findings of exertional dyspnea and 3+ pitting edema on feet and ankles. Health risks in the respiratory system include obstructive sleep apnea, resulting from decreased lung expansion (Djalalinia et al., 2015). Besides, Mr. C is at risk of Obesity hypoventilation syndrome, as evidenced by sleep apnea and shortness of breath with activity due to decreased chest wall compliance.

Health concerns in the metabolic system include type 2 diabetes, as evidenced by hyperglycemia. High blood pressure is a risk factor for diabetes as well as hyperlipidemia, which is associated with resistance of body cells to insulin resulting in hyperglycemia (Djalalinia et al., 2015). Furthermore, high blood pressure and heart failure are a risk factor for kidney failure, which is a concern for Mr. C due to the elevated levels of serum creatinine and BUN.

Bariatric surgery is the only available treatment associated with significant and comparatively sustained weight loss in individuals with morbid obesity, presenting with comorbidities (Albaugh & Abumrad, 2018). Candidates for bariatric surgery include persons with a BMI greater than 40 or a weight 45 kgs above the defined ideal weight for age and sex. For individuals with a BMI of 35-40, they should present with at least one major comorbidity (Albaugh & Abumrad, 2018). Comorbidities that have been established to improve or resolve with bariatric surgery include hypertension, heart failure, peripheral edema, type 2 diabetes, obstructive sleep apnea, hyperlipidemia, respiratory insufficiency, and osteoarthritis (Albaugh & Abumrad, 2018). Additionally, a person should be aged 21 to 65 years for bariatric surgery. Mr. C is an ideal candidate for bariatric surgery based on a BMI of 46.4.  He also has comorbidities such as hyperlipidemia, high blood pressure, peripheral edema, sleep apnea, hyperglycemia, and heart failure symptoms.

Actual/Potential Problems from the Functional Health Patterns

Nutritional-metabolic Pattern

Altered nutrition, more than body requirements related to an imbalance between energy expenditure and energy intake, as evidenced by a high BMI. Risk for impaired skin integrity related to pruritus. Pruritus may cause skin breakdown, thus undermining skin integrity.

Elimination Pattern

Risk for impaired urinary elimination related to reduced kidney function. The reduced kidney function evidenced by elevated BUN and creatinine levels is at risk of progressing to chronic kidney failure.

Activity-Exercise Pattern

Altered tissue perfusion (cardiopulmonary) related to decreased cardiac output, as evidenced by shortness of breath with activity and tachypnea.

Activity intolerance related to a decreased blood supply to the myocardium, as evidenced by reports of increased shortness of breath with activity.

Moreover, the risk for self-care deficit related to shortness of breath with activity also exists. The patient is at risk of developing an inability to carry out activities of daily living secondary to shortness of breath with activity (Djalalinia et al., 2015).

Sleep-Rest Pattern

Disturbed sleep pattern related to chest wall compliance from obesity, as evidenced by reports of sleep apnea.

Self-perception/Self-concept Pattern

Disturbed body image related to large body size and obesity. The disturbed body image is further likely to result in lowered self-esteem (Djalalinia et al., 2015).

Staging of End-Stage Renal Disease (ESRD)

The basis for diagnosing ESRD include the presence of kidney damage for a period not less than three months or a glomerular filtration rate (GFR) below 60 mL/min in the same duration (Benjamin & Lappin, 2018). ESRD has five stages, namely:
Stage 1- kidney damage with normal GFR greater than 90 ml/min.

Stage 2- mild reduction in GFR of 60-89 ml/min (Benjamin & Lappin, 2018).

Stage 3- 3A has a moderate reduction in GFR of 45-59 ml/min and Stage 3b with a decreased GFR of 30-44 ml/min (Benjamin & Lappin, 2018).

Stage 4- severe reduction in GFR of15-29 ml/min.

Stage 5 – Renal failure with a GFR of less than 15 ml/min.

Contributing factors that should be considered in ESRD include systemic hypertension, uncontrolled diabetes, dehydration, hyperphosphatemia, Nephrotoxins, hyperlipidemia, proteinuria, and history of smoking (Benjamin & Lappin, 2018).

ESRD Prevention and Health Promotion Opportunities

ESRD prevention opportunities include aggressive glycemic control to target a hemoglobin A1C of below 7%. Patients with diabetic kidney disease and proteinuria should be prescribed with drugs that act on the renin-angiotensin system, such as ACE inhibitors and Angiotensin receptor blockers (Benjamin & Lappin, 2018). Patients should also avoid nephrotoxins, such as IV radiocontrast media, aminoglycosides, and NSAIDs. Patients with hypertension should be on aggressive blood pressure control through lifestyle interventions and medications as per hypertension guidelines (Benjamin & Lappin, 2018). Furthermore, hyperlipidemia should be managed via lifestyle modification and medications to achieve target cholesterol levels. For patients with a history of smoking, they should be recommended on smoking cessation to help delay the advancement of kidney disease to ESRD.

Patient education for Mr. C should include lifestyle modification comprising of increased physical activity and a healthy diet to promote weight loss and lower blood pressure, which will prevent deterioration of renal status (Benjamin & Lappin, 2018). To further lower blood pressure, Mr. C should be recommended to lower dietary sodium intake and adopt the DASH diet. In addition, a low- protein diet should be encouraged to facilitate protein metabolism, thus preventing proteinuria (Benjamin & Lappin, 2018). A low-protein has been found to slow the GFR decline in persons with a rapid decline in GFR, and it also improves proteinuria.

Resources Available for ESRD Patients for Non-Acute Care and Type of Multidisciplinary Approach

Non-acute care resources provided to ESRD patients comprise of medication follow-up, review of treatment adherence, nutrition counseling, education on treatment options, advanced care planning, placement in dialysis centers, and kidney transplant coordination (Kensinger et al., 2015). The purpose of these resources is to impede the advancement of acute kidney disease to ESRD and to lower the mortality rates associated with ESRD.

A multidisciplinary team consists of a nephrologist, pharmacist, renal dietitian, nurse, primary care physician, and social worker (Kensinger et al., 2015). The role of the nephrologist is to assess the prognosis of ESRD and review the management plan. The pharmacist reviews prescribed medications and dosing reviews adherence, and educates patients on OTC medications and alternative therapies such as herbal preparations (Kensinger et al., 2015). The physician assesses the patient for comorbid conditions, developing treatment plans for the comorbidities, and referring patients to specialists. The renal dietitian conducts dietary counseling and planning patients’ diet plans based on dietary and fluid restrictions (Kensinger et al., 2015). Furthermore, the nurse has the role of providing health, providing, and disease prevention interventions for patients. Lastly, the social worker has a vital role in assisting patients in obtaining essential resources such as transportation and housing.

Conclusion

Obesity is a condition that occurs when there is an imbalance between energy input and energy expenditure. It is associated with numerous comorbidities such as hypertension, type 2 diabetes, peripheral edema, hyperlipidemia, obstructive sleep apnea, and ESRD. Bariatric surgery is the only therapeutic intervention that promotes sustained weight loss. It is indicated for persons with a BMI greater than 40 or a BMI of 30-40 with at least one comorbidity. Prevention strategies for ESRD include aggressive hypertension, hyperlipidemia, and glycemic control through lifestyle modification and medications. A low protein diet is also recommended to promote protein metabolism and prevent proteinuria. Furthermore, ESRD non-acute resources aim at preventing the progression of acute kidney disease to ESRD and lower mortality rates. The multidisciplinary team in the care of ESRD patients comprise of a nephrologist, physician, nurse, pharmacists, renal dietitian, and social worker.

References

Albaugh, V. L., & Abumrad, N. N. (2018). Surgical treatment of obesity. F1000Research, 7, F1000 Faculty Rev-617. https://doi.org/10.12688/f1000research.13515.1

Benjamin, O., & Lappin, S. L. (2018). End-stage renal disease. In StatPearls [Internet]. StatPearls Publishing.

Djalalinia, S., Qorbani, M., Peykari, N., & Kelishadi, R. (2015). Health impacts of obesity. Pakistan journal of medical sciences, 31(1), 239–242. https://doi.org/10.12669/pjms.311.7033

Kensinger, C., Brownie, E., Bream, P., Jr, & Moore, D. (2015). Multidisciplinary team approach to end-stage dialysis access patients. The Journal of surgical research, 199(1), 259–265. https://doi.org/10.1016/j.jss.2015.04.088

Criteria Description

Clinical Manifestations of Mr. C.

5. Excellent

12 points

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

4. Good

10.68 points

Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.

3. Satisfactory

9.48 points

Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.

2. Less Than Satisfactory

9 points

Clinical manifestations are partially presented. There are major omissions and inaccuracies.

1. Unsatisfactory

0 points

Clinical manifestations are omitted.

Criteria Description

Potential Health Risks for Obesity and Bariatric Surgery

5. Excellent

12 points

A detailed discussion of the potential health risks for obesity is presented. A through and compelling discussion on whether bariatric surgery is an appropriate intervention is presented. The discussion is well-developed and supported by evidence and additional rationale.

4. Good

10.68 points

A discussion on the potential health risks for obesity is presented. A discussion on whether bariatric surgery is an appropriate intervention is presented but needs some evidence or rationale for support.

3. Satisfactory

9.48 points

A summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are some inaccuracies. More evidence or rationale is needed to support discussion.

2. Less Than Satisfactory

9 points

A partial summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are major inaccuracies. More information is needed. No evidence or rationale is provided to support discussion.

1. Unsatisfactory

0 points

Potential health risks for obesity and whether bariatric surgery is an appropriate intervention are not discussed.

Criteria Description

Functional Health Patterns

5. Excellent

18 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The discussion is insightful, and the identified problems are highly relevant for the patient and his condition. The discussion is well-supported by rationale and evidence.

4. Good

16.02 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The identified problems are relevant for the patient and his condition. Overall, the discussion is supported by rationale and evidence. Some detail is needed for clarity or accuracy.

3. Satisfactory

14.22 points

At least five actual or potential problems identified from the functional health patterns are summarized. The identified problems are generally relevant for the patient and his condition. Some rationale and evidence is required for support.

2. Less Than Satisfactory

13.5 points

At least four actual or potential problems identified from the functional health patterns are presented. The identified problems are not entirely relevant for the patient and his condition. Rationale or evidence is required for support.

1. Unsatisfactory

0 points

Actual or potential problems based on the assessment of functional health patterns of the patient are omitted or are irrelevant for the patient and his condition. The overall criteria for this assignment are not met.

Criteria Description

Staging and Contributing Factors of End-Stage Renal Disease (ESRD)

5. Excellent

12 points

The staging of ESRD and the contributing factors for ESRD are explained. The information is accurate and reflects contemporary practice and research.

4. Good

10.68 points

The staging of ESRD and the contributing factors for ESRD are explained. Some information or detail is needed for clarity or detail.

3. Satisfactory

9.48 points

The staging of ESRD and the contributing factors for ESRD are generally explained. Some information is required; there are minor inaccuracies.

2. Less Than Satisfactory

9 points

Staging of ESRD is partially summarized. The contributing factors for ESRD are vague. There are inaccuracies.

1. Unsatisfactory

0 points

Staging and contributing factors for ESRD are omitted or inaccurate.

Criteria Description

Health Promotion and Prevention for ESRD

5. Excellent

24 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is thoroughly described. The proposed items are clearly presented and highly relevant and supportive of patient and his health status. Strong evidence and rationale generally support the discussion.

4. Good

21.36 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is described. The proposed items are relevant and appropriate for the patient and his health status. Evidence and rationale generally support the discussion.

3. Satisfactory

18.96 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is generally described. There are minor inaccuracies. Overall, the proposed items are relevant for the patient and his health status. Some evidence and rationale are needed to support the discussion.

2. Less Than Satisfactory

18 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is partially summarized. There are inaccuracies. Some aspects are not relevant for the patient and his health status.

1. Unsatisfactory

0 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is omitted.

Criteria Description

Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach

5. Excellent

18 points

A clear and detailed explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. The explanation demonstrates insight into both resources and multidisciplinary approaches for nonacute care for ESRD patients.

4. Good

16.02 points

An explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. Some detail is required for clarity.

3. Satisfactory

14.22 points

A general explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are minor inaccuracies. Some additional information is required.

2. Less Than Satisfactory

13.5 points

An incomplete explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are major inaccuracies.

1. Unsatisfactory

0 points

Types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, are not discussed.

Criteria Description

Thesis Development and Purpose

5. Excellent

6 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. Good

5.34 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. Satisfactory

4.74 points

Thesis is apparent and appropriate to purpose.

2. Less Than Satisfactory

4.5 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Criteria Description

Argument Logic and Construction

5. Excellent

6 points

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. Good

5.34 points

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. Satisfactory

4.74 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. Less Than Satisfactory

4.5 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5. Excellent

6 points

Writer is clearly in command of standard, written, academic English.

4. Good

5.34 points

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

3. Satisfactory

4.74 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. Less Than Satisfactory

4.5 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

1. Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

5. Excellent

2.4 points

All format elements are correct.

4. Good

2.14 points

Appropriate template is fully used. There are virtually no errors in formatting style.

3. Satisfactory

1.9 points

Appropriate template is used. Formatting is correct, although some minor errors may be present.

2. Less Than Satisfactory

1.8 points

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

1. Unsatisfactory

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5. Excellent

3.6 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4. Good

3.2 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3. Satisfactory

2.84 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2. Less Than Satisfactory

2.7 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1. Unsatisfactory

0 points

Sources are not documented.

Total 120 points