NRS-410V Case Study: Mr. C. Solved

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, NRS 410V Case Study Mr C Solved, 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.

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 nonacut

e resources and multidisciplinary approach strategies from which ESRD patients can sap limitless benefits.

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 ar

e 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

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/

 

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