Case Study: Mr. M. NRS 410

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. M., 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. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.

1. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
2. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
3. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
4. Discuss what interventions can be put into place to support Mr. M. and his family.
5. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

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.

Case Study Mr. M

Neurological, perceptual, and cognitive complexities are common among elderly patients from the age of 55 years. They are associated with aging and chronic illnesses that affect the elderly. Neurocognitive complexities have been linked to poor health outcomes among patients and are a major cause of morbidity, prolonged hospital stays, and mortality rates among geriatric patients. The most prevalent neurocognitive disorder is dementia, which could be secondary to Alzheimer’s, Vascular, or Lewy Body. The purpose of this paper is to analyze the case of Mr. M, a patient with neurocognitive complexities. I will discuss the patient’s clinical manifestations, medical diagnoses, and support interventions.

Clinical Manifestations Present in Mr. M

Mr. M presents with a decline in memory with a history of having trouble recalling familiar names and places, repeating what he has just read, getting lost, and wandering at night. He is also easily agitated with aggression and cannot perform most ADLs. He has a history of hypertension and hypercholesterolemia. Positive objective data include a height of 69.5 inches and a weight of 87 kg, which calculates to a BMI of 27.9 categorized as overweight. Lab results reveal a WBC count of 19,200/uL and lymphocyte count of 6700 cells/uL, which indicates leukocytosis and lymphocytosis, respectively, with a systemic infection. In addition, urinalysis results show cloudy urine and moderate amounts of leukocytes, which point to a urinary tract infection. The patient’s protein, AST, and ALT levels are within the normal range.

Medical Diagnoses

Primary Diagnosis

Alzheimer’s disease (AD) Dementia. This is a neurodegenerative condition marked by impairment in cognitive and behavioral processes, which interferes with individuals’ occupational and social functioning (Rodríguez et al., 2016). Mr. M has Moderate AD based on positive symptoms of increasing memory loss, difficulties recalling familiar names and places, and the presence of agitation, aggression, and anxiety (Rodríguez et al., 2016). Moreover, Mr. M has confusion that causes wandering at night, difficulties in reading, and limitations in performing ADLs.

Secondary Diagnosis

Asymptomatic Bacteriuria (ABU): ABU is characterized by an infection in the urine but with no subjective data of a urinary tract infection such as dysuria or urinary frequency and urgency (Biggel et al., 2019). ABU refers to the isolation of bacteria in an appropriately collected urine specimen from a person without symptoms of urinary tract infection. ABU’s pertinent positive findings include urinalysis results revealing cloudy urine and a moderate amount of leukocytes with negative patient’s urinary symptoms. Besides, the patient has leukocytosis and lymphocytosis, which indicate presence of infection.

Expected Abnormalities in the Nursing Assessment

Patients with moderate AD are expected to portray abnormal findings in the neurologic and mental status exam. Expected findings on general examination include anxiety and restlessness, with the patient getting aggressive during the interview (Mukherjee et al., 2017). Cognitive impairment is expected with the patient portraying difficulties in reading, writing, and simple calculations secondary to cognitive difficulties.

Expected findings on neurologic exam include decreased attention and concentration levels, poor recent and remote memory, language difficulties, and declined executive function (Rodríguez et al., 2016). Expected finding in the mental status exam include an angry mood as a result of anxiety and confusion. Thought process is expected to be characterized by disorganizes thought and illogical thinking due to an altered thought process (Mukherjee et al., 2017). Thought content is likely to be marked by paranoia, visual or auditory hallucinations, and delusions. Mr. M might be disoriented to both place and time with a declined immediate, short, and long-term memory due to confusion (Rodríguez et al., 2016). Furthermore, the patient is expected to portray an impaired judgment marked by making poor decisions as well as lack of insight evidenced by denial of symptoms or decline in functioning.

Physical, Psychological, And Emotional Effects of Mr. M.’S Current Health Status

Mr. M’s current health status may result in physical injuries such as bruises and fractures secondary to falls. The patient has an unsteady gait with difficulties in ambulation as well as increased confusion levels that put him at a high risk of falls (Brooke, 2016). Besides, the ABU may result in complications in the upper urinary tract, causing urinary stones and prostatic hyperplasia (Biggel et al., 2019). Limitations in performing ADLs, such as inability to feed himself, may result in decreased intake, causing symptoms of nutritional deficiency such as muscle wasting, drastic weight loss (Brooke, 2016). The patient may also develop dehydration marked by loss of skin turgor. Besides, the patient’s existing may worsen, such as hypertension, causing frequent cases of hypertensive urgencies and emergencies.

A decline in the ability to perform ADLs may cause psychological distress to both the patient and his family. Dementia patients often lose confidence in themselves and their abilities due to limitations in performing ADLs, and they also feel insecure (Mukherjee et al., 2017). Mr. M may lose control over his life and health and may develop distrust in his judgment, which can have adverse effects on his psychological wellbeing. The family members are at risk of developing psychological distress such as depression seeing their loved ones lose the ability to perform ADLs. Besides, they will be forced to help the patient perform ADLs, which can result in exhaustion and psychological distress (Mukherjee et al., 2017). Caring for AD patients is often challenging and demanding. It results in physical and mental exhaustion leading to social isolation and increased stress anxiety and depression levels.

Mr. M and his family may encounter social stigma due to the AD, which will negatively impact the patient’s self-esteem and significantly contribute to psychological distress (Mukherjee et al., 2017). Furthermore, the patient will be required to undergo frequent medical follow-ups, resulting in financial strains in the family. Financial strains have a negative impact on the psychological and emotional wellbeing of patients and their families.

Interventions That Can Be Put Into Place to Support Mr. M. And His Family

Interventions that can support Mr. M include Cognitive Stimulation Therapy (CST), which is designed to engage and stimulate patients with dementia. CST is strengthened by key principles of person-centeredness, involvement, respect, inclusion, choice, fun, reminiscence, and maximizing potential and strengthening relationships (Johnston & Narayanasamy, 2016). Reminiscence therapy can also be used to help the patient tap into his long-term memory and recall past pleasurable experiences. It is one of the most popular interventions which can be enjoyed by both patients, their families, and health providers (Johnston & Narayanasamy, 2016). Furthermore, the patient can be encouraged to engage in physical activities, and the provider can design exercise programs for the patient. The exercise programs should be tailored to meet the patient’s interests, abilities, preferences, and safety needs (Johnston & Narayanasamy, 2016). There is evidence validating how physical activity can lessen depressive symptoms and behavioral disturbances such as agitation, noisiness, and aggression in patients with dementia (Brooke, 2016).

Interventions to support the family who are the informal caregivers include providing information on how to dementia and care of the patient. The family can be linked to online support groups where they can learn from others on how to interact and care for a family member with AD (Brooke, 2016). Additionally, the family can be provided psychological counseling interventions to lower the perceived burden and levels of depression and delay admissions to nursing homes.

Actual or Potential Problems Mr. M Faces

The patient faces self-care deficit, as evidenced by the patient’s inability to perform ADLs independently such as feeding, dressing, and bathing. Self-care deficit is as a result of declined memory loss, limited physical activity, confusion, and impaired cognitive functioning. Moreover, he also faces disturbed thought process related to cognitive dysfunction, as evidenced by memory loss. Other findings that indicate a disturbed thought process include wandering, disorientation, and decreased attention span.

Mr. M similarly faces risk for injury related to the patient having difficulties in ambulation and unsteady gait. Confusion further puts the patient at risk of injury since he may fail to recognize environmental hazards and may result in Mr. M making decisions that put him in danger (Brooke, 2016). Further the patient faces risk for social isolation related to alteration in mental status. Mr. M is at risk of facing social isolation due to the progression of AD as well as confusion, memory loss, agitation, and unacceptable social behavior (Mukherjee et al., 2017). He may face social isolation from his family, friends, and the community that may result in further progression of SD symptoms.

 

 

 

 

References

Biggel, M., Heytens, S., Latour, K., Bruyndonckx, R., Goossens, H., & Moons, P. (2019). Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization. BMC geriatrics, 19(1), 170.https://doi.org/10.1186/s12877-019-1181-4

Brooke, J. (2016). Caring for patients with dementia. Nursing in Practice, 89, 68-71.

Johnston, B., & Narayanasamy, M. (2016). Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy-an integrative review. BMC geriatrics, 16(1), 77.https://doi.org/10.1186/s12877-016-0250-1

Mukherjee, A., Biswas, A., Roy, A., Biswas, S., Gangopadhyay, G., & Das, S. K. (2017). Behavioral and psychological symptoms of dementia: correlates and impact on caregiver distress. Dementia and geriatric cognitive disorders extra, 7(3), 354-365. https://doi.org/10.1159/000481568

Rodríguez, T. M., Galán, A. S., Flores, R. R., Jordán, M. T., & Montes, J. B. (2016). Behavior and emotion in dementia. Update on Dementia, 449. https://doi.org/10.5772/64681

The case study concerns Mr. M 70-year-old male living at an assisted living facility. The patient’s health status has rapidly deteriorated in the past two months. He struggles to remember his family members’ names and room number and repeats things he has read. Mr. M quickly becomes agitated and aggressive. The purpose of this assignment is to analyze Mr. M’s health condition and interventions to support him and the family.

Clinical Manifestations of Mr. M.

Mr. M exhibits clinical manifestation of cognitive decline in memory as seen by forgetting family members’ names and room number and getting lost. He has mood symptoms, as evidenced by getting quickly agitated and aggressive. In addition, the patient has difficulties performing ADLs independently. The patient is overweight, with a BMI of 27.9. Diagnostic results show that the patient has leukocytosis and lymphocytosis. Urinalysis results reveal cloudy urine and leukocytes, indicating a possible urinary tract infection (UTI).

Diagnoses and Secondary Diagnoses

The primary diagnosis is Alzheimer’s dementia (AD). The patient demonstrates positive AD symptoms like a gradual decline in memory, difficulties remembering familiar names and places, confusion with wandering at night, aggression and agitation, reading difficulties, and inability to perform ADLs independently (Tahami Monfared et al., 2022).

The secondary diagnosis is Asymptomatic Bacteriuria (ABU). ABU is characterized by leukocytes on urinalysis but with no reported clinical symptoms of UTI. Persons living with dementia often have atypical clinical manifestations and high ABU rates (Yourman et al., 2020). The patient has not expressed any symptoms consistent with UTI, but urinalysis results of cloudy urine and leukocytes indicate UTI, making ABU the secondary diagnosis. The nursing diagnosis derived from AD is Impaired memory related to chemical imbalances in the brain as evidenced by memory loss. The nurse should consider this diagnosis by evaluating the patient’s cognitive function and memory.

Expected Abnormalities during Nursing Assessment

Abnormal findings are expected in nursing assessment in the general, neurological, and mental status assessment based on the AD medical diagnosis. On general assessment, the nurse can expect to find a nervous, restless, and disoriented patient with explosive behavior when asked about his cognitive decline symptoms (Tahami Monfared et al., 2022). The patient may also exhibit paranoia and inappropriate social behavior. The likely neurological exam findings include short-term memory loss, reduced attention span, dysarthria, and impaired executive functioning.

The expected abnormal mental status exam (MSE) findings include disorganization, disorientation to time, place, and person, impaired reasoning, abstract thought and judgment, problems with calculation, and decreased attention span. In addition, the patient may demonstrate deterioration in personal care and appearance and have poor cooperation (Tahami Monfared et al., 2022). The nurse may not identify any abnormal findings with ABU because it is asymptomatic. However, a thorough genitourinary exam is crucial to identify if the patient has costovertebral angle tenderness, penile ulcers or lesions, scrotal tenderness, meatal discharge, or prostatic tenderness.

Health Status Effect on Physical, Psychological, and Emotional Aspects of Patient and Family

AD has a significant physical, psychological, and emotional impact on patient and their families. The patient is at risk of developing perceptual-motor problems which cause disturbances in ambulation, gait, balance, and motor coordination. This increases the risk of falls and fractures (Grabher, 2018). Besides, the difficulties in performing ADLs cause self-care deficits in bathing, dressing, and toileting. If the skin is not properly cleaned or dried, it can cause skin conditions due to impaired skin integrity. Self-care deficit in feeding can also cause nutrition deficiency and dehydration because of inadequate dietary intake (Grabher, 2018). The limited ability to perform ADLs and cognitive decline in AD patients cause psychological distress, which increases the risk of developing depression and anxiety disorders. Therefore, Mr. M’s aggression and agitation can be linked to cognitive decline.

The family of Mr. M may be required to help him with ADLs, which causes physical exhaustion and burnout, especially if they have not been trained to care for an AD patient. Besides, they may develop psychological distress that progresses to depression or anxiety when they see their loved one lose his independence (Grabher, 2018). Exhaustion and burnout also increase psychological distress. Furthermore, Mr. M’s care will require financial resources if the family hires a caregiver or takes him to a nursing home. The financial drain caused by the care of AD patients adversely affects the patient’s and family’s emotional well-being.

Interventions for Support

Mr. M can be supported through supportive psychotherapy, where he gets a platform to talk about how his thoughts and feelings affect his mood and behavior. For instance, he can be started on group psychotherapy for persons with dementia, which improves depression and anxiety symptoms and interpersonal functioning. Supportive psychotherapy can also help Mr. M understand his life situation’s reality, including his limitations and what he can and cannot achieve. Mr. M’s family can be supported through caregiver training to educate them on how to provide care to their loved ones at home and avoid burnout (Simpson et al., 2018). Besides, the family can be introduced to social support groups for AD caregivers, where they interact with other families and learn how to cope.

Actual/Potential Problems

Mr. M’s actual problems include impaired memory caused by the AD disease process and chemical imbalances in the brain. He also has self-care deficits in bathing, dressing, and feeding caused by impairment in neuromuscular and cognitive functioning (Breijyeh & Karaman, 2020). In addition, the patient has confusion with a reduced ability to interpret his environment caused by the AD disease process. The patient has a risk for injury due to confusion, disorientation, and impaired decision-making.

Conclusion

Mr. M has clinical features of memory loss, confusion, disorientation, and aggression, which are consistent with Alzheimer’s disease making it the primary diagnosis. The secondary diagnosis is ABU since urinalysis results suggest a UTI, but the patient has no symptoms. AD affects the patient’s and family’s physical, psychological, and emotional well-being, increasing the risk of depression and anxiety disorders. The patient and family can be supported through psychotherapy, training on caregiving, and social support groups.

 

 

 

References

Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https://doi.org/10.3390/molecules25245789

Grabher, B. J. (2018). Alzheimer’s disease and the Effects it has on the Patient and their Family. Journal of Nuclear Medicine Technology, jnmt-118.

Simpson, G. M., Stansbury, K., Wilks, S. E., Pressley, T., Parker, M., & McDougall, G. J., Jr (2018). Support groups for Alzheimer’s caregivers: Creating our own space in uncertain times. Social work in mental health, 16(3), 303–320. https://doi.org/10.1080/15332985.2017.1395780

Tahami Monfared, A. A., Byrnes, M. J., White, L. A., & Zhang, Q. (2022). Alzheimer’s Disease: Epidemiology and Clinical Progression. Neurology and therapy, 11(2), 553–569. https://doi.org/10.1007/s40120-022-00338-8

Yourman, L. C., Kent, T. J., Israni, J. S., Ko, K. J., & Lesser, A. (2020). Association of dementia diagnosis with urinary tract infection in the emergency department. Journal of the American College of Emergency Physicians open, 1(6), 1291–1296. https://doi.org/10.1002/emp2.12268

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/