Mr. C. Case Study Paper

Mr. C. Case Study Paper

Mr. C. Case Study Paper
Subjective and Objective Clinical Manifestations Present in Mr. C.
Mr. C is a 32-year-old single man seeking information about bariatric surgery to treat his obesity. Following assessment, he reports various subjective symptoms indicating that his weight is creating serious health problems. He reports that he has always been overweight, even as a child, and that he has gained around 100 pounds in the previous 2-3 years. For the last six months, he has also reported growing shortness of breath with exertion, swollen ankles, and pruritus.

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Swollen ankles and shortness of breath are objective clinical symptoms suggesting fluid retention and impaired circulation. These symptoms are most likely caused by Mr. C.’s severe obesity, which places significant strain on his heart and circulatory system. Itching or pruritus may well be caused by inadequate circulation or a skin disease related to obesity. Mr. C. also states to have sleep apnea and high blood pressure. Mr. C. attempts to control his hypertension by limiting his dietary salt intake, but his blood pressure remains quite high at 172/98 mmHg, showing that his hypertension is not well-controlled.
Mr. C’s substantial health difficulties are further supported by objective facts. His BMI is 45.1 kg/m2, putting him in Class II obesity. His weight is 134.5 kg, and he is 68 inches tall. His feet and ankles have 3+ pitting edema, indicating fluid retention and impaired circulation. His fasting blood glucose level of 146 mg/dL indicates uncontrolled diabetes, and his total cholesterol and triglyceride levels are high, while his HDL level is low, putting him at risk of heart disease. Serum creatinine of 1.8 mg/dL and BUN of 32 mg/dL indicate decreased kidney function, which may be connected to his diabetes and hypertension (Wedro, 2022).
Potential Health Risks for Obesity that are of Concern for Mr. C.
Obesity is a major risk factor for cardiovascular disease, which includes coronary artery disease, heart failure, and stroke. Mr. C. has elevated total cholesterol and triglyceride levels, as well as low HDL, which increases his risk of heart disease (Garg & Rustagi, 2018). High blood pressure is also a typical consequence of obesity, and Mr. C.’s blood pressure is significantly high, despite his efforts to regulate it by limiting dietary salt. Obesity elevates the risk of developing type 2 diabetes, and Mr. C.’s fasting blood glucose level of 146 mg/dL indicates that he has uncontrolled diabetes (Garg & Rustagi, 2018).
Obesity is a primary cause of sleep apnea, which causes a person’s breathing to stop and resume repeatedly during sleep. Mr. C. reports having sleep apnea, which might explain his shortness of breath and poor sleep quality. Obesity is a risk factor for renal disease, and Mr. C.’s increased blood creatinine and BUN values indicate that his kidney function is compromised. Mr. C.’s case may benefit from bariatric surgery to help him lose weight, enhance his cardiovascular health, control his diabetes, and improve his renal function.
Nevertheless, a thorough examination is required to establish if a patient is a good candidate for the procedure. Factors such as the patient’s age, overall health status, and willingness to make lifestyle changes must be considered before recommending bariatric surgery. Additionally, any underlying health issues, such as uncontrolled hypertension or diabetes, must be managed before surgery to reduce the risk of complications pre-op and post-op.
Mr. C.’s Functional Health Patterns
Based on the data presented, the following actual or possible concerns can be recognized when assessing each of Mr. C.’s functional health patterns:
1. Health-Perception-Health Management Pattern: Mr. C. reports having sleep apnea and high blood pressure, which he attempts to control by limiting his dietary salt intake, but still, his blood pressure is high, indicating that his control measures are ineffective. He also experiences shortness of breath worsening with activity, which suggests poor management of his weight and related health concerns.
2. Nutritional-Metabolic Pattern: Mr. C. has gained an estimated 100 pounds in the last 3 years, signifying poor dietary practices and insufficient physical activity. His fasting blood glucose level of 146 mg/dL, as well as his increased triglyceride and cholesterol readings, point to uncontrolled diabetes and impaired lipid metabolism.
3. Activity-Exercise Pattern: Mr. C. reports increasing breathlessness with activity, implying poor physical exercise. His 3+ pitting edema in bilateral feet and ankles could impede his capacity to participate in physical exercise, further limiting him to exercise.
4. Mr. C. reports experiencing sleep apnea, which may interfere with his ability to have comfortable sleep. This may add to his exhaustion and low energy levels, limiting his capacity to participate in physical exercise and control his weight, as well as worsening hypertension and elevated blood sugar.
5. Metabolic functional health: Mr. C. has actual concerns relating to his metabolic functional health pattern based on the information presented. To begin with, Mr.C’s fasting blood glucose level of 146 mg/dL indicates uncontrolled/ undiagnosed diabetes (National Kidney Foundation, 2022). Uncontrolled diabetes can cause several health consequences, including cardiovascular disease, renal damage, and nerve damage. Mr. C.’s increased triglyceride and cholesterol readings, on the other hand, suggest impaired lipid metabolism, according to National Kidney Foundation (2022). Elevated triglyceride and cholesterol levels raise the risk of cardiovascular disease, a serious health issue for obese people. Further, Mr. C.’s increased blood creatinine and BUN values indicate that his renal function is compromised (Whitney, 2021). The kidneys play a crucial role in metabolic and endocrine functions, such as controlling blood glucose levels and generating hormones that regulate blood pressure. Poor kidney function can result in several health issues, such as fluid and electrolyte imbalances and anemia (Whitney, 2021).
Stages Of Renal Disease That Lead To End-Stage Renal Disease
End-stage renal disease (ESRD) is the terminal stage of chronic kidney disease (CKD), a progressive disorder that impairs kidney function. The glomerular filtration rate, which measures kidney function, is used to classify CKD into five phases (GFR), according to Oshima et al. (2018).
Stage 1: Normal GFR in kidney injury (GFR > 90 mL/min/1.73 m2)
Stage 2: Mild GFR decrease (GFR = 60-89 mL/min/1.73 m2)
Stage 3: Moderate GFR reduction (GFR = 30-59 mL/min/1.73 m2)
Stage 4: Severe GFR decrease (GFR = 15-29 mL/min/1.73 m2)
Stage 5: Kidney failure (GFR less than 15 mL/min/1.73 m2 or dialysis dependant)
Mr. C.’s increased blood creatinine and BUN values indicate that he has stage 5 CKD or ESRD. ESRD can be caused by a variety of reasons, including uncontrolled diabetes, hypertension, autoimmune illnesses, and hereditary factors. Mr. C.’s uncontrolled diabetes and hypertension may have contributed to his ESRD, according to the information presented. Both disorders can cause renal blood vessel damage, resulting in reduced kidney function over time. Mr. C.’s increased BUN and creatinine levels indicate that his kidneys cannot adequately filter waste materials from his blood, which is a symptom of CKD. Mr. C.’s obesity may also have contributed to his ESRD (Oshima et al., 2018
ESRD Prevention and Health Promotion Opportunities
ESRD prevention and health promotion are critical components of chronic renal disease management and treatment (CKD). Patient education is critical to assisting patients in understanding their illness, successfully managing it, and preventing future worsening of their renal function. Blood Pressure and Blood Sugar Control is also an important health promotion message. Uncontrolled hypertension and diabetes are the major causes of CKD and ESRD, as stated by Faucon et al. (2019). Mr. C. should be taught how to frequently monitor his blood pressure and blood sugar levels, as well as how to take medications as recommended, to properly manage these illnesses.
Nutritional changes can be beneficial in controlling CKD and ESRD. Mr. C. should be informed about salt, potassium, and phosphorus-rich foods and advised to reduce his intake of these nutrients (Faucon et al., 2019). He should also be recommended to eat more fiber, fruits, and vegetables. Mr. C. should be informed of the need to take his medications exactly as recommended to control his disease and prevent the future worsening of his renal function. Mr. C. should further be encouraged to avoid nephrotoxic substances such as NSAIDs which can harm the kidneys and lead to CKD and ESRD.
Resources Available for ESRD Patients For Nonacute Care
Patients with end-stage renal disease (ESRD) require continuing and coordinated treatment to adequately manage their illness. A multidisciplinary strategy, including healthcare providers, can give ESRD patients complete support and medical care. Dialysis Centers are some of the options available for non-acute treatment for ESRD patients and the multidisciplinary approach can be useful to them. Social workers can assist ESRD patients in navigating the healthcare system and connecting them to options that can help them live a better life. They can also help patients deal with the emotional and social consequences of having ESRD (National Kidney Foundation, 2022). Others include dieticians and nephrologists.

References
Faucon, A.-L., Bobrie, G., & Clément, O. (2019). Nephrotoxicity of iodinated contrast media: From pathophysiology to prevention strategies. European Journal of Radiology, 116, 231–241. https://doi.org/10.1016/j.ejrad.2019.03.008
Garg, R., & Rustagi, T. (2018). Management of hypertriglyceridemia-induced acute pancreatitis. BioMed Research International, 2018, 1–12. https://doi.org/10.1155/2018/4721357
National Kidney Foundation. (2022). Chronic kidney disease (CKD). National Kidney Foundation. https://www.kidney.org/atoz/content/about-chronic-kidney-disease
Oshima, M., Toyama, T., Haneda, M., Furuichi, K., Babazono, T., Yokoyama, H., Iseki, K., Araki, S., Ninomiya, T., Hara, S., Suzuki, Y., Iwano, M., Kusano, E., Moriya, T., Satoh, H., Nakamura, H., Shimizu, M., Hara, A., Makino, H., … Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan. (2018). Estimated glomerular filtration rate decline and risk of end-stage renal disease in type 2 diabetes. PloS One, 13(8), e0201535. https://doi.org/10.1371/journal.pone.0201535
Wedro, B. (Ed.). (2022). Kidney Failure. In Palliative Medicine (pp. 443–451). Elsevier. https://doi.org/10.1016/b978-0-323-05674-8.50086-4
Whitney, S. (2021). Elimination complexities. Accessed 11th April 2023 from https://studyexcell.com/elimination-complexities/

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Evaluate the Health History and Medical Information for Mr. C., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.
Objective Data:
• Height: 68 inches; weight 134.5 kg
• BP: 172/98, HR 88, RR 26
• 3+ pitting edema bilateral feet and ankles
• Fasting blood glucose: 146 mg/dL
• Total cholesterol: 250 mg/dL
• Triglycerides: 312 mg/dL
• HDL: 30 mg/dL
• Serum creatinine 1.8 mg/dL
• BUN 32 mg/dl
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:
• Describe the subjective and objective clinical manifestations present in Mr. C.
• Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
• Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
• Explain the stages of renal disease that lead to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
• Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
• Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Rubric Criteria

Collapse All Rubric CriteriaCollapse All

Clinical Manifestations of Mr. M.

12 points

Criteria Description

Clinical Manifestations of Mr. M.

5. Target

12 points

Subjective and objective clinical manifestations are thorough.

4. Acceptable

10.68 points

Subjective and objective clinical manifestations are detailed.

3. Approaching

9.48 points

Subjective and objective clinical manifestations are present.

2. Insufficient

9 points

Subjective and objective clinical manifestations are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Subjective and objective clinical manifestations are omitted.

Diagnoses and Secondary Diagnoses

12 points

Criteria Description

Diagnoses and Secondary Diagnoses

5. Target

12 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are thorough.

4. Acceptable

10.68 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are detailed.

3. Approaching

9.48 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and evidence used to support the medical and nursing diagnosis are present.

2. Insufficient

9 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis are present, but lack detail or are incomplete. .

1. Unsatisfactory

0 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis is omitted.

Explanation of Expected Abnormalities During Nursing Assessment

18 points

Criteria Description

Explanation of Expected Abnormalities During Nursing Assessment

5. Target

18 points

A thorough discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. Strong rationale and evidence are provided for support.

4. Acceptable

16.02 points

A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support.

3. Approaching

14.22 points

A general discussion on the abnormalities a nurse would expect to find during a nursing assessment is presented. There are minor inaccuracies. Some rationale or evidence is provided for support.

2. Insufficient

13.5 points

An incomplete summary of some abnormalities a nurse would expect to find during a nursing assessment is presented. There are inaccuracies. No rationale or evidence is provided for support.

1. Unsatisfactory

0 points

A discussion of what abnormalities a nurse would expect to find during a nursing assessment is omitted; or, the expected findings are not relevant for the patient or his health status.

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

18 points

Criteria Description

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family.

5. Target

18 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is thorough.

4. Acceptable

16.02 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is detailed.

3. Approaching

14.22 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is present.

2. Insufficient

13.5 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family.is omitted.

Interventions for Support

18 points

Criteria Description

Discussion of interventions that can be put into place to support patient and his family

5. Target

18 points

Discussion of interventions that can be put into place to support the patient and his family is thorough.

4. Acceptable

16.02 points

Discussion of interventions that can be put into place to support the patient and his family is detailed.

3. Approaching

14.22 points

Discussion of interventions that can be put into place to support the patient and his family is present.

2. Insufficient

13.5 points

Discussion of interventions that can be put into place to support the patient and his family are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Discussion of interventions that can be put into place to support the patient and his family is omitted.

Actual or Potential Problems Based on Condition

18 points

Criteria Description

Discussion and rationale of four or more actual or potential problems faced by the patient

5. Target

18 points

Discussion and rationale of four or more actual or potential problems faced by the patient are thorough.

4. Acceptable

16.02 points

Discussion and rationale of four or more actual or potential problems faced by the patient are detailed.

3. Approaching

14.22 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present.

2. Insufficient

13.5 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present but lack detail or are incomplete.

1. Unsatisfactory

0 points

Discussion and rationale of four or more actual or potential problems faced by the patient are omitted.

Thesis, Position, or Purpose

6 points

Criteria Description

Communicates reason for writing and demonstrates awareness of audience.

5. Target

6 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

4. Acceptable

5.34 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.

3. Approaching

4.74 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

2. Insufficient

4.5 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

1. Unsatisfactory

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

Development, Structure, and Conclusion

6 points

Criteria Description

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

5. Target

6 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

4. Acceptable

5.34 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

3. Approaching

4.74 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

2. Insufficient

4.5 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.

1. Unsatisfactory

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

Evidence

6 points

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

5. Target

6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

4. Acceptable

5.34 points

Relevant evidence that includes other perspectives is used.

3. Approaching

4.74 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

2. Insufficient

4.5 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

1. Unsatisfactory

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

Mechanics of Writing

3.6 points

Criteria Description

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

5. Target

3.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

4. Acceptable

3.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3. Approaching

2.84 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

2. Insufficient

2.7 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

1. Unsatisfactory

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

Format/Documentation

2.4 points

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

5. Target

2.4 points

No errors in formatting or documentation are present.

4. Acceptable

2.14 points

Appropriate format and documentation are used with only minor errors.

3. Approaching

1.9 points

Appropriate format and documentation are used, although there are some obvious errors.

2. Insufficient

1.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

1. Unsatisfactory

0 points

Appropriate format is not used. No documentation of sources is provided.