NRS 410 WEEK 3 Case Study: Mr. C. Paper

NRS 410 WEEK 3 Case Study: Mr. C. Paper

NRS 410 WEEK 3 Case Study: Mr. C. Paper

Case Study: Mr. C.
Describe the subjective and objective clinical manifestations present in Mr. C.
Based on his weight and height, Mr. C has a body mass index (BMI) of 47.9, making him morbidly obese and at risk for developing type 2 diabetes, diabetes and coronary heart disease. His pulse rate, blood pressure, and breathing all point to high blood pressure, stage 2, which he is aware of and tries to control by reducing the sodium in his diet, but this persists despite his efforts. Diabetes is likely given his high BMI and fasting blood glucose (FBS) level of 146 mg/dL. Mr. C has hyperlipidemia, as evidenced by his lipid panel results of 250 mg/dL for cholesterol, 30 mg/dL for HDL, and 312 mg/dL for triglycerides. The blood creatinine level is 1.8 mg/dL, a BUN of 32 mg/dL, and 3+ pitting edema in both feet and ankles. He admits he has been overweight since childhood, increasing his risk for diabetes, depression, and cardiovascular illnesses.

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Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
Mr. C’s weight increases his risk for numerous diseases and conditions, such as type 2 diabetes, stroke, coronary heart disease, hypertension, sleep apnea, osteoarthritis, fatty liver disease, and chronic renal disease. He may be a suitable candidate for bariatric surgery, which can help him lose weight and retake control of his health. Eligibility criteria for bariatric surgery include a BMI of 40 or more, the absence of any medical or psychological issues of any severity, age between 18 and 65, and abstinence from substance abuse or abstinence from alcohol and tobacco use for three months before the procedure. (Sudlow et al., 2020) Patients must also adhere to a healthy lifestyle by eating well, taking their medications as prescribed, exercising regularly, joining a support group, and keeping their scheduled appointments. Mr. C’s weight loss will have further health benefits, as metabolic surgery is an effective treatment for sleep apnea, hypertension, obesity, and diabetes (Sudlow et al., 2020). Mr. C will benefit from bariatric surgery because it addresses more than just his weight and includes behavioral modification and mental health counseling.
Mr. C’s Functional Health Patterns
Health awareness: Mr. C. thinks his weight is a problem and wants to learn more about bariatric surgery. However, he does not seem to realize how his weight affects his wellness and the risks he will be taking. He has a history of hypertension and sleep apnea but seems unconcerned about either. His lack of awareness underestimates the seriousness of his health problem.
Health-Management: Mr. C is taking a low-sodium diet in a bid to manage his elevated blood pressure. His blood pressure and diabetes are not adequately addressed, and he is not taking any medications. For the past six months, he has also seen increased pruritus and shortness of breath with activities. He needs to better manage his health by learning to keep his weight, blood pressure, and sugar levels in check.
Nutritional: Mr. C.’s total triglyceride, cholesterol, and HDL levels are all outside of acceptable ranges, and his FBS is also high, 146 mg/dL. He has put on around 100 lbs in the last 2–3 years due to bad eating habits and inactivity. He needs to consult a nutritionist to create a diet to help him reach his goals.
Metabolic: Mr. C. may be diabetic since his FBS level is 146 mg/dL, which is high. His HDL, cholesterol, and triglyceride levels are all elevated, indicating a metabolic condition. He has to be evaluated further to identify and treat any metabolic problems accordingly.
Activity-Exercise: Mr. C. has severe edema in both ankles and notes that his shortness of breath worsens with physical exertion. Even if he wanted to, he would be unable to engage in physical activity due to this, which may lead to further weight gain and negative consequences for his health. He has to collaborate with his medical staff to create a healthy fitness regimen that will help enhance his health.
Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
ESRD occurs progressively over five distinct phases. The initial phase is kidney damage, but with a normal glomerular filtration rate of over 90 ml/min (Martinusen et al., 2020). The second stage progresses with kidney damage, but the FGR is decreased mildly to 60 to 89 ml/min. Stage three has a moderately decreased GFR of 30 to 59 ml/min, while the fourth stage presents a GFR of 15 to 29 ml/min (Martinusen et al., 2020). The last stage has a GFR of less than 15 ml/min, indicating kidney failures.
A convergence of events caused Mr. C’s ESRD. His hypertension and diabetes, which can lead to kidney damage if left untreated, had a history of being inadequately managed. His increased levels of serum creatinine and BUN suggested renal injury. In addition, he was overweight and had high cholesterol, all of which are risk factors for developing kidney disease. All of these factors probably contributed to Mr. C’s ESRD.
ESRD Health Promotion and Prevention
Despite the lack of a cure for ESRD, treatment options such as kidney transplants and renal dialysis are available to patients. According to Andreoni (2021), kidney transplants are safe for patients of any age, provided they are devoid of cancer and infections and have accessibility to psychological evaluations to address any issues that may occur. As the GFR drops below 15 ml/min and the kidney function drops to between 85 and 90%, dialysis becomes a viable treatment option for ESRD (Andreoni, 2021). Hence, Mr. C has to know that sticking to his dialysis regimen is crucial for keeping his body free of hazardous wastes. As his kidneys cannot filter out all the toxins in his blood, he needs guidance on altering his diet to help. Mr. C should consume more protein and less potassium, salt, and phosphorus. He also has to learn why he must start and maintain a regular exercise program as a person with ESRD.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
Group therapy and multidisciplinary approaches involving nephrologists, nutritionists, doctors, and emergency resources are available to ESRD patients. Patients with ESRD can get strength and encouragement from their peers and role models by participating in a support group (Evans et al., 2021). Their healthcare givers are invaluable resources for teaching them about their renal health, ESRD risk factors, and symptoms. Dietitians educate and support patients in adopting a diet that slows or stops renal deterioration. Dialysis machines and other essential supplies are available at dialysis clinics or can be provided for home use (Evans et al., 2021). With the help of a social worker, the patient’s health insurance can provide for other essential resources like transport and housing. Social workers are crucial in facilitating their return to the workforce and realizing their potential.
Conclusion
The illness processes highlighted by Mr. C’s case study span various conditions caused by obesity and poor lifestyle choices. He can lessen his risk of many diseases by having bariatric surgery. If he eats well and continues to have ESRD, he can choose between dialysis and a kidney transplant. The case study demonstrates that nurses may improve treatment for ESRD patients by listening to the client’s perspectives and teaching them about their condition and the resources available for enhancing their health.
 
References
Andreoni, A. (2021). Kidney transplant program specific reporting and transplant metrics. Current Opinion in Organ Transplantation, 27(1), 70–74. https://doi.org/10.1097/mot.0000000000000947
Evans, M., Lewis, D., Morgan, R., Yousef, Z., Patel, C., & Strain, D. (2021). A narrative review of chronic kidney disease in clinical practice: Current challenges and future perspectives. Advances in Therapy, 39(1), 33–43. https://doi.org/10.1007/s12325-021-01927-z
Martinusen, D., Marin, G., Cheng, E., & Lau, W. (2020). Chronic kidney disease and end-stage renal disease. Renal Medicine and Clinical Pharmacy, 45–115. https://doi.org/10.1007/978-3-030-37655-0_4
Sudlow, A., Pournaras, J., & Osborne, A. (2020). Bariatric surgery. Surgery (Oxford). https://doi.org/10.1016/j.mpsur.2020.08.00

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WEEK 3 NRS 410

Case Study: Mr. C.

Requires Lopeswrite
Assessment Description
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:
1. Height: 68 inches; weight 134.5 kg
2. BP: 172/98, HR 88, RR 26
3. 3+ pitting edema bilateral feet and ankles
4. Fasting blood glucose: 146 mg/dL
5. Total cholesterol: 250 mg/dL
6. Triglycerides: 312 mg/dL
7. HDL: 30 mg/dL
8. Serum creatinine 1.8 mg/dL
9. 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:
1. Describe the subjective and objective clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
3. 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.)
4. Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
5. 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.
6. 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.
You are required to submit this assignment to LopesWrite.

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RUBRIC

Case Study: Mr. C. – Rubric

Rubric Criteria

Clinical Manifestations of Mr. C.

Criteria Description
Detail of subjective and objective clinical manifestations.

Potential Health Risks for Obesity and Bariatric Surgery

Criteria Description
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention.

Functional Health Patterns

Criteria Description
Discussion of at least five actual or potential problems identified from the functional health patterns assessment, and rationale for each.

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

Criteria Description
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD.
Health Promotion and Prevention Opportunities for ESRD

Criteria Description
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach

Criteria Description
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues.

Thesis, Position, or Purpose

Criteria Description
Communicates reason for writing and demonstrates awareness of audience.

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

Development, Structure, and Conclusion

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

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.

Evidence

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

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

Mechanics of Writing

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

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

No errors in formatting or documentation are present.

RESOURCES
Pathophysiology: Clinical Applications for Client Health
Read Chapter 3 in Pathophysiology: Clinical Applications for Client Health. Note: Table 3.4 is incorrect, and should say low protein diet instead of high protein diet. … Read More
View Resource

Acute Kidney Failure
Read “Acute Kidney Failure,” located on the Mayo Clinic website.
https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

Chronic Kidney Disease (CKD) Symptoms and Causes
Read “Chronic Kidney Disease (CKD) Symptoms and Causes ,” located on the National Kidney Foundation website (2022).
https://www.kidney.org/atoz/content/about-chronic-kidney-disease

Estimated Glomerular Filtration Rate Decline and Risk of End-Stage Renal Disease in Type 2 Diabetes
Read “Estimated Glomerular Filtration Rate Decline and Risk of End-Stage Renal Disease in Type 2 Diabetes,” by Megumi et al., fro
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=131037700&site=eds-live&scope=site

Kidney Failure (Symptoms, Signs, Stages, Causes, Treatment, and Life Expectancy)
Read “Kidney Failure (Symptoms, Signs, Stages, Causes, Treatment, and Life Expectancy),” by Wedro, located on the MedicineNet web
… Read More
https://www.medicinenet.com/kidney_failure/article.htm

Nephrotoxicity of Iodinated Contrast Media: From Pathophysiology to Prevention Strategies
Read” Nephrotoxicity of Iodinated Contrast Media: From Pathophysiology to Prevention Strategies,” by Faucon, Bobrie, and Clement,
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0720048X19300993

Optional- Ascites: A Common Problem in People With Cirrhosis
For additional information, the following is recommended:
“Ascites: A Common Problem in People With Cirrhosis,” by Chalasan
… Read More

Ascites: A Common Problem in People with Cirrhosis

Optional- Changes in Glomerular Filtration Rate and Outcomes in Patients With Atrial Fibrillation
For additional information, the following is recommended:
“Changes in Glomerular Filtration Rate and Outcomes in Patients With
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0002870317304052

Optional- Management of Hypertriglyceridemia Induced Acute Pancreatitis
For additional information, the following is recommended:
“Management of Hypertriglyceridemia Induced Acute Pancreatitis,”
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130921988&site=eds-live&scope=site

Optional- Pathophysiological, Molecular and Therapeutic Issues of Nonalcoholic Fatty Liver Disease: An Overview
For additional information, the following is recommended:
“Pathophysiological, Molecular and Therapeutic Issues of Nonalcoholic
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsdoj&AN=edsdoj.77dea836b8444414af8c314454c86ceb&site=eds-live&scope=site

Optional- Recurrent Acute Pancreatitis During a Ketogenic Diet—A Case Report and Literature Review
For additional information, the following is recommended:
“Recurrent Acute Pancreatitis During a Ketogenic Diet—A Case R
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=152462962&site=ehost-live&scope=site

Optional- Screening and Management of Hepatitis C: Use Education to Dispel the Myths About the Disease and Increase Screening and Treatment
For additional information, the following is recommended:
“Screening and Management of Hepatitis C: Use Educat
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131761864&site=eds-live&scope=site

Optional- Social Determinants of Health: Understanding the Basics and Their Impact on Chronic Kidney Disease
For additional information, the following is recommended:
“Social Determinants of Health: Understanding the Basics and Their Im
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=149941863&site=ehost-live&scope=site&custid=s8333196&groupid=main&profile=ehost

Optional- Using Learning Science to Optimize Chronic Kidney Disease Education for Patients and Providers
For additional information, the following is recommended:
“Using Learning Science to Optimize Chronic Kidney Disease Education
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=155481796&site=ehost-live&scope=site&custid=s8333196&groupid=main&profile=ehost

Optional- Variceal Bleeding in Alcoholic Liver Cirrhosis – A Short Review
For additional information, the following is recommended:
“Variceal Bleeding in Alcoholic Liver Cirrhosis – A Short Revie
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=135073058&site=eds-live&scope=site