Question

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 clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss 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 can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
5. 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.
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. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Answer 1

Mr.C has a bmi of 45.5 which clearly indicates he is an obese person . He works in a call centre which indicates his sedantry lifestyle which also contributes to his obesity.

Due to obesity he suffers from sleep apnea, high blood pressure, and the last 6 months he has shortness of breath, swollen ankle and pruritus .

If obesity continues in Mr.C it may lead to

• Cardiovascular disease
• Gall bladder disease
• Fatty liver disorders
• Diabetes
• Chronic kidney disease
• also leads to impotency

Thus BARIATRIC SURGERY is indicated in Mr.C because he is highly obese with a bmi of 45 and he also suffers from conditions like sleep apnea and high blood pressure .

Bariatric surgery is done between 18 to 60 yrs of age ,, where persons bmi is greater than 40 and has comorbid conditions like diabetes , sleep apnea , blood pressure .

FUNCTIONAL HEALTH PROBLEMS IN Mr.C

• Serum creatinie level elevated to 1.8 normal range is 0.6to1.2 which indicates decreased kidney function or renal hypoperfusion due to cardiac failure.
• He has a increased systolic bp of 172 and diastolic of 98 which is a serious condition to be noted
• There is increased total cholesterol, triglycerides and decreased HDL which is indicative of dyslipidemia
• BUN is elevated to 32 from a normal range of 12 to 20 which is also indicative of renal or cardiac etiology
• Due to increased blood urea he also suffers from pruritis .

Thus the above conditions can be treated by proper medications and healthy lifestyle changes and mr.c is indicative of bariatric surgery which helps to resolve or reverse the above listed conditions.

STAGING OF ESRD :

• Stage 1 gfr greater or equal to 90 =normal
• Stage 2 gfr 60 to 89ml/min =mild
• Stage 3a gfr 45 to 59 ml/min =moderate
• Stage 3b gfr 30 to 44ml /min =moderate
• Stage 4 gfr 15 to 24 ml/min =severe
• Stage 5 gfr less than 15 ml/min= end stage renal disease

For avoidance of future deterioration of renal status mr.c must be educated to

• Reduced consumption of sodium , potassium, phosphorous in his diet
• Avoid processed foods and advice to increase intake of vegetables and fruits .

RESOURCES AVAILABLE FOR ESRD PATIENTS

• Dialysis including renal and peritoneal dialysis
• Kidney transplant
• Supportive care with decreased protein diet
• And treating other conditions like hypertension which is a secondary cause .

A study done in 2016 by kun li etal on bariatric surgery on renal function in obese patient suggests reduction in hyperfiltration , proteinuria and albuminuria after bariatric surgery

A study done in 2017 by alex r chung etal on bariatric surgery and kidney related outcomes suggests decrease in albuminuria and proteinuria