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 non acute 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

Answer 1

1. Clinical manifestations :-

- sleep apnea

- high blood pressure

- ankle swelling

- shortness of breath

- pruritis

2. Factors that contribute to obesity

poor eating habits, sedentary lifestyles, environmental factors, genetic predisposition, metabolic, cultural, socioeconomic facors

#. diseases and disorders associated with obesity

asthma

cancers

stroke

cholecystitis

cholelithiasis

chronic back pain

coronary artery disease

type 2 diabetes

heart failure

hypercholesterolemia

hypertension

nonalcoholic fatty liver

obstructive sleep apnea

osteoarthritis

pulmonary embolism

#. medical management of obesity

1. lifestyle modifications

2. pharmacotherapy

3. bariatric surgery

#. lifestyle modification for obese patients

placing a person on a weight loss diet in conjunction with behavioral modification and exercise

1. diet therapy: most commonly prescribed therapy, problem- when patients aren't compliant with diet

2. acupuncture in combination with diet restrictions found to be effective in enhancing weight loss and improving dyslipidemia

3. hypnosis in combination with diet therapy- for stress reduction and energy intake reduction also has been shown to increase weight loss

#. pharmacologic management of patients with obesity

Orlistat (xenical)- prescription and OTC

reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats

side effects: increased frequency of bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, decrease absorption of some vitamins

multivitamin usually recommended/ should not be taken by pregnant or nursing women or transplant recipients

Lorcaserin (belvic)-

new antiobesity drug

acts by stimulating serotonin receptors in the satiety and appetite centers of the hypothalamus in the brain, thus curbing appetite

side effects- few and tend to diminish with continued use; these include headaches, dry mouth, fatigue, and nausea

#. bariatric surgery

the average weight loss after bariatric surgery in the majority of patients is approximately 25% to 35% of previous body weight within the first 18 to 24 months

comorbid conditions improve or may resolve: diabetes, hypertension, sleep apnea, dyslipidemia

So, biriatric surgery is one of the appropriate approche.

3. Staging of end stage renal disease :-

Stage 1- Kidney damage with normal GFR (90+ ml/min.)

Satge 2 - Kidney damage with mildly low GFR (60-89 ml/min.)

Stage 3 - Kidney damage with moderately low GFR (30-59 ml/min.)

Stage 4 - Kidney damage with severely low GFR (15-29 ml/min.)

Stage 5 - Kidney failure. End-stage Renal Disease- (GFR less than 1

#. Causative factors for ESRD are :-

Diabetes

Hypertension

GN

Cystic disease

4. Prevention of ESRD include :-

- Having healthy diet

- regular exercise

- medical checkup

- compliance to medications

- adoption of healthy lifestyle