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Case Study-Mr C

Case Study-Mr C

Clinical Manifestations in Mr. C.

Mr. C is obese and is exhibiting clinical manifestations of high blood pressure. His heart rate is above normal at 88RR (UPMC, 2015). He also has fluid accumulation on his ankle area and feet because of being overweight and not engaging in movement as he ought to. The ideal fasting blood glucose reading is less than 100, yet that of Mr. C is 146, which means he is developing or has developed diabetes (Diabetes Action n,d). He is also hyperglycemic with a cholesterol reading of 250mg/dL, Triglycerides: 312 mg/dL, and HDL: 30 mg/dL. The serum creatinine levels are too high at 1.8 mg/dL and may be causing edema in the patient’s feet and ankles and contributing to insomnia. The patient’s kidneys need to be assessed because of the high levels of BUN, which currently read 32 mg/dl (Cunha, 2019).

The potential health risks for obesity that are of concern for Mr. C. and whether bariatric surgery is an appropriate intervention.

Obesity is a medical condition characterized by the accumulation of high body fat and which increases the probability of other medical conditions developing as well. Mr. C is at risk of diabetes; HTN; high blood fats; heart attack resulting from stroke, heart failure and coronary heart disease; joint and bone complications as weight puts excessive pressure on these areas and leads to osteoarthritis; sleep apnea that results in daytime fatigue, work problems, and poor attention; liver problems and gall stones; and some form of cancers such as colon cancer (Upadhyay et al., 2018).

Mr. C is a high-risk patient for bariatric surgery because of several factors. The predictive factors of severe post-operation complications and mortality should be used in evaluating the risk-to-benefits ratio, in an objective manner. The main risk factors for bariatric surgery, which some of the patients already exhibit, include obstructive sleep apnea; high BMI; male gender; diabetes and insulin resistance; functional disability; tobacco use; cardiovascular disease; hypoalbuminemia; and age (Garg et al., 2016). After losing weight, the patient may have retardation of glomerular filtration rate (GFR) loss though there may be an increase in oxalate stones frequency. The main hyperoxaluria threat is renal oxalosis, which is most times irreversible and which results in persistent renal failure. The causes are a reduction in calcium binding to the oxalate because of calcium saponification resulting in fat malabsorption, increased oxalate permeability because of increased colon mucosa permeability triggered by reduced oxalobacter formigenes colonization, and also an increase in the bile salts (Upala et al., 2016).

Five actual or potential problems can you identify from the functional health patterns and provide the rationale for each

Health Perception and Health Management Pattern: The patient has some detrimental health habits that have continued to promote his weight gain. He may be over-eating and consuming unhealthy food choices, hence the weight gain. It is also possible that he smokes tobacco as a contributing factor to his kidney failure.

Nutrition and Metabolism Pattern: The patient states that he has been overweight since childhood an indication that his nutritional intake is unhealthy. He has not indicated being diagnosed with a metabolic disease, though the obesity could be genetic or behavioral from an early stage.

Elimination Pattern: The patient has urinary excretory problems, as seen from his lab work. He has high levels of creatinine and BUN, which indicates that his urine consistency is abnormal, and this could be affecting his elimination as well.

Activity and Exercise Pattern: the patient does a desk job at a catalog telephone center. The job more than likely requires prolonged hours of sitting and very little exercise. This contributes to his weight gain and also to his foot and ankle edema.

Sleep and Rest Pattern: The patient has pointed out that he has sleep apnea, and this could be because of his excessive weight. Obese persons often suffer from apnea because fat deposits in the upper respiratory tract cause a narrowing of the airway; muscle activity decreases, and this leads to apneic and hypoxic episodes and, consequently, sleep apnea.

Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.

End-stage renal disease (ESRD) is the permanent and last stage of kidney disease where the kidneys can no longer function on their own. A patient at this point needs a kidney transplant and dialysis to survive (Albertus et al., 2016). The main cause of kidney disease is diabetes which the patient already exhibits symptoms of. HTN is also another cause of ESRD. Both HTN and diabetes damage the kidneys as time progresses and as is the case with Mr. C. Other risk factors are being male, older age and African American (Albertus et al., 2016).

Source: KidneyFund (n.d)

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.

There are several things that the patient can be educated on to slow down the progression of ESRD (Assadi, 2019). Mr. C will need to lose weight first before even opting for bariatric surgery. This can be achieved through changing his diet and incorporating exercises into his routine. He needs to consume low-sodium and low-fat foods as well as high-fibre foods. He will also need to come to the clinic for regular cholesterol check-ups. Mr. C will be started on blood sugar control medication, hypertensive medication, and hyperlipidaemia medication. That said, the patient will be educated on the need for medication adherence to ensure that his conditions are controlled and to avoid negative health outcomes. Mr. C will need to go on a tobacco cessation program as well.

References

Albertus, P., Morgenstern, H., Robinson, B., & Saran, R. (2016). Risk of ESRD in the United States. American Journal of Kidney Diseases68(6), 862-872.

Assadi, F. (2019). The growing epidemic of chronic kidney disease: preventive strategies to delay the risk for progression to ESRD. Primordial Prevention of Non Communicable Disease, 57-59.

Cunha, J.P. (2019). Creatinine Blood Tests. https://www.emedicinehealth.com/creatinine_blood_tests/article_em.htm

Diabetes Action (n.d). Questions And Answers – Symptoms Of Diabetes. https://diabetesaction.org/questions-symptoms.

Garg, T., Rosas, U., Rivas, H., Azagury, D., & Morton, J. M. (2016). National prevalence, causes, and risk factors for bariatric surgery readmissions. The American Journal of Surgery212(1), 76-80.

KidneyFud (n.d). Stages of Chronic Kidney Disease. https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/

Upadhyay, J., Farr, O., Perakakis, N., Ghaly, W., & Mantzoros, C. (2018). Obesity as a disease. Medical Clinics102(1), 13-33.

Upala, S., Jaruvongvanich, V., & Sanguankeo, A. (2016). Risk of nephrolithiasis, hyperoxaluria, and calcium oxalate supersaturation increased after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Surgery for Obesity and Related Diseases12(8), 1513-1521.

UPMC (2015). What Is a Healthy Heart Rate? Understanding Your Heart Rate. https://share.upmc.com/2015/07/healthy-resting-heart-rate/

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Question 


Case Study-Mr C

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.

    Case Study-Mr C

    Case Study-Mr C

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