Critical Thinking Essay on Mr. C Case Study

Critical Thinking Essay on Mr. C Case Study

Mr. C is a 32-year-old obese patient who has gained about 100 pounds in the last 2-3 years. Even though there is no evidence of any metabolic disease from the previous medical evaluations, he has a blood pressure of 172/98mmHg, which is very high. He also has sleep apnea and experiences shortness of breath with activity. Besides, his ankles are swollen, and he has been experiencing pruritus for the past 6 months. Currently, Mr. C has elevated fasting blood glucose (146mg/dl), total cholesterol (250mg/dl), triglycerides (312mg/dl), HDL (30mg/dl), serum creatinine (1.8mg/dl), and BUN 32 (mg/dl). He also has 3+ pitting edema bilateral feet and ankles. This paper focuses on an analysis of Mr. C’s health condition and what he needs to do to avoid developing renal failure.

Several health risks of obesity should be of concern to Mr. C. Obese patients are at risk of kidney disease, hypertension, type 2 diabetes mellitus, cardiovascular diseases, and stroke (Parmar, 2018). For him to avoid being predisposed to these conditions, he needs to reduce his weight. Although bariatric surgery would help Mr. C reduce weight, it is currently inappropriate for him. Bariatric surgery should be done when the patient has attempted other means of weight loss. For instance, he should try other methods of weight loss, such as regular exercises and a medically monitored weight loss program, before considering bariatric surgery. Moreover, bariatric surgery would expose him to risks such as stomach obstruction, esophagus dilation, and anesthesia-related risks.

Several problems can be identified in Mr. C’s functional health patterns. Based on his health perception/health management pattern, it would be difficult to convince him to use other methods of weight loss other than bariatric surgery. He thinks his obesity has been there since childhood, and the only option is bariatric surgery. Based on his self-perception that he has always been obese, he might feel stressed while searching for ways to reduce his weight. This might make him develop depression. His activity-exercise pattern shows his movements are minimal since he works at a telephone catalog center. This might be one of the reasons why he is obese and thus developing conditions related to obesity, such as hypertension. His lack of activity also means he has a  low exercise tolerance, and this makes him experience shortness of breath when involved in an activity. Looking at his sleep-rest pattern, he experiences sleep apnea. Sleep apnea increases the risk of health problems such as diabetes mellitus, stroke, and hypertension (Javaheri et al., 2017). These health problems could lead to end-stage renal failure (ESRD).

The staging of ESRD is done based on the glomerular filtration rate (GFR). There are five different stages of ESRD. In stage 1, the kidney is damaged, and the GFR is normal (greater than 90ml/min). Stage 2 has a mild reduction in the glomerular filtration rate. Patients with stage 2 end-stage renal disease have a GFR of 60 to 89ml/min. Stage 3 ESRD is divided into stage 3a and stage 3b. In stage 3a, the GFR is 45-59ml/min, while that of stage 3b is 30-44 ml/min. In stage 4 ESRD, there is a severe reduction in GFR. Patients with stage 4 ESRD have a GFR of 15-29ml/min. Patients with stage 5 ESRD are said to have kidney failure; their GFR is less than 15ml/min.

When assessing the risk factors of ESRD, it is important to consider high blood pressure and diabetes mellitus. A blood pressure of 172/98 mmHg implies Mr. C has hypertension. Even though it has not been stated that Mr. C has diabetes mellitus, there is the possibility that he could be suffering from the condition due to the elevated levels of fasting blood glucose. Both hypertension and diabetes mellitus could make him develop end-stage renal disease.

For the prevention of future events, restoration of health, and avoidance of deterioration of kidney function, it is vital to educate Mr. C on various things. First, he should be educated about the factors that could lead to end-stage renal disease. He should be notified that both diabetes and hypertension are potential risk factors for ESRD. He should thus be advised to adopt measures that can help him prevent these conditions. For instance, he should be advised to exercise regularly and take adequate fruits and vegetables. Besides helping him reduce his weight, dietary changes will also help him control his blood glucose levels. Effective control of blood glucose levels prevents patients from developing complications of diabetes mellitus (Bellomo, 2018). Moreover, he needs to regularly visit the hospital to check his blood pressure and blood sugar levels. In case he is asked to take antihypertensive or antidiabetic medications, he should be advised to be compliant with the medications. In addition, he should continue restricting salt intake to manage high blood pressure.

Several types of resources and multidisciplinary approaches can be beneficial to ESRD patients for nonacute care. ESRD patients can interact with nutritionists, nurses, physicians, and nephrologists. Nutritionists can guide patients on their diet, thus helping them control conditions like diabetes. Support groups can also help ESRD patients since patients can share important information that is beneficial to them. Non-acute care patients can also make regular visits to the renal units and make use of devices such as dialysis machines.

All in all, Mr. C’s health condition predisposes him to several other conditions, such as renal failure. He is an obese patient, and this obesity predisposes him to several other conditions such as diabetes mellitus and hypertension. Even though weight loss would benefit him, bariatric surgery may not be the most appropriate method. He also needs to be educated on several things for his health to stop deteriorating.

References

Bellomo, R. (2018). Acute glycemic control in diabetics. How sweet is oprimal? Pro: Sweeter is better in diabetes. Journal of Intensive Care, 6(1), 5–7. https://doi.org/10.1186/s40560-018-0336-2

Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J. A., Khayat, R., Javaheri, S., Malhotra, A., Martinez-Garcia, M. A., Mehra, R., Pack, A. I., Polotsky, V. Y., Redline, S., & Somers, V. K. (2017). Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. Journal of the American College of Cardiology, 69(7), 841–858. https://doi.org/10.1016/j.jacc.2016.11.069

Parmar, M. (2018). Obesity and Type 2 diabetes mellitus. Integrative Obesity and Diabetes, 4(4), 1–2. https://doi.org/10.15761/iod.1000217

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Critical Thinking Essay on Mr. C Case Study

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:

• 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:

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.
   

   Critical Thinking Essay on Mr. C Case Study

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