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.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Answer 1

1. Describe the clinical manifestation of Mr.C

• ​​​​​high blood pressure (hypertension )
• Shortness of breath with activity
• 3+pitting edema bilateral feet and ankles
• Increased blood sugar level(hyperglycemia )
• increased cholesterol level(dyslipedemia)

2. Potential health risk for obesity that are of concern for Mr. C

• Coronary artery disease (high BP 172/98mm of hg, high cholesterol 250mg/dl,triglycerides 312mg/dl
• End stage renal disease (S. creatinine 1.8,BUN 32 both are increased and 3+pitting edema bilateral feet and ankles
• Diabetes mellitus (FBS146 mg/dl is higher level )
• Sleep apnea
• Cancer (BMI is 46kg/m2)

3. Discuss bariatric surgery appropriate intervention

The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effect which can be removed or improved by successful weight loss in patient who have been unable to sustain weight loss by non surgical means and a criteria is BMI more than 40

Here Mr. C has belongs to the extreme obesity category and have multiple effect.

4.Assess each of Mr. C 's functional health pattern and describe the health problems

• Health perception -He concern about obesity and seek surgical intervention. He tries to control by restricting dietary sodium
• Nutrional: Height 68 inches and weight 134.5kg BMI is 46 He comes under extreme obesity. Health problems are shortness of breath with activity , sleep apnea)
• Activity-Physical inactivity leads to heart disease, osteoarthritis
• Sleep:sleep apnea

5.Explain the staging of ESRD

• Stage1: Reduved renal reserve  ​​​​​ characterised by 40-70% of loss of nephron functon. Patient is asymptomatic
• Stage2: Renal insufficiency 75-90% nephrone function is loss. S. Creatinine and BUN rise. Kidney loss ability to concentrate urine.
• ESRD- Final stage less than 10%of nephrone function

Contributing factors : Here S.creatinine 1.8mg/dl BUN 32mg/dl and patient have 3+pittin edema bilateral feet and ankles

6.ESRD prevention and health promotion

• control risk factors such as high BP,high sugar level
• Make life style changes ie, healthy eating to prevent kidney damage
• Use medication for lower BP to slow CKD progress
• Avoid over the counter pain medication like ibuprofen

7.Typeof resources

• ​​​​​​​Education snd employment resources
• Family and partner resources
• Insurance resources

Reference :

• Suddharth and Brunner(2003), Text book of medical surgical nursing, 10th edition Mosby publication philadelphia, pp-1326-1327
• CDC National chronic kidney disease fact sheet, 2017