NRS 410 Case Study Mr. C.

Sample Answer

Health problems such as obesity have immense health impacts on the affected populations. Nurses and other healthcare providers utilize patient-centered evidence-based interventions that enable patients to overcome obesity and its associated complications. Therefore, this paper explores a case study involving an obese patient. It explores health risks, prevention, health issues, and resources available for the patient.

Subjective and Objective Clinical Manifestations

Subjective clinical manifestations refer to the patient’s information about experience with a health problem. The subjective clinical manifestations in the case study include being always heavy even when he was a child, gaining about 100 pounds in the last 2-3 years, sleep apnea, high blood pressure, swollen ankles, shortness of breath with activity, and pruritus over the last six months.

Objective clinical manifestations refer to the data that healthcare providers obtain during patient assessment. The objective clinical manifestations in the case study include obesity, hypertension, 3+ pitting edema on ankles and bilateral feet, hyperglycemia, hypercholesteremia, elevated triglyceride levels, and serum creatinine and BUN.

Health Risks

Mr. C is increasingly predisposed to health risks for obesity. One of them is diabetes. The client’s fasting blood sugar level is elevated, translating into either hm being diabetic or prediabetic. The other risk identified from the objective data is hypertension. The patient currently has elevated blood pressure. Obesity causes the deposition of fats in the arteries and other small blood vessels, which increase the risk of other cardiovascular complications such as atherosclerosis (Cercato & Fonseca, 2019).

Mr. C is also at a high risk of developing stroke as a complication of cardiovascular events such as hypertension. The patient is also at a risk of kidney failure. His serum BUN and creatine levels are currently elevated, which imply that he has reduced renal functions (Stahl & Malhotra, 2022). The additional health risks that Mr. C is predisposed include obstructive sleep apnea and non-alcohol fatty liver disease.

Bariatric surgery is appropriate for Mr. C. Accordingly, obese patients with commodities are the ideal candidates for bariatric surgery. In addition, patients with a BMI of 40 kg/m2 or above without any medical problems and no excessive risk of bariatric surgery are also ideal candidates for the procedure. The other conditions that influence if a patient can undergo bariatric surgery include the presence of other conditions such as hyperlipidemia, hypertension, type 2 diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, asthma, severe urinary incontinence, venous stasis disease, and impaired quality of life would qualify to undergo bariatric surgery (Stahl & Malhotra, 2022). Mr. C meets most of these conditions, hence, bariatric surgery is ideal for him.

Functional Health Patterns

Mr. C has actual and potential health problems that should be prioritized in the nursing care plan. One of the actual health problems is activity intolerance related to excessive body weight gain as evidenced by his shortness of breath with activity. The implication is that his quality of life is lowered since he cannot engage independently in most activities of daily living such as exercising.

The second actual health problem is impaired blood glucose control as evidenced by elevated blood glucose level. The elevated blood glucose levels predispose the patient to complications such as renal disease, hypoglycemia, and diabetic retinopathy and neuropathy. The third actual health problem from functional health patterns is impaired renal function as evidenced by elevated BUN and creatinine levels.

The impairment could be attributed to hypertension and diabetes, which are due to obesity. This makes it necessary to implement interventions that aim at preserving optimum renal functioning. The fourth actual health problem is impaired cardiac function as evidenced by elevated blood pressure and other markers such as triglyceride and total cholesterol levels. Interventions that ensure optimum cardiac functioning should be adopted (Blüher, 2020).

The last actual problem is altered sleep pattern as evidenced by the patient reporting obstructive sleep apnea. Cumulatively, these health problems affect Mr. C’s health and wellbeing.

Stages of Renal Disease

Renal disease occurs in stages that ultimately results in end-stage renal disease (ESRD). The first stage, stage 1 is characterized by glomerular filtration rate of above 90. This stage is asymptomatic but the kidneys may not be functioning optimally as expected. Stage 2 is characterized by glomerular filtration rate of 60-89. This stage is also asymptomatic and often diagnosed when patients come to the hospital for other health problems such as diabetes and hypertension.

Stage 3 is characterized by glomerular filtration rate of 30-59. Patients experience symptoms such as fluid retention, fatigue, and alterations in urinary patterns. Stage 4 is when glomerular filtration rate is severe and ranges between 15 and 29. The symptoms experienced in this stage include vomiting, nausea, edema of the extremities, and impaired cognitive function. 2A glomerular filtration rate of less than 15 is the fifth stage of kidney failure, also known as ESRD (Ammirati, 2020). The factors that contributed to Mr. C developing ESRD include obesity, hypercholesteremia, elevated triglycerides, hypertension, and diabetes.

ESRD Prevention and Health Promotion Opportunities

The health education offered to Mr. C on ESRD prevention should focus on several aspects. One of them is the need for weight loss. Weight loss should be a priority to reverse additional complications such as hypertension and diabetes mellitus type 2. The other aspect of health education that should be of focus is dietary modification. Mr. C she be educated about the importance of avoiding diets rich in sodium. Sodium increases fluid retention, worsening the complications of renal disease and cardiac system. The other aspect of health education is avoiding over the counter medications.

Over the counter medications such as acetaminophen are nephrotoxic. As a result, the patient should be educated on the importance of avoiding any medications that may damage the kidneys further. Mr. C should also be educated about the importance of maintaining active physical activity. Accordingly, physical activity should be encouraged, as it promotes weight loss, cardiac functioning, and glycemic control (Gonsalez et al., 2019; Lv & Zhang, 2019). Lastly, Mr. C should avoid alcohol intake or abuse of any substance, which may alter the normal kidney functioning.

Resources for ESRD Patients

Patients with ESRD have access to a wide range of resources they can utilize for their health. They include social support groups, hospice care, home health, and clinical toolkits that have been developed to guide clinicians in providing the care that the affected patients need. The other resource is the ESRD networks that help patients to access their needed services such as dialysis and kidney transplant services.

Conclusion

This paper has explored Mr. C’s case study. It has examined his clinical manifestations and health risks associated with obesity. The paper has also explored the prevention strategies for ESRD and its stages as well as resources available for the patient. Mr. C should implement interventions that minimize the risk of obesity complications. Nurses should also link him with the available community resources.

References

• Ammirati, A. L. (2020). Chronic Kidney Disease. Revista Da Associação Médica Brasileira, 66, s03–s09. https //doi.org/10.1590/1806-9282.66.S1.3
• Blüher, M. (2020). Metabolically Healthy Obesity. Endocrine Reviews, 41(3), bnaa004. https //doi.org/10.1210/endrev/bnaa004
• Cercato, C., & Fonseca, F. A. (2019). Cardiovascular risk and obesity. Diabetology & Metabolic Syndrome, 11(1), 74. https //doi.org/10.1186/s13098-019-0468-0
• Gonsalez, S. R., Cortês, A. L., Silva, R. C. da, Lowe, J., Prieto, M. C., & Silva Lara, L. da. (2019). Acute kidney injury overview From basic findings to new prevention and therapy strategies. Pharmacology & Therapeutics, 200, 1–12. https //doi.org/10.1016/j.pharmthera.2019.04.001
• Lv, J.-C., & Zhang, L.-X. (2019). Prevalence and Disease Burden of Chronic Kidney Disease. In B.-C. Liu, H.-Y. Lan, & L.-L. Lv (Eds.), Renal Fibrosis Mechanisms and Therapies (pp. 3–15). Springer. https //doi.org/10.1007/978-981-13-8871-2_1
• Stahl, J. M., & Malhotra, S. (2022). Obesity Surgery Indications And Contraindications. In StatPearls. StatPearls Publishing. http //www.ncbi.nlm.nih.gov/books/NBK513285/