Nursing Case Study: Mr C

Nursing Case Study: Mr C

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. Nursing Case Study: Mr C

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. Nursing Case Study: Mr C

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

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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.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Nursing Case Study: Mr C

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Brief Introduction

The nurse’s professional activity is related not only to the provision of appropriate care for the patient but also to the establishment of the primary diagnosis, confirmed by analysis of laboratory data and information on the pathophysiology. In this case, Mr. C. has overweight problems, which at first glance, appear to cause complications. The signs of respiratory and cardiovascular dysfunctions observed during the history collection may be additional evidence of the obesity seen in Mr. C. This work is reduced to a detailed discussion of the described scenario in the context of the nurse’s RN-BSN professional activity.

Description of a Clinical Case

The study of health threats and prescription of a particular treatment should be preceded by a comprehensive analysis of Mr. C’s current health state. According to the attached clinical history, the man has high blood pressure: at the norm of 120/80 mmHg, 172/98 mmHg was registered (“High blood pressure symptoms and causes,” 2020). During physical activity, whether climbing stairs or moving around the room, Mr. C. begins to suffocate: this is due to increased breathing. Problems with the kidneys or the cardiovascular system can be recorded indirectly: the examination of the patient found that he suffers from 3+ pitting edema bilateral feet and ankles. Finally, a biochemical blood test of the man showed overestimated results in glucose and cholesterol levels. According to “Diabetes” (2020) and “Cholesterol levels” (2020), the norm for healthy middle-aged men is glucose concentration lower than 140 mg/dL and lipophilic alcohol content not more than 200 mg/dL. These clinical manifestations can lead to serious health risks for Mr. C.

In general, it should be recognized that several clinical signs can confirm a disappointing diagnosis for the patient. Excessive blood pressure, in combination with cholesterol and triglyceride, indicates the potential for coronary heart disease. On the other hand, excess glucose concentration may indicate a previous stage of diabetes. Anxiety caused by cognitive stress due to the development of serious diseases, and probably physical pain due to ulcers, leads to a disturbance of habitual activity, including expressed as night apnea. The man has the final stage of renal failure, as evidenced by high creatinine levels in the blood and increased levels of urea in the blood. Indirect confirmation of the diagnosis is also dictated by the presence of bilateral foot edema: the body’s tissues contain an excess of fluids. Finally, it is well known that a high body mass index is associated with the development of serious chronic diseases, including cancer (Greenlee et al., 2017). The calculated patient index exceeds the mark of 44 kg/m2, which is an indicator of undesirable consequences. Given the dynamics of weight gain and the patient’s predisposition to obesity, bariatric medicine is a suitable strategy for therapy.

Meanwhile, Mr. C.’s functional health is at risk in several ways. The cognitive perception of the circumstances in which he has been placed makes the man worry and seek a solution to the problem; for example, he tries to limit the consumption of sodium. Although no data are available, it is difficult to say whether the patient considers himself sexually active: most likely, due to obesity problems, he has not had a relationship for a long time. The physical component of health is also in decline since the patient suffers from breathlessness even under elementary efforts. His sleep is disturbed by periodic apnea seizures, which can cause insomnia and anxiety. Finally, there is no doubt that the patient will benefit from a change in diet: it is necessary to add more water and fiber and reduce the consumption of trans fats and carbohydrates, and then Mr. C. will go for the correction.

Serious attention should be paid to the discussion of kidney failure, probably developed in a patient against the background of obesity associated with diabetes. The final stage of the failure is a dynamic process of urinary system dysfunction, which includes: (i) asymptomatic destruction of the nephron by 70% and (ii) almost complete destruction of the kidneys with loss of ability to concentrate urine. The opportunistic sources of the disease contributing to the development are high blood pressure, diabetes mellitus, nephritis, and renal tissue inflammation down to cysts. Although the patient shows signs of the final stage of the disease, compliance with some preventive measures may make sense. This applies to a strict diet, transparent control of sugar consumption, taking antihypertensive drugs, including diuretics. The man will have to get used to the new rules of physical activity and strict compliance with the doctor’s instructions.

A serious step to maintain the dynamics of recovery is the training provided by the nurse. The health care provider must tell the patient about the necessity and relevance of following the rules and bans, to offer alternatives to bad habits or certain foods. For instance, this applies to meat products such as fatty bacon, sausages, or ham: the main objective is to reduce sodium levels in the menu (Medical Advisory Committee, 2020). Mr. C. should be aware of the prohibition of taking any medication not prescribed by a doctor, even if they are necessary to eliminate pain. To control the disease and study the problem, the man can use some resources available: (i) insurance coverage, (ii) dialysis department, (iii) informational training programs, (iv), and local patient support funds.

While there are many examples of people living with ESRD, the presence of a diagnosis does somewhat limit the patient’s freedom of life. This applies to both adherence to a strict diet and movement. Patients change their eating habits and control sodium consumption (Michishita et al., 2017). Although the usual lifestyle is modified by regular visits to the dialysis department, people can continue to work, and any travel must be planned in advance. A person with a diagnosis should watch their health more closely and consult a doctor.

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Case Study: Mr. C. RN-BSN-prepared Nurse

Critical Thinking Case Study: Mr. C

Diseases manifest differently, either as a presentation of an underlying condition or predisposing risk factor. A proper understanding of the underlying illness confers proper management by the healthcare providers based on the presenting complaints. In Mr. C’s case, he has morbid obesity, an underlying primary condition that has predisposed him to various chronic illnesses. He reportedly has elevated blood pressure, diabetes mellitus, sleep apnea, dyspnea on exertion, dyslipidemia, and chronic renal disease. Laboratory investigations show deranged kidney functions. the discussion below aims to highlight clinical manifestations, and risk factors of obesity, assess functional health patterns and consider renal disease (end-stage) management.

Question 1: Clinical Manifestations

Clinical manifestation of the disease is derived from the patient’s symptoms (subjective data), examination of the patient, as well as laboratory investigations (objective data). Mr. C is a case of obesity which has predisposed him to other illnesses. He currently complains of dyspnea on exertion, sleep apnea, and skin itchiness. He also has swollen limbs. On examination, Mr. C has 3+ bilateral pitting edema. His laboratory findings indicate that his fasting blood sugar is 146 mg/dl. This points to diabetes as per (Chatterjee & Davies, 2018), which is defined by blood glucose >126mg/dl. Body weight and height give an estimation of the general health status of an individual, a parameter called body mass index (BMI), which estimates the overall body store of fat. (Shan et al., 2019). A BMI of 18.5- 24.5 is considered normal, whereas a BMI of 25.5- 29.9 is overweight. BMI of above 30 is obese, graded into 3 classes with BMI > 40 being morbid obesity. Obesity is a risk factor for diabetes, hypertension, and renal disease. Increased accumulation of fat in the blood vessels leads to narrowing and resultant hypertension. Laboratory findings show derangement in his lipid profile. He has elevated cholesterol levels (normal is <200mg/dl) as well as hypertriglyceridemia (normal- 40- 140). His HDL is low (normal is >40 in a male adult). He also has deranged urea and creatinine levels pointing to kidney problems. He presents with itchiness, which can e attributed to the accumulation of urea, pointing to uraemic pruritus. This could be a chronic renal disease, with obesity as the primary complicating condition. Uraemia points to end-stage renal disease (ESRD).

Question 2

Various risk factors contribute to obesity, some of which can be identified in Mr. C’s condition. These risk factors include hypertension, deranged lipid profile, sleep apnea, and diabetes mellitus. Obesity may complicate by gout, congestive heart failure, osteoarthritis, coronary arterial disease, and accumulation of gallstones (cholelithiasis). He works at a catalog telephone center. This could be a risk for a sedentary lifestyle, and a risk of obesity. modification of obesity should be aimed at weight reduction. Bariatric surgery aims to cut down on body fats and reduce symptomatic obstructive sleep apnea. Mr. C is a candidate for bariatric surgery owing to his hypertension, BMI >40, and other complicating factors for obesity. he, however, may not be qualified for this operation due to having the chronic renal disease.

Question 3: Functional Health Pattern (FHP)

Functional health patterns in nursing involve one’s perception of his/ her health, health management programs, and role relationship and impact (Khatiban et al., 2019). Mr. C’s case shows that he has a good perception of his health. He understands that he is overweight and has made previous attempts to cut down on weight.  Health management programs employed include salt and fat restrictions. These previous trials have failed hence he has sought further intervention. He reports having unresolving obesity which could be exacerbated by the sedentary nature of his work.  Sleep apnea and exertional dyspnea are a result of the accumulation of fat on the neck and pharyngeal wall. This poses difficulty in exercise, further worsening his obesity. patients should be educated on the impact of obesity on general life productivity. They need to understand how obesity impacts sexual health and general stress tolerance.

Question 4: Staging of ESRD and Contributing Factors

End-stage renal disease (ESRD) can be classified into 5 stages based on the kidney functions, assessed as glomerular filtration rate (GFR). Stage one is a GFR > 90ml/ min, stage 2 is GFR between 60- 89ml/ min, stage 3 is between 30- 59 ml/min with moderate loss in kidney function. A renal GFR of 15-29 is stage 4 with a severe loss in function. Stage 5 is an end-stage renal disease requiring dialysis (Chen et al., 2019). Etiological factors implicated in ESRD in his case are hypertension and diabetes. Others include Urinary tract infections and acute kidney injury. Chronic kidney stones also contribute to developing ESRD.

Question 5: Preventive Measures

Lifestyle modifications are the hallmark of the prevention of the development of renal disease. Control of diabetes and blood pressure is key. Control of dyslipidemias with antilipemic drugs prevents disease progression to CKD. Dietary modification limited to strict salt and fat intake reduction is key. Prevention should be aimed at weight reduction by undertaking aerobic exercise (Chen et al., 2019). Adherence to medications is essential. Bariatric surgery is also a possible preventive strategy in management.

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Non- acute Resources in ESRD and Multidisciplinary Approach

ESRD poses a significant challenge to the quality of life of these patients, hence impacting morbidity and mortality. Regular dialysis is a possible non-acute service available for these patients, aimed at improving kidney function. Personal monitoring of blood pressure and glucose levels using insulin pumps and personal BP machines prove to be useful. These patients are over- dependent, hence care should be diversified. A multi-disciplinary approach, involving nephrologists, physicians, nutritionists, and urologists, should, therefore, be adopted. (Collister et al., 2019).

Conclusion

Obesity is a significant health determinant, predisposing to several chronic illnesses, including but not limited to ESRD. Nursing care should be aimed at wholesomely evaluating the patient and providing preventive measures. Patient education also plays important role in preventing disease progression. Non-acute resources should be included in their management.

References

Cholesterol levels: What you need to know. (2020). Medicine Plus. Web.

Diabetes. (2020). Mayo Clinic. Web.

End-stage renal disease. (2019). Mayo Clinic. Web.

End stage renal disease (ESRD). (2019). Johns Hopkins. Web.

Greenlee, H., Unger, J. M., LeBlanc, M., Ramsey, S., & Hershman, D. L. (2017). Association between body mass index and cancer survival in a pooled analysis of 22 clinical trials [PDF document]. Web.

High blood pressure symptoms and causes. (2020). CDC. Web.

Medical Advisory Committee. (2020). Kidney-friendly diet for CKD. American Kidney Fund. Web.

Michishita, R., Matsuda, T., Kawakami, S., Tanaka, S., Kiyonaga, A., Tanaka, H.,… & Higaki, Y. (2017). The association between changes in lifestyle behaviors and the incidence of chronic kidney disease (CKD) in middle-aged and older men. Journal of Epidemiology, 27(8), 389-397. Web.

Chatterjee, S., & Davies, M. J. (2018). Accurate diagnosis of diabetes mellitus and new paradigms of classification. Nature Reviews. Endocrinology, 14(7), 386–387. https://doi.org/10.1038/s41574-018-0025-1

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: A review: A review. JAMA: The Journal of the American Medical Association, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

Collister, D., Pyne, L., Cunningham, J., Donald, M., Molnar, A., Beaulieu, M., Levin, A., & Brimble, K. S. (2019). Multidisciplinary chronic kidney disease clinic practices: A scoping review. Canadian Journal of Kidney Health and Disease, 6, 2054358119882667. https://doi.org/10.1177/2054358119882667

Khatiban, M., Tohidi, S., & Shahdoust, M. (2019). The effects of applying an assessment form based on the health functional patterns on nursing student’s attitudes and skills in developing the nursing process. International Journal of Nursing Sciences, 6(3), 329–333. https://doi.org/10.1016/j.ijnss.2019.06.004

Shan, M.-J., Zou, Y.-F., Guo, P., Weng, J.-X., Wang, Q.-Q., Dai, Y.-L., Liu, H.-B., Zhang, Y.-M., Jiang, G.-Y., Xie, Q., & Meng, L.-B. (2019). Systematic estimation of BMI: A novel insight into predicting overweight/obesity in undergraduates: A novel insight into predicting overweight/obesity in undergraduates. Medicine, 98(21), e15810. https://doi.org/10.1097/MD.0000000000015810

Song, N., Liu, F., Han, M., Zhao, Q., Zhao, Q., Zhai, H., Li, X.-M., Du, G.-L., Li, X.-M., & Yang, Y.-N. (2019). Prevalence of overweight and obesity and associated risk factors among adult residents of northwest China: a cross-sectional study. BMJ Open, 9(9), e028131. https://doi.org/10.1136/bmjopen-2018-028131

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