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Assessment Description
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:
- Describe the subjective and objective clinical manifestations present in Mr. C.
- Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
- Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can 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.)
- Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
- Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
- 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. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of three 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.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Expert Solution Preview
Introduction:
Mr. C., a 32-year-old male, is seeking information for possible bariatric surgery for his obesity. In this critical thinking essay, we will evaluate Mr. C.’s health history and medical information for potential diagnosis and interventions. We will evaluate the subjective and objective clinical manifestations presented by Mr. C., potential health risks, and appropriate interventions. We will also assess Mr. C.’s functional health patterns, explain the stages of renal disease that lead to ESRD, consider prevention and health promotion opportunities, and describe resources available for ESRD patients.
1. Describe the subjective and objective clinical manifestations present in Mr. C.
Subjective clinical manifestations reported by Mr. C. include obesity, sleep apnea, high blood pressure, increasing shortness of breath with activity, swollen ankles, and pruritus over the last six months. Objective data shows that Mr. C. has a BMI of 48.7 and his weight has increased by approximately 100 pounds in the last two to three years. His systolic and diastolic blood pressure levels are 172 mmHg and 98 mmHg, respectively, his heart rate is 88 beats per minute, and respiratory rate is 26 breaths per minute. Mr. C. also has 3+ pitting edema in both feet and ankles, fasting blood glucose of 146 mg/dL, total cholesterol of 250 mg/dL, triglycerides of 312 mg/dL, HDL of 30 mg/dL, serum creatinine of 1.8 mg/dL, and BUN of 32 mg/dL.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
Obesity increases the risk for several health conditions, including hypertension, diabetes, heart disease, stroke, sleep apnea, and certain cancers. Mr. C. has already developed hypertension, sleep apnea, and type 2 diabetes. Bariatric surgery can be considered a viable option for individuals with a BMI above 40 or those with a BMI of 35 or higher with comorbidities. Mr. C.’s BMI is 48.7, which meets the criteria for bariatric surgery. However, before surgery, Mr. C. should undergo further evaluation to assess his candidacy for surgery and determine if he has adequate social support.
3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can identify from the functional health patterns and provide the rationale for each.
Health-perception: Mr. C. perceives himself as overweight and is seeking information regarding possible bariatric surgery for his obesity. Potential problem: lack of knowledge regarding the risks and benefits of bariatric surgery.
Health-management: Mr. C. reports restricting dietary sodium to control his hypertension. Potential problem: poor glycemic control evidenced by fasting blood glucose of 146 mg/dL.
Nutritional: Mr. C. has gained approximately 100 pounds in the last two to three years. Potential problem: poor dietary habits resulting in uncontrolled weight gain.
Metabolic: Mr. C. has type 2 diabetes and high levels of total cholesterol and triglycerides. Potential problem: increased risk for cardiovascular disease.
Elimination: No significant issues reported.
Activity-exercise: Mr. C. reports increasing shortness of breath with activity, which could suggest physical deconditioning. Potential problem: decreased functional capacity and activity intolerance.
4. Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
Chronic kidney disease (CKD) progresses through five stages, from mildly reduced kidney function (stage 1) to complete kidney failure (stage 5) or ESRD. Mr. C.’s creatinine level of 1.8 mg/dL and BUN of 32 mg/dL suggest he is in stage 4 CKD, which is characterized by severe kidney damage and eGFR between 15 and 29 mL/min/m2. Contributing factors to Mr. C.’s ESRD could be his poorly controlled hypertension, uncontrolled diabetes, and hyperlipidemia.
5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
ESRD prevention and health promotion opportunities include improving glycemic and blood pressure control, controlling hyperlipidemia, maintaining a healthy weight, and avoiding nephrotoxic medications. Patient education for ESRD should include information about a renal-friendly diet consisting of reduced protein, phosphorus, and sodium, monitoring blood pressure and blood glucose, adhering to medication and treatment plans, regular exercise, and the importance of regular follow-up care with healthcare providers.
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. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
ESRD patients may require nonacute care such as hemodialysis or peritoneal dialysis, nutritional and psychosocial support, and physical rehabilitation. Several resources are available for ESRD patients, including medical equipment and supplies, transportation services, financial assistance, and emotional and social support groups. A multidisciplinary approach to ESRD care would be beneficial and involves a team of healthcare providers, including nephrologists, primary care physicians, dieticians, social workers, and physical therapists. The team works together to manage all aspects of ESRD care, including dialysis, medication management, nutrition counseling, lifestyle interventions, and emotional and mental health support.