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 clinical manifestations present in Mr. C.
- Describe the potential health risks for obesity that are of concern for Mr. C. Discuss 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 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.)
- Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
- 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.
- 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.
Expert Solution Preview
Introduction:
This critical thinking essay aims to evaluate the health history and medical information of Mr. C., a 32-year-old single male who seeks information regarding possible bariatric surgery for obesity. This essay will critically evaluate Mr. C.’s potential diagnosis and intervention(s) by describing the clinical manifestations present, potential health risks, functional health patterns, staging of end-stage renal disease, ESRD prevention and health promotion opportunities, and resources available for ESRD patients.
1. Describe the clinical manifestations present in Mr. C.
Mr. C. presents clinical manifestations that include shortness of breath with activity, swollen ankles, and pruritus over the last six months. Objective data revealed that his blood pressure was 172/98 mmHg, and he had a heart rate of 88 beats per minute and respiratory rate of 26 breaths per minute. He also exhibited pitting edema in both feet and ankles. His fasting blood glucose level was recorded at 146 mg/dL with total cholesterol level of 250 mg/dL, triglycerides level of 312 mg/dL, HDL level of 30 mg/dL, serum creatinine level 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. Discuss whether bariatric surgery is an appropriate intervention.
Obesity can increase the risk factors for hypertension, cardiovascular disease, respiratory difficulties, diabetes mellitus, renal dysfunction, and stroke. Considering Mr. C.’s high blood pressure, high glucose levels, and elevated lipid markers, his potential health risks for obesity include complications with the cardiovascular system, metabolic system, and renal function. Bariatric surgery can be an appropriate intervention after considering the clinical manifestations present and potential health risks. However, a physician’s evaluation of his condition must be prioritized before surgery.
3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems that 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.)
Health-perception: Mr. C. lacks knowledge about the effects of obesity on his body systems.
Health-management: Mr. C. demonstrates poor self-management of his health, as he does not seek medical attention until the late stages of his health deterioration.
Nutritional: Mr. C.’s diet seems to be high in sodium, considering he imposes sodium restrictions in his diet but has developed edema in his feet and ankles.
Metabolic: Mr. C. has high blood glucose, cholesterol, and triglycerides levels indicating poor metabolic health.
Elimination: Mr. C.’s high levels of creatinine and BUN indicate that his kidneys are not working optimally, which can lead to electrolyte imbalances and further complications.
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
ESRD can be categorized into five stages based on the degree of renal failure, GFR rate, and creatinine level. Mr. C.’s serum creatinine level of 1.8 mg/dL indicates that he is in stage three or four of ESRD. Contributing factors to consider include hypertension, diabetes, glomerulonephritis, and polycystic kidney disease.
5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for the prevention of future events, health restoration, and avoidance of the deterioration of renal status.
Prevention and health promotion in ESRD patients include proper blood pressure control, diabetes management, and a low-sodium, well-balanced diet. It is also important to keep a healthy weight, manage stress, and engage in regular physical activity. Mr. C. should be educated on the importance of compliance with medication and lifestyle modifications and the negative impact of uncontrolled hypertension, diabetes, and metabolic syndrome on renal function.
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.
ESRD patients can seek non-acute care resources such as prescription and medication assistance programs, outpatient rehabilitation for physical and occupational therapy, vocational rehabilitation programs, and mental health services. Multidisciplinary teams can comprise of a nurse, social worker, physician, dietician, and therapist to provide holistic care and address various aspects affecting ESRD patients. Transportation service, Medicaid programs, home care assistance, and social security benefits can be resources for patients with ESRD.
