Health History

Health History

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 900-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.

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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.

Case Study: Mr. C

The nurse training that prepares nurses for RN-BSN roles equip nurses with relevant skills, knowledge and techniques used to critically analyze the pathophysiology of various conditions, their predisposing factors, the pharmacological and therapeutic intervention measures and how to help the patient recover and continue living a quality life. This paper aims to critically analyze the condition of Mr. C, his medical history and explain the rationale behind the various health promotion measures take to ensure the patient recovers from obesity.

Clinical Manifestations

Mr. C is a single 32-year-old man who presents himself at the outpatient health facility for an enquiry about the possibility of him having a bariatric surgery for his obesity. He reports of struggling with maintaining his weight since his childhood. He notes that in the past two to three years he has gained about 100 pounds. He has no history of metabolic disorders; however, he is struggling with sleep apnea and high blood pressure. He has been managing his blood pressure by restricting the use of dietary sodium. In the past half a year, Mr. reports of experiencing shortness of breath when doing any activity, swollen ankles and pruritus.

Potential Health Risks for Obesity

Obesity has been strongly linked to high rates of mortality that results from conditions caused by obesity. The potential health risks related to obesity include; hypertension (high blood pressure), dyslipidemia, type 2 diabetes, coronary heart disease and stroke among others. Obesity is defined as a condition of one having a weight of greater or equals to twenty percent above the ideal weight (Jiang et al., 2016). Obesity results from the accumulation of fats around vital organs like the heart, liver, kidneys, lungs and the colon. The fats results to hypercholesteremia and free fatty acids in the blood. These triggers the formation of angiotensin I and II. The angiotensinogen causes and elevated blood pressure by mechanism of angiotensin II. This stimulates the vasoconstriction, inducing water sodium retention and trigger the release of aldosterone hormone hence high blood pressure (Jiang et al., 2016).

Is Bariatric Surgery the Best Intervention for Mr. C?

According to the National Institute of Health (NIH), the criteria for a patient to be subjected to the bariatric surgery include; the patient should have a BMI (Kg/m2) of above 40 and patients BMI range of 35-40 and with other associated comorbid conditions (Wolfe et al., 2016). This criterion fits Mr. medical condition because his BMI is within the range of 35-40 and he is already battling a comorbidity of hypertension that is related to obesity hence making the bariatric surgery and appropriate intervention measure for his obese condition.

Assessment of the Functional Health Patterns of the Patient

The nursing procedures require the assessment of the patient’s functional health patterns (Khatiban et al., 2019). This is a concept that was first developed in 1987 by nurse Marjory Gordon. It involves 11 functional patterns, they include; health perception, nutritional- metabolic, elimination, activity- exercise, sleep-rest, cognition- perceptual, self-perception, role-relationship, sexuality-reproductive, coping-stress tolerance and value-belief patterns (Functional Health Patterns – M. Gorden, n.d.). Mr. C has already a self-perception and notes that he has always been heavy since his childhood. The fact that Mr. C is 32-year-old and still single could be an indicator of the functional health pattern of role-relationship and sexuality- reproductive. The obese condition could be hindering him from establishing and sustaining a long-term relationship with a partner. The other possible functional health pattern that Mr. exhibits is the sleep-rest pattern since he has reported of suffering from sleep apnea. The fact that Mr. C works at a catalog telephone center could be hindering him from physical exercise and activity hence functional health pattern of activity- exercise is affected.

Staging of End-Stage Renal Disease and Contributing Factors

The end stage kidney disease (ESRD) is the stage five of the chronic disease. The staging is done by assessing the functioning of the kidneys. It is the final stage of kidney disease and the performance of the kidney is just about 10-15 percent of the normal functioning, where the glomerular filtration rate (GFR) is less than 60mL/minute for the same time (Benjamin & Lappin, 2019). At this moment the kidney functioning and efficiency is highly compromised and purification, elimination and hormone secreting enzyme functions are greatly impaired. In the staging of the ESRD the risk factors considered include; diabetes, hypertension, kidney problems, teenage obesity, use of certain medications, and the race.

ESRD Health Promotion Measures and Education for Mr. C

Patient education has been associated with greater success in promoting better kidney health. The educational programs encompass the use of self -management support, incorporation of technology, and community engagement programs. The education program should be targeted to individuals with progressive diseases and the efficiency of the program is promoted through utilization of interdisciplinary teams’ collaboration (Narva et al., 2015). Additionally, Mr. C should be sensitized on the need to adopt a more active lifestyle and take up regular physical exercises.

Type of Resources Available for ESRD Patients for Non-Acute Care

There are various efforts by both the state and federal governments and private agencies to promote better care for patients with chronic kidney diseases. Some of the resources that have been utilized include the integration of mobile technology in the self-management and care for patients with end stage kidney diseases. Since the chronic kidney diseases are associated with a number of various comorbidities, it is imperative for the healthcare organizations handling these patients to enhance multidisciplinary care. This will ensure a holistic approach to the treatment and improve the general quality of life of the patient towards recovery or to prevent further deterioration of the renal functioning (Fluck & Taal, 2018).

References

Benjamin, O., & Lappin, S. L. (2019, November 15). End-Stage Renal Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499861/

Fluck, R. J., & Taal, M. W. (2018). What is the value of multidisciplinary care for chronic kidney disease? PLOS Medicine, 15(3), e1002533. https://doi.org/10.1371/journal.pmed.1002533

Functional Health Patterns – M. Gorden. (n.d.). Www.currentnursing.com. https://www.currentnursing.com/theory/functional_health_patterns.html

Jiang, S.-Z., Lu, W., Zong, X.-F., Ruan, H.-Y., & Liu, Y. (2016). Obesity and hypertension. Experimental and Therapeutic Medicine, 12(4), 2395–2399. https://doi.org/10.3892/etm.2016.3667

Khatiban, M., Tohidi, S., & Shahdoust, M. (2019). The effects of applying an assessment form based on the health functional patterns on nursing student’s attitude 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

Narva, A. S., Norton, J. M., & Boulware, L. E. (2015). Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care. Clinical Journal of the American Society of Nephrology, 11(4), 694–703. https://doi.org/10.2215/cjn.07680715

Wolfe, B. M., Kvach, E., & Eckel, R. H. (2016). Treatment of Obesity. Circulation Research, 118(11), 1844–1855. https://doi.org/10.1161/circresaha.116.307591

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