NRS 410 Case Study: Mr. C.
NRS 410 Case Study Mr. C.
The Case Scenario
The 32year old Mr. C who has had the challenge of being overweight since childhood presents to the clinic inquiring about the possibility of undergoing bariatric surgery. He has been experiencing leg swelling, shortness of breath during physical activity, and pruritus. He is employed at the catalog telephone center and reports to have both high blood pressure and sleep apnea that he has been managing by restriction of sodium intake. His laboratory assessment reveals deranged kidney functions, hyperglycemia, and dyslipidemia whereas his physical assessment shows morbid obesity and high blood pressure. The purpose of this assignment is to explain Mr. C’s clinical manifestation and the risks he faces due to obesity, then discuss the functional health patterns identified in the case study, describe the staging of end-stage renal disease (ESRD) and ESRD prevention strategies that could be employed for Mr. C.
Mr. C’s Clinical Manifestations
Mr. C reports that he has had problems with being overweight since childhood with 100pounds being gained in the previous 2-3years. Currently, he complains of sleep apnea, high blood pressure, easy fatigability, ankle edema, and pruritus. Further, his objective assessment reveals high blood pressure, elevated fasting blood sugar, dyslipidemia, and deranged liver function owing to the elevated BUN and serum creatinine. Most of these patients’ presentations are related to being obese.
Patients who are obese have increased fat storage in the adipose tissues. These fat deposits increase the fatty acid availed to the liver for conversion into triglycerides which contributes to dyslipidemia (Vekic et al., 2019). When the serum cholesterol and lipids are deposited into the vessel walls, they lead to atherosclerosis by stiffening the vessel walls and narrowing the lumen. Given the blood pressure depends on the size of the lumen of the vessel, the narrowed lumen due to dyslipidemia would lead to hypertension (Shariq & McKenzie, 2020). Further, obesity also leads to increased serum levels of glucose due to increased conversion of lipids to glucose. The obese patients are therefore at risk of type 2 diabetes mellitus (DM) (Ortega et al., 2020). Hypertension, diabetes mellitus, and dyslipidemia are risk factors for kidney disease.
Hypertension, diabetes mellitus, and dyslipidemia may lead to atherosclerosis including that of renal arteries. This impairs the blood supply to the kidney parenchyma which can then lead to its necrosis, scarring, and eventual kidney damage (de Leeuw et al., 2018). Kidney damage and kidney failure affect the excretion of water, toxins such as urea, and even creatine thus leading to edema of the legs and uremic pruritus (Vekic et al., 2019). Clinical manifestations of Mr. C, therefore, developed as complications of obesity.
Potential Health Risks of Obesity
The potential risks of obesity as has manifested in Mr. C include type 2 DM, hypertension, and dyslipidemia. These may then cause narrowing of the vessels thus predisposing to cardiovascular events such as myocardial infarction, cerebrovascular events including stroke, and even end organ damages such as renal failure (Shariq & McKenzie, 2020). These complications should be addressed by strict lipid control and weight reduction strategies.
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One of the strategies for weight reduction is a bariatric surgery that involves modifying the gastrointestinal tract to bypass the gastric bypass to minimize the absorption of nutrients (Arterburn et al., 2020). These surgeries would be appropriate for Mr. C whose weight reduction has not been possible through modification of diet. He has also met other conditions for the surgery including being diabetic and hypertensive, morbidly obese but with a weight less than 450pounds thus appropriateness of the surgery (Nedeljkovic-Arsenovic et al., 2020).
Functional Health Patterns
Different health patterns are recognized in the Case study including health perception, health management, healthcare prevention measures, and complications of the underlying disease. Mr. C has recognized that he has problems of being overweight manifested since childhood and the recent weight gain of 100pounds. His perception of health is further evident by his need for bariatric surgery. He reports that he has attempted to manage his weight by employing salt reduction in his diet which would serve both as health management and nutrition modification. His metabolic disturbances are identified in the laboratory reports that indicate hyperglycemia, dyslipidemia, and renal derangements with elevated BUN and creatinine. Some of these disturbances such as elevated BUN and creatinine resulted from deranged renal elimination processes. He also reports a sedentary lifestyle due as he works as a telephone cataloguer thus contributing to the weight challenges. His sleep is affected by the weight, he is cognizant of his current health challenge, although the role relationship, sexuality, and stress coping strategies are not reported. From such assessment, we can conclude that the health problems include sleep apnea, hypertension, end-stage renal disease, and obesity and their complications.
Stages of End-Stage Renal Disease (ESRD)
Different criteria are used during the staging of ESRD with most of them considering the glomerular filtration rates (GFR), sodium retention or creatinine clearance rates, and severity of albuminuria (Chen et al., 2019). Stage 1 ESRD has kidney damage with GFR of more than ≥90 mL/min/1.73 m2, stage 2 GFR between 60–89, stage 3 GFR between 30-59, stage 4 has GFR of 15-29 whereas stage 5 is a renal failure with GFR less than 15 (de Leeuw et al., 2018). In Mr. C some of the predisposing factors included hypertension, dyslipidemia, obesity, and diabetes mellitus which posed a risk of kidney damage.
ESRD Prevention and Health Promotion Measures
ESRD prevention seeks to modify the risk factors that have been identified in Mr. c. Some of the strategies that would be emphasized during patient education are encouraging him to adopt aerobic exercise, dietary modification, or undergoing bariatric surgery to help with weight reduction (Shariq & McKenzie, 2020). Other measures also include strict blood pressure, glycemic and lipid control through adherence to prescribed medication, daily weight monitoring, and regular monitoring of blood sugar and serum lipid levels (Vekic et al., 2019). These preventive and promotive measures help reduce the deterioration of the kidney damage thus enhancing the health status of the patient.
Resources for Non-acute Care of ESRD Patients
ESRD reduces an individual’s performance thus the need for non-acute care to improve the long-term management of the disease. The patient has deranged kidney performance with reduced renal clearance and is thus at risk of accumulation of toxins that may pose different risks to the patient including uremic gastritis, pruritis, and encephalopathy. This leads to the need for hemodialysis twice weekly. The patients may therefore be given a portable hemodialysis device with vascular access (Nowak & Kusztal, 2021). They may also benefit from renal rehabilitative services, financial assistance, and job-protected leaves to facilitate their recovery.
In conclusion, the assessment of Mr. C’s case study informs the need for bariatric surgery. The obesity has predisposed him to develop diabetes, dyslipidemia, hypertension, and sleep apnea that would be addressed by lifestyle modification. It has also led to ESRD that will require non-acute care services such as portable hemodialysis devices, rehabilitative services, financial assistance, and job-protected leaves to assist in enhanced health status.
Arterburn, D. E., Telem, D. A., Kushner, R. F., & Courcoulas, A. P. (2020). Benefits and risks of bariatric surgery in adults: A review: A review. JAMA: The Journal of the American Medical Association, 324(9), 879–887. https://doi.org/10.1001/jama.2020.12567
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
de Leeuw, P. W., Postma, C. T., Spiering, W., & Kroon, A. A. (2018). Atherosclerotic renal artery stenosis: Should we intervene earlier? Current Hypertension Reports, 20(4). https://doi.org/10.1007/s11906-018-0829-3
Nedeljkovic-Arsenovic, O., Banovic, M., Radenkovic, D., Rancic, N., Polovina, S., Micic, D., & Nedeljkovic, I. (2020). Five-year outcomes in bariatric surgery patients. Medicina (Kaunas, Lithuania), 56(12), 669. https://doi.org/10.3390/medicina56120669
Nowak, K., & Kusztal, M. (2021). Cardiac implantable electronic devices in hemodialysis and chronic kidney disease patients-an experience-based narrative review. Journal of Clinical Medicine, 10(8), 1745. https://doi.org/10.3390/jcm10081745
Ortega, M. A., Fraile-Martínez, O., Naya, I., García-Honduvilla, N., Álvarez-Mon, M., Buján, J., Asúnsolo, Á., & de la Torre, B. (2020). Type 2 Diabetes Mellitus Associated with obesity (diabesity). The central role of gut Microbiota and its translational applications. Nutrients, 12(9), 2749. https://doi.org/10.3390/nu12092749
Shariq, O. A., & McKenzie, T. J. (2020). Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surgery, 9(1), 80–93. https://doi.org/10.21037/gs.2019.12.03
Vekic, J., Zeljkovic, A., Stefanovic, A., Jelic-Ivanovic, Z., & Spasojevic-Kalimanovska, V. (2019). Obesity and dyslipidemia. Metabolism: Clinical and Experimental, 92, 71–81. https://doi.org/10.1016/j.metabol.2018.11.005