The case scenario presented is a 32-year-old male patient seeking information about possible bariatric surgery. The following paper assesses the clinical manifestations of the 32-year-old male and management options of patients that may present similarly.
Clinical Manifestations
Mr. C is a 32-year-old male with a class 3 BMI of 44.9kg/m 2 presenting with increased shortness of breath with activity, swollen ankles and pruritus over the last 6 months. He reports a rapid weight gain of 100 pounds in the last 2 to 3 years. The patient is known hypertensive suffering from sleep apnea. The laboratory investigations reveal a stage 2 elevated blood pressure, hyperglycemia, hyper uremia and dyslipidemia. The clinical manifestations are suggestive of metabolic syndrome complicated by chronic kidney disease.
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Obesity Health Risks
The patient’s BMI of 44.9kg/m 2 and markedly high triglyceride levels, predispose him to coronary artery disease and insulin resistance. Although previous examinations show no history of metabolic disease his fasting blood glucose indicates diabetic blood glucose levels. The markedly elevated total cholesterol predisposes him to cholelithiasis. Bariatric surgery is a gastric bypass surgery that is done to help patients manage their weight. The indications are BMI of 35 or greater with 1 or more obesity-related complications (Stahl & Malhotra, 2019). Mr. C meets the criteria and would, therefore, benefit from the surgery.
Functional Health Patterns
The functional health pattern problems are nutritional metabolic, activity-exercise, sleep-rest, and elimination. A potential problem with sexuality reproductive may arise. In this scenario, Mr. C’s class 3 BMI of 44.9kg/m 2 , diabetic hyperglycemia and dyslipidemia indicate poor nutritional, elimination and activity patterns. Mr. C complains of sleep apnea that is not definitively managed. Diabetic hyperglycemia and hypertension may lead to problems with sexual reproductive patterns as a result of microvascular complications.
End-Stage Renal Disease
End-Stage Renal Disease is the final stage in the sequelae of chronic kidney disease. It is characterized by glomerular filtration of less than 15mL/min, impaired filtration and a definitive need for a kidney transplant (Barsoum et al., 2017). The contributing factors to End-Stage Renal Disease are long-standing pathological states that damage the kidney such as diabetes, hypertension, inflammation and long-standing blockage of urine flow. These states result in long-standing ischemia or mechanical damage of the glomerulus and tubules causing irreversible damage.
Health Education Process
Mr. C would benefit from assessing the causative factors of his chronic kidney disease that have to be addressed to restore health, prevent future events and renal deterioration. To prevent future events, Mr. C should be assisted to set goals of nutritional, physical inactivity and weight reduction in the long term. This is followed by assessing his awareness of hyperglycemia and hypertension and their respective complications and management strategies. Mr. C can be educated on pre-dialysis measures, drug adherence, water intake, and dietary restrictions to restore his health status. Finally, to avoid deterioration of his renal status conclusive education on how to continuously monitor and control his blood glucose and blood pressure should be given.
Non-acute Care and Multidisciplinary approach
In non-acute care, the primary goal is often monitoring and offering supportive care to the patient. ESRD patients can benefit from resources such as support groups, dialysis center information, pre-dialysis education, transplant registry, palliative care and education on kidney disease. The interdisciplinary approach has patients with progressive chronic kidney disease at the center being offered support from different specialties such as a physician, pharmacists, dieticians, and social workers. The interdisciplinary approach attempts to achieve education on treatment options, adherence to medication, nutrition, dialysis, and transplant access, and advanced care preparations (Johns et al., 2015).
References
Barsoum, R. S. (2017). End Stage Renal Disease (ESKD) in Egypt and North Africa. In Chronic Kidney Disease in Disadvantaged Populations (pp. 113-123). Academic Press.
Johns, T. S., Yee, J., Smith-Jules, T., Campbell, R. C., & Bauer, C. (2015). Interdisciplinary care clinics in chronic kidney disease. BMC nephrology , 16 (1), 161.
Stahl, J. M., & Malhotra, S. (2019). Obesity surgery indications and contraindications.
