Mr. C’s Clinical Presentation
The patient is a male aged 32 years old. Mr. C. has a sedentary job and is currently seeking bariatric surgery due to the health challenges he is experiencing. Mr. C. weighs 134.5 kg and admits he has been heavy all his life, and his health records report no past metabolic problems. Mr. C. has a height of 68 inches and has a BMI pf 47.9, which points to morbid obesity (Whitney, 2018). The patient admits to hypertension, which he tries to regulate by uptake of low salt; his blood pressure reads 172/98. Mr. C. complains of shortness of breath (SOB) with activity, has ankles that are swollen, and he has pruritus for more than six months. Mr. C. has a serum creatinine of 1.8 mg/dL and a BUN of 32. The lab report of elevated BUN and creatinine levels indicate that Mr. C. has renal failure.
Also, the lab report indicates fasting blood glucose of 146 mg/dL, which suggests that Mr. C. has diabetes or prediabetes. Mr. C also has hyperlipidemia indicated by the high cholesterol amount of 250 mg/dL and the low High Density Lipoprotein level of 30 mg/dL, which also suggests he has diabetes (Whitney, 2018). In addition, swelling of the ankles and pruritus are indicators of kidney diseases in diabetic patients. Along with the kidney disease, the patient has fluid overload, which leads to SOB with activity and swollen ankles.
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Potential Health Risks That May Concern Mr. C and Bariatric Surgery
Based on Mr. C’s objective data, he is already manifesting several of the risks for obesity. These include sleep apnea, hypertension, SOB with activity, hyperlipidemia, swelling of ankles, and the possibility of diabetes (Machado-Rodriguez et al. 2018). All these health issues are currently preventing Mr. C’s kidneys from functioning appropriately, which predisposes him to a risk of CHF. Conferring to ASMBS (2019), the patient is a candidate for Bariatric surgery because he has a BMI of 45. Some of the requirements for Bariatric surgery, according to the ASMBS (2019), is a BMI ≥ 35, a patient must be aged 18-65 years, and a patient must have at minimum two co-morbidities. Mr. C. fits and surpasses these requirements; hence he is a candidate for bariatric surgery. The ASMBS also requires a patient to be in an excellent psycho-emotional condition. Provided Mr. C. matches the psychological requirements, bariatric surgery could assist in reversing his co-morbid state.
Functional Health Pattern of Mr. C
Assessing the health pattern of a patient is essential to establish the health pattern of a patient. The first health pattern of Mr. C. is his Nutritional – Metabolic Pattern. In the past 2-3 years, Mr. C. Has gained more than 100 pounds of weight, which has contributed to his co-morbidities. Mr. C. has dyslipidemia, hypertension, obesity, and diabetes, which are categorized as metabolic syndromes (Whitney, 2018). The second health pattern is the activity-exercise pattern. Mr. C. experiences SOB with an activity, which is a hindrance to engaging physical exercise. Lack of physical exercise has contributed to obesity and swollen ankles, which prevent him from addressing his weight problems. The third pattern is the sleep-rest pattern. Mr. C. has sleep apnea due to obesity and has been linked to hypertension, depression, CHF, depression, and memory problems (Machadoet-Rodriguez et al. 2018). The fourth is Mr. C’s cognitive-perceptual functional health pattern. The patient understands the need for lifestyle changes to manage his weight and has also opted for bariatric surgery. The fifth is Mr. C’s health pattern of coping with stress. Mr. C has been overweight, the whole of his life; he is single and has a sedentary job, which may indicate he has poor coping skills. Mr. C. can improve his coping skills by avoiding stress eating.
ESRD Staging and Contributing Elements
According to Krolewski et al. (2017), Chronic Kidney Disease (CKD) results when an individual suffers from gradual and often permanent loss of kidney function over time. CKD occurs in five stages. ESRD is the last stage of CKD and occurs when the role of the kidney falls below ten percent of its normal functioning. ESRD has several contributing elements such as gender, age, diabetes, race, HTN, nocturia, smoking, high cholesterol, genetics, drug use, hyperuricemia, and obesity (Krolewski et al. 2017). Though CKD is due to primary diseases by the kidney, the primary cause of CKD is HTN and diabetes.
ESRD Prevention and Health Promotion Options and Patient Education
ESRD has no cure. Hence, health promotion options include dialysis and kidney transplant (Krolewski et al. 2017). Kidney transplant can be conducted to people of all ages provided they are healthy enough for the procedure, have no cancer or infection, and have undergone and passed a psychological evaluation. Dialysis helps in the removal of toxic waste from the body and therefore helps in the thinning of the blood (Krolewski et al. 2017). Patient education for MR. C. includes educating the patient on the need to adhere to the dialysis schedule and concerning healthy eating to deter further collapse of his renal condition. The nutritional intake for ESRD patients is a sufficient vital amount of metabolic waste from the body; hence Mr. C. has to restrict his fluid intake and change his diet. Also, Mr. C. should be educated on the importance of physical exercise to prevent muscle loss, which often leads to mortality.
Resources Available for ESRD Patients
According to Bischoff et al. (2017), there are numerous resources available to ESRD patients, such as support groups and multidisciplinary approaches to ESRD treatment. Support groups make it possible for ESRD patients to communicate with peer mentors who can serve as positive role models. Multidisciplinary approach via collaboration with nurses, physicians, dieticians, social workers, advanced practitioners, and pharmacists, emergency resources are essential resources for ESRD patients (Bischoff et al. 2017). The Multidisciplinary approach can help in reducing hospitalizations, prepare patients better for treatment, can delay ESRD progress, and reduce mortality rates. The collaboration of all these health workers, for the benefit of patients, may assist in identifying the strengths and weaknesses within the support system of a patient, which can be addressed.
A physician can explain an ESRD patient his condition, the risk factors, signs, and symptoms. Physicians can advise family members on how to manage an ESRD patient (Bischoff et al. 2017). A dietician can provide advice to ESRD patients on the healthy foods to consume, how to limit fluid intake, and the foods to avoid. Emergency resources on devices for dialysis either for peritoneal dialysis or dialysis treatment center may be provided to ESRD patients. Resources for devices, living condition matters, and transportation may be offered by a patient’s healthcare coverage with the aid of a social health worker. Conferring to Bischoff et al. (2017), social health workers for patients with ESRD are essential members of the interdisciplinary treatment group since they employ an individual-centered method to assist patients in achieving the maximum potential physically, vocationally, socially, and emotionally.
References
American Society for Metabolic and Bariatric Surgery [ASMBS] website. (2019). https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery
Bischoff, S. C., Boirie, Y., Cederholm, T., Chourdakis, M., Cuerda, C., Delzenne, N. M., ... & Koletzko, B. (2017). Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clinical nutrition , 36 (4), 917-938.
Krolewski, A. S., Skupien, J., Rossing, P., & Warram, J. H. (2017). Fast renal decline to end-stage renal disease: an unrecognized feature of nephropathy in diabetes. Kidney international , 91 (6), 1300-1311.
Machado ‐ Rodrigues, A. M., Fernandes, R., Gama, A., Mourão, I., Nogueira, H., Rosado ‐ Marques, V., & Padez, C. (2018). The association of irregular sleep habits with the risk of being overweight/obese in a sample of Portuguese children aged 6–9 years. American Journal of Human Biology , 30 (4), e23126.
Whitney, S. (2018). Pathophysiology clinical applications for client health. In G. C. University (Ed.), Elimination complexities (1 ed.). Retrieved from https://lc.gcumedia.com/nrs410v/ pathophysiology-clinical-applications-for-client-health/v1.1/#/chapter/3
