Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5 years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. Patient’s previous medical evaluation includes end stage renal disease (ESRD) on dialysis and referral for recommendations for initiating exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. Patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months

Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5 years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. Patient’s previous medical evaluation includes end stage renal disease (ESRD) on dialysis and referral for recommendations for initiating exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. Patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months

Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5 years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. Patient’s previous medical evaluation includes end stage renal disease (ESRD) on dialysis and referral for recommendations for initiating exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. Patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.

Case Study: Mr. D. 

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. D., presented below.

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Health History and Medical Information

Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5 years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. Patient’s previous medical evaluation includes end stage renal disease (ESRD) on dialysis and referral for recommendations for initiating exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. Patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. 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: 140/94, HR 84, RR 22
3. 2+ 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
10. GRF (glomerular filtration rate)-13mL/min

Clinical Manifestations Describe the clinical manifestations present in Mr. D., focusing on the normal and abnormal findings and how this relates to his current condition.
Subjective
Objective
Potential Health Risks for Diabetes With End-Stage Renal Disease Identify the potential health risks for a diabetic with ESRD and the impacts of nonadherence.
Identify the potential health risks for a diabetic with end-stage renal disease (ESRD) that are of concern for Mr. D.
How does Mr. D.’s nonadherence to his diabetes self-management plan for DM Type II contribute to ESRD?
Describe the common considerations with insulin use for practicing Muslims.
Pathophysiology of Renal Dialysis Explain the pathophysiology of renal dialysis.
Explain the pathophysiology of renal dialysis. Compare peritoneal dialysis and hemodialysis.
Describe in detail the pathophysiological explanation and stages of renal disease that leads to ESRD.
Explain the potential factors that contributed to Mr. D.’s ESRD.
Functional Health Problems Evaluate of Mr. D.’s functional health patterns.
Evaluate each of Mr. D.’s functional health patterns using the information given.
Discuss at least five actual or potential problems you can identify from the “Functional Health Patterns Assessment Guide,” located in the Topic 3 Resources. Provide a rationale for each.
Nursing Health Management and Health Promotion Provide ESRD nursing management and health promotion opportunities.
Provide ESRD nursing management and health promotion opportunities.
Develop a patient education plan for ESRD that could be offered to Mr. D. for prevention of future events, health restoration, and maintaining renal status.
Assume Mr. D. lives in your community. Include community resources and supportive care available for Mr. D. for ESRD care and management at home.
Discuss the nurse’s role in using the holistic multidisciplinary care approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence.