Assignment: Case Study of 32 Year-Old MR. C with Obesity and Hypertension

Assignment: Case Study of 32 Year-Old MR. C with Obesity and Hypertension

Assignment: Case Study of 32 Year-Old MR. C with Obesity and Hypertension

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.

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Objective Data:

Height: 68 inches; weight 134.5 kg
BP: 172/98, HR 88, RR 26
3+ pitting edema bilateral feet and ankles
Fasting blood glucose: 146 mg/dL
Total cholesterol: 250 mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Serum creatinine 1.8 mg/dL
BUN 32 mg/dl

Critical Thinking Essay

In 750-1,000 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.
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.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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Case Study of 32 Year-Old MR. C with Obesity and Hypertension

Looking at the laboratory and vital values of Mr C it is clear that he has a very big problem with obesity that makes him require immediate interventions. Calculation of his body mass index or BMI from his given weight and height reveals that he has a BMI of 45.1 kg/m². This is class III obesity or what is described as morbid/ severe obesity (Abdelaal et al., 2017; Hammer & McPhee, 2018). He also has a medical history of high blood pressure and his BP of 172/98 mmHg confirms that he is indeed hypertensive. All the other laboratory values are abnormal. For instance, the fasting blood sugar test indicates that he also has type II diabetes mellitus (a fasting blood sugar of 146 mg/dL when the normal should be less than 99 mg/dL). Total cholesterol (250 mg/dL), triglycerides (312 mg/dL), and high-density lipoprotein or HDL cholesterol (30 mg/dL) all indicate that he has hyperlipidemia/ hypercholesterolemia and therefore too obese. In males normal total cholesterol should be less than 200 mg/dL, triglycerides should be less than 150 mg/dL, and the desirable HDL (“good cholesterol”) level should be above 60 mg/dL. He is also in renal failure as far as the serum creatinine (1.8 mg/dL) and blood urea nitrogen or BUN (32 mg/dL) levels are concerned. For males normal BUN should be 6-24 mg/dL and normal serum creatinine 0.74-1.35 mg/dL (Abdelaal et al., 2017; Hammer & McPhee, 2018). The purpose of this paper is to look at the health implications of Mr C’s obesity.

A Description of the Clinical Manifestations of Mr C

This patient is presenting with several manifestations. He has sleep apnea and this is a known manifestation of obesity and especially morbid obesity. With obesity, there is usually an interference with the usual circadian rhythm of a person and sleep apnea is just one of the results of this (Noh, 2018). He also shows the symptom of shortness of breath and swollen ankles or pedal edema. These two together indicate that this patient is in renal failure and the glomerular filtration rate has dropped to critical levels. Just as the BUN and the serum creatinine levels are elevated indicating that urea and creatinine are not being cleared effectively from the body, the same is true of fluids or water that is not being removed as efficiently as before. This is the reason why he has pedal edema and pulmonary edema (causing the shortness of breath). The pruritus is due to the many skin folds that are the result of excess adipose tissue under the skin (Hammer & McPhee, 2018; Pasqua et al., 2020). Of course the hypertension and diabetes are the result of his obesity and they are the major causes of renal failure.

The Potential Health Risks for Obesity that are the Concerns of Mr C

The potential health risks for obesity that are concerning to this patient have already been referred to above. They include hypertension which he already has developed. Hypertension and hypercholesterolemia predispose to coronary artery disease such as myocardial infarction because of injury to the internal lining of arteries and deposition of atheromatous plaques in the arteries. These cause narrowing of the arteries and subsequent ischemia (Hammer & McPhee, 2018). The other risk os type II diabetes which the fasting blood sugar also shows he has already developed. Lastly but not least is the concern for renal failure or chronic kidney disease (CKD). The laboratory tests as well as the pulmonary and pedal edema show that he is already going into end-stage kidney disease or ESKD. Bariatric surgery is indeed an option but before that is considered he should be first put on lifestyle measures together with medications. Only when these have failed should surgery be contemplated. So far he has only tried restricting dietary sodium.

Five Functional Health Patterns for Mr C

Nutritional: The actual problem in this functional health pattern that the patient has is a high intake of high-calorific value foods and fatty foods in the absence of enough fresh fruits and vegetables. The rationale for this is the high total cholesterol and triglycerides with low HDL levels.

Metabolic: He also has an actual problem of metabolism in that he has glucose intolerance with insulin resistance. The rationale is that fatty tissue or adipose tissue is highly resistant to insulin (Hammer & McPhee, 2018).

Elimination: There is an actual problem with elimination in that his kidneys show reduced glomerular filtration efficacy. The rationale is the high serum creatinine and BUN.

Activity-Exercise: He has also an actual problem of lack of physical activity. The rationale for this is the morbid obesity and his occupation that involves long hours of sitting.

Sleep-Rest: He has an actual problem with sleep disturbance and the rationale for this is his sleep apnea.

Staging of End-Stage Renal Disease

According to the National Kidney Foundation (2021), stage I ESRD is remaining kidney function of 90-100%, stage II is 89-60%, stage III is 59-30%, stage IV is 29-15%, and stage V is less than 15%. Stage five is ESRD and it requires renal replacement therapy (RRT) such as dialysis or a kidney transplant. The contributing factors to consider are comorbidities such as hypertension and diabetes as well as modifiable lifestyle factors such as smoking and poor diet.

ESRD Prevention and Health Promotion Opportunities

This patient should be encouraged to lose weight through both aerobic and resistance exercises. He should also comply with prescribed medications and take them as ordered. Diet is also a very important factor and he should take a strictly renal diet with less potassium and salt and lots of fresh fruits and vegetables. He should also control the amount of water he drinks to keep the pulmonary edema in check. If these measures work he may regain some renal function. But if they fail he should be encouraged to consider kidney transplantation.

Resources for ESRD Patients

These would include self-monitoring of blood glucose or SMBG (Zheng et al., 2020) by devices, a robust family social support system to encourage compliance to exercise and dietary measures, and sanitary living conditions. Employment by supportive employers is also crucial. Effective management of this patient will need a multidisciplinary team approach involving but not limited to registered nurses, advanced practice nurses, physicians, pharmacists, dieticians, physical therapists, social workers, and family members.

Conclusion

Mr C has morbid obesity that has caused complications such as hypertension and diabetes already. These have in turn resulted in renal failure. He already has pulmonary and pedal edema meaning that he is quickly going into ESRD. Lifestyle measures in conjunction with medications would help him. However, if these fail bariatric surgery may be considered.

References

Abdelaal, M., le Roux, C.W., & Docherty, N.G. (2017). Morbidity and mortality associated with obesity. Annals of Translational Medicine, 5(7), 1-12. http://dx.doi.org/10.21037/atm.2017.03.107

Hammer, D.G., & McPhee, S.J. (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

National Kidney Foundation (2021). Estimated glomerular filtration rate (eGFR). https://www.kidney.org/atoz/content/gfr

Noh, J. (2018). The effect of circadian and sleep disruptions on obesity risk. Journal of Obesity & Metabolic Syndrome, 27(2), 78-83. https://doi.org/10.7570/jomes.2018.27.2.78

Pasqua, T., Cerra, M.C., & Angelone, T. (2020). Mechanisms and pathophysiology of obesity: Upgrading a complex scenario. Current Medicinal Chemistry, 27(2), 172-173.  https://doi.org/10.2174/092986732702200218123007

Zheng, M., Luo, Y., Lin, W., Khoja, A., He, Q., Yang, S., Zhao, X., & Hu, P. (2020). Comparing effects of continuous glucose monitoring systems (CGMs) and self-monitoring of blood glucose (SMBG) amongst adults with type 2 diabetes mellitus: A systematic review protocol. Systematic Reviews, 9(120), 1-6. https://doi.org/10.1186/s13643-020-01386-7