Pathophysiology and Nursing Management of Client’s Health Essay

Pathophysiology and Nursing Management of Client’s Health Essay

Pathophysiology and Nursing Management of Client’s Health Essay

This is a case study of Mr. C, a 32-year-old obese male client who visited the outpatient clinic. He has always been overweight since childhood and reports to have recently gained 100 pounds in about 3 years.  He has, however, never been diagnosed with any metabolic disorder. He is not married and works at a telephone catalog center. He is a known hypertensive patient who is not on treatment but limits his salt intake to control his hypertension. The purpose of his visit is to be enlightened about bariatric surgery which is one of the effective interventions for managing obesity (Stahl et al., 2021). The purpose of this essay is to explore the patient’s clinical presentation, his functional health status, the health risks associated with obesity, and various aspects of ESRD.

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Clinical Manifestations Present

The patient is morbidly obese with a BMI of 45.1. He currently has hypertension evidenced by high blood pressure measurement results. He is not on any medications to control his blood pressure but supportively restricts salt intake. He also has sleep apnea most likely attributed to his obesity. He has tachypnea but his pulse rate is within normal ranges. The further assessment also reveals dyspnea on exertion, pruritus, and hyperglycemia. A lipid profile shows hyperlipidemia with high cholesterol and triglycerides and low HDL levels. His renal function tests are deranged and he has bilateral pitting edema up to the ankle. These two findings are consistent with renal disease.

Potential Health Risks for Obesity

Obesity predisposes the affected individual to serious health risks. These include non-communicable diseases such as cardiovascular diseases, obstructive sleep apnea, type 2 diabetes mellitus, cancer, gastro-esophageal reflux disease, and hypertension among others (Ansari et al., 2020).  Obesity has also been associated with dyslipidemia and increased risk for a renal disease that eventually leads to end-stage renal disease. Hypertension and diabetes secondary to obesity can initiate or worsen renal disease.  The patient in this case study already has diabetes evidenced by hyperglycemia. He also has hypertension and dyslipidemia and signs of renal disease. This shows that there is a high possibility that these health conditions may be a consequence of obesity. Bariatric surgery is a weight loss surgery that effectively treats obesity and its associated comorbidities (Stahl et al., 2021). It is usually indicated based on a BMI greater than 40 and the presence of obesity-associated complications. Mr. C meets these requirements thus the surgery is an appropriate intervention for him. Any serious complications may, however, need to be treated first before the surgical procedure.

Client’s Functional Health Patterns

Functional health pattern assessment can be integrated into the nursing process to diagnose any dysfunction and implement appropriate interventions. Functional health patterns are subdivided into eleven distinct subgroups such as health perception, cognitive, self-perception, activity-exercise, sleep-rest, and nutritional patterns among others (Mishra et al., 2020). Regarding health perception, the client is aware that he is unhealthy. He knows he has been overweight since childhood and is even seeking information on possible therapeutic interventions such as bariatric surgery. In health management, the patient knows he is hypertensive and tries to control this by restricting his sodium intake. The sleep/rest functional pattern is compromised since the patient reports sleep apnea. The renal elimination pattern has also been affected. This is evidenced by findings from the assessment such as deranged renal function tests and bilateral lower limb edema. The patient is relatively inactive with a sedentary lifestyle contributed by his occupation. This affects the activity-exercise health pattern. The shortness of breath during activity may also limit the patient’s involvement in physical activities. This partly contributes to his obesity.

Renal Disease Staging and Factors Contributing to Client’s ESRD

Chronic kidney disease can be classified into 5 stages based on the KDIGO practice guidelines. This classification is based on the glomerular filtration rate or the level of proteinuria (Benjamin et al., 2021). The first stage has features of kidney damage but with GFR within normal ranges of more than 90ml/minute. The second stage is characterized by mildly reduced GFR of between 60 and 89 ml/minute. GFR is moderately reduced in stage three, with stage 3a being between 45 and 59 ml/minute and 3b between 30 and 44 ml/minute. The fourth stage has severely reduced GFR of between 15 and 29 ml/minute. End-stage renal disease is the fifth and final stage with GFR below 15ml/minute. Some of the identified risk factors for the development of end-stage renal disease include male gender, hypertension, cardiovascular diseases,  and diabetes (Dahnan et al., 2019). This might have exacerbated the patient’s renal disease causing its ultimate progression to end-stage renal disease.

ESRD Prevention and Health Promotion

The cost of renal replacement therapy for end-stage renal disease is particularly high.  There is thus the need for early recognition and treatment of renal diseases before their progression. Risk factor modification, good blood sugar control, blood pressure control, and adequate treatment of comorbidities are some of the effective ESRD preventive measures (Li et al., 2020). The patient will thus need to engage in weight loss strategies, and be on management anti-hypertensives for his high blood pressure and anti-diabetic medications. Hyperlipidemia will also require adequate treatment. Lifestyle modifications such as regular exercise, physical activity, and a healthy low-fat diet may also need to be embraced by the patient. The patient will need to fully understand his condition, including the importance of adhering to the devised treatment plan to promote recovery and prevent disease progression.

Resources for ESRD Patients

Management of ESRD patients requires collaborative efforts from the involved healthcare professionals for better patient outcomes. The level of resource utilization is dependent on several factors such as the patient’s level of education, socioeconomic status, and psychological status (Yao et al., 2021). The multidisciplinary team will include nurses, physicians, pharmacists, and laboratory technicians among others. These patients may also require devices such as portable dialysis devices, glucometers, and blood pressure machines for progress monitoring for those with comorbidities. Means of transportation may also be availed for these patients so that they can attend their dialysis sessions to ensure continuity of care. Counseling services should be offered owing to the devastating psychological and financial implications of ESRD. Health education materials should be accessible to the patients for better health promotion. There should also be a smooth transition back to work and financial support where possible.

Conclusion

Objective and subjective data obtained from Mr. C reveals that he is morbidly obese and the appropriate therapeutic intervention needed is bariatric surgery. Obesity has predisposed him to adverse health risks like hypertension, sleep apnea, diabetes, dyslipidemia, and renal disease. Evaluation of his functional health patterns shows dysfunctions in renal elimination, sleep-rest, and activity-exercise patterns. His kidney disease has advanced to ESRD which will necessitate health prevention and promotion measures. Owing to the concomitant comorbidities,  there is a need to manage the patient holistically for better health outcomes. This will include availing of necessary resources to ensure continuity of care.

References

Ansari, S., Haboubi, H., & Haboubi, N. (2020). Adult obesity complications: challenges and clinical impact. Therapeutic Advances In Endocrinology And Metabolism, 11, 204201882093495. https://doi.org/10.1177/2042018820934955

Benjamin, O., & Lappin, S. L. (2021). End-Stage Renal Disease. In StatPearls. StatPearls Publishing.

Dahnan, M., Assabri, A., & Khader, Y. (2019). Risk Factors for End-Stage Renal Failure Among Patients on Hemodialysis in Aljomhory Hospital, Sa’adah Governorate, Yemen: Hospital-Based Case-Control Study. JMIR Public Health And Surveillance, 5(3), e14215. https://doi.org/10.2196/14215

Li, P., Garcia-Garcia, G., Lui, S., Andreoli, S., Fung, W., & Hradsky, A. et al. (2020). Kidney health for everyone everywhere – from prevention to detection and equitable access to care. Brazilian Journal Of Medical And Biological Research, 53(3). https://doi.org/10.1590/1414-431×20209614

Mishra, A., Skubic, M., Popescu, M., Lane, K., Rantz, M., & Despins, L. et al. (2020). Tracking personalized functional health in older adults using geriatric assessments. BMC Medical Informatics And Decision Making, 20(1). https://doi.org/10.1186/s12911-020-01283-y

Stahl, J. M., & Malhotra, S. (2021). Obesity Surgery Indications And Contraindications. In StatPearls. StatPearls Publishing.

Yao, X., Wang, Y., Liu, Z., Li, Y., & Fan, X. (2021). Influencing factors of resource utilisation in haemodialysis patients—Based on socioecological pyramid model. Journal Of Clinical Nursing, 31(5-6), 770-780. https://doi.org/10.1111/jocn.15935

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Assessment Description
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. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

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.

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:

Describe the subjective and objective clinical manifestations present in Mr. C.
Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can 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.)
Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
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. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of three 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.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful c