Clinical Manifestations
Objective perceptions of Mr. C’s health are as follows:
- Swollen ankles, pitting edemas on both feet, pruritus;
- Obesity (BMI 44.9);
- High blood pressure of 172/98 (120/80 – 140/90 is considered the norm); Normal heart rate of 88 BPM, High respiratory rate of 26 breaths per minute (norm is 1220) (Pagana & Pagana, 2017);
- High levels of fasting blood glucose levels of 146 mg/dL (norm is around 100 mg/dl);
- High levels of total cholesterol (250 mg/dL vs. 200 mg/dL or less as norm, and 240 mg/dL as borderline high);
- High levels of triglycerides, standing at 312 mg/dL, when the norm is 150, with the upper border at 199 mg/dL;
- Low levels of highdensity lipoproteins (HDL), standing at 30 mg/dL, when the norm is 4060 mg/dL;
- High levels of serum creatinine, standing at 1.8 mg/dL when the normal age for an adult male is between 0.6 – 1.2 mg/dL (Pagana & Pagana, 2017);
- High blood urea nitrogen (BUN) levels, standing at 32 mg/dL when the norm is between 7 to 20 mg/dL for adults (Pagana & Pagana, 2017).
The patient’s subjective reports of having gained over 100 pounds in the last 2-3 years, shortness of breath, sleep apnea, and exhaustion.
Potential Risks of Obesity and Bariatric Surgery as an Appropriate Intervention
Obesity presents a variety of healthcare risks to an individual such as Mr. C. The primary hazards faced by obese patients include high blood sugar levels, diabetes, hypertension, dyslipidemia, high blood fats, a variety of heart diseases, increased chances of heart failure and stroke (Sattar & Preiss, 2018). In addition, the increased weight forces more pressure on bones and joints, causing a plethora of problems associated with low mobility (Sattar & Preiss, 2018). One of the most common diseases on obese people is osteoarthritis, which causes unpleasant feelings in joints and sleep apnea – a condition when a patient stops breathing during sleep. It reduces the effectiveness of rest, increases sleepiness, and causes lapses in attention (Sattar & Preiss, 2018). Gallstones and liver problems are also associated with obesity and overeating/drinking. Finally, obesity is associated with increased chances of developing esophageal, colorectal, breast, kidney, thyroid, bladder, and pancreatic cancers (Sattar & Preiss, 2018).
Bariatric surgery achieves weight by restricting stomach space (Tewksbury, Williams, Dumon, & Sarwer, 2017). Alternatively, the same result is achieved by blocking parts of the intestinal tract, or by creating food passage sleeves through the stomach (Tewksbury et al., 2017). Bariatric surgery is recommended to obese individuals with BMI above 40, individuals at risk of kidney failure, and diabetic patients (Tewksbury et al., 2017). At the same time, the surgery is associated with numerous side-effects, and is quite expensive (Tewksbury et al., 2017). Based on the analyses and information provided, the patient would be eligible for bariatric surgery.
Health Patterns Assessment
Mr. C’s assessment of functional health patterns based on the case presented is as follows (Urden, Stacy, & Lough, 2019):
- Health perception. The patient is obviously overweight and suffering from one or several diseases. He perceives himself as unwell;
- Health management. The patient is willing to participate in health management and has attempted to do so by controlling the amounts of consumed sodium;
- Nutritional. It is unclear whether obesity from a young age is associated with poor eating habits of hormonal irregularities. Since he has a normal metabolism, the connection between overweightness and overeating is likely;
- Metabolic. Normal metabolism, no irregularities;
- Elimination. No problems with elimination were reported;
- Activityexercise. No information is given;
- Sleeprest. The patient suffers from sleep apnea;
- Cognitiveperceptual. No cognitive or perceptual issues indicated;
- Selfperception. Though nothing was directly mentioned about the customer’s selfperception, it is likely that obesity caused a negative perception of himself;
- Rolerelationship. No information is given;
- Sexuality. No direct information is given. However, since the patient is obese, 32, and single, it is likely that he is not engaging in active sexual relationships;
- Coping/Stress tolerance. No information is given.
The patient’s most prominent actual and potential problems are associated with activity/exercise, sleep-rest (sleep apnea), self-perception (likely poor due to stigma of obesity), sexuality (decreased attractiveness as a result of obesity), and health perception (likelihood of developing diabetes/ESRD/cirrhosis/etc.) (Urden et al., 2019).
What is ESRD?
ESRD stands for end-stage renal disease, and it is the 5th stage of chronic kidney disease (Nissenson & Fine, 2016). At this point, kidneys operate only at 15% efficiency, requiring a transplant or a dialysis machine to survive (Nissenson & Fine, 2016). Contributing factors to ESRD include diabetes, high blood pressure, existing kidney problems, childhood obesity, certain medicine, genetic predisposition, alcohol, and smoking (Nissenson & Fine, 2016). The majority of these factors are already present in Mr. C.
ESRD Prevention and Health Promotion
In order to prevent ESRD and promote health in patients, the first step is to teach them about what ESRD and CKD are, especially individuals who are obese and at risk of developing diabetes (Nissenson & Fine, 2016). Managing blood sugar and blood pressure will help reduce the damage to kidneys. Lifestyle changes would include healthy eating, exercises, and adhering to an eating plan that is low in salt and fat (Nissenson & Fine, 2016). Medications include those that lower blood pressure and reduce the decline of kidney functions. No smoking or drinking policy is also a good idea. Finally, the patient must avoid certain drugs that might trigger renal dysfunction (Nissenson & Fine, 2016). All of these steps should be included in Mr. C’s patient education plan.
Available Resources
There are multiple resources available to Mr. C. The primary source of consultation and information is his nephrologist. However, other sources of information and control include dietitians, community centers, social services, and online support groups (Nissenson & Fine, 2016). Mobile devices could be used to remind oneself to take medicine, control activity progress, and food intake (Nissenson & Fine, 2016). Assistance with mobility and return to work should be administered when required.
References
Nissenson, A. R., & Fine, R. E. (2016). Handbook of dialysis therapy. New York, NY: Elsevier Health Sciences.
Pagana, K. D., & Pagana, T. J. (2017). Mosby’s manual of diagnostic and laboratory tests. New York, NY: Elsevier Health Sciences.
Sattar, N., & Preiss, D. (2018). Research digest: Assessment and risks of obesity. The Lancet Diabetes & Endocrinology, 6(6), 442.
Tewksbury, C., Williams, N. N., Dumon, K. R., & Sarwer, D. B. (2017). Preoperative medical weight management in bariatric surgery: a review and reconsideration. Obesity Surgery, 27(1), 208-214.
Urden, L. D., Stacy, K. M., & Lough, M. E. (2019). Priorities in critical care nursing. New York, NY: Elsevier Health Sciences.