Case Study: Mr. C. RN-BSN-prepared Nurse
Case Study: Mr. C. RN-BSN-prepared Nurse
Critical Thinking Case Study: Mr. C
Diseases manifest differently, either as a presentation of an underlying condition or predisposing risk factor. A proper understanding of the underlying illness confers proper management by the healthcare providers based on the presenting complaints. In Mr. C’s case, he has morbid obesity, an underlying primary condition that has predisposed him to various chronic illnesses. He reportedly has elevated blood pressure, diabetes mellitus, sleep apnea, dyspnea on exertion, dyslipidemia, and chronic renal disease. Laboratory investigations show deranged kidney functions. the discussion below aims to highlight clinical manifestations, and risk factors of obesity, assess functional health patterns and consider renal disease (end-stage) management.
Question 1: Clinical Manifestations
Clinical manifestation of the disease is derived from the patient’s symptoms (subjective data), examination of the patient, as well as laboratory investigations (objective data). Mr. C is a case of obesity which has predisposed him to other illnesses. He currently complains of dyspnea on exertion, sleep apnea, and skin itchiness. He also has swollen limbs. On examination, Mr. C has 3+ bilateral pitting edema. His laboratory findings indicate that his fasting blood sugar is 146 mg/dl. This points to diabetes as per (Chatterjee & Davies, 2018), which is defined by blood glucose >126mg/dl. Body weight and height give an estimation of the general health status of an individual, a parameter called body mass index (BMI), which estimates the overall body store of fat. (Shan et al., 2019). A BMI of 18.5- 24.5 is considered normal, whereas a BMI of 25.5- 29.9 is overweight. BMI of above 30 is obese, graded into 3 classes with BMI > 40 being morbid obesity. Obesity is a risk factor for diabetes, hypertension, and renal disease. Increased accumulation of fat in the blood vessels leads to narrowing and resultant hypertension. Laboratory findings show derangement in his lipid profile. He has elevated cholesterol levels (normal is <200mg/dl) as well as hypertriglyceridemia (normal- 40- 140). His HDL is low (normal is >40 in a male adult). He also has deranged urea and creatinine levels pointing to kidney problems. He presents with itchiness, which can e attributed to the accumulation of urea, pointing to uraemic pruritus. This could be a chronic renal disease, with obesity as the primary complicating condition. Uraemia points to end-stage renal disease (ESRD).
Various risk factors contribute to obesity, some of which can be identified in Mr. C’s condition. These risk factors include hypertension, deranged lipid profile, sleep apnea, and diabetes mellitus. Obesity may complicate by gout, congestive heart failure, osteoarthritis, coronary arterial disease, and accumulation of gallstones (cholelithiasis). He works at a catalog telephone center. This could be a risk for a sedentary lifestyle, and a risk of obesity. modification of obesity should be aimed at weight reduction. Bariatric surgery aims to cut down on body fats and reduce symptomatic obstructive sleep apnea. Mr. C is a candidate for bariatric surgery owing to his hypertension, BMI >40, and other complicating factors for obesity. he, however, may not be qualified for this operation due to having the chronic renal disease.
Question 3: Functional Health Pattern (FHP)
Functional health patterns in nursing involve one’s perception of his/ her health, health management programs, and role relationship and impact (Khatiban et al., 2019). Mr. C’s case shows that he has a good perception of his health. He understands that he is overweight and has made previous attempts to cut down on weight. Health management programs employed include salt and fat restrictions. These previous trials have failed hence he has sought further intervention. He reports having unresolving obesity which could be exacerbated by the sedentary nature of his work. Sleep apnea and exertional dyspnea are a result of the accumulation of fat on the neck and pharyngeal wall. This poses difficulty in exercise, further worsening his obesity. patients should be educated on the impact of obesity on general life productivity. They need to understand how obesity impacts sexual health and general stress tolerance.
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Question 4: Staging of ESRD and Contributing Factors
End-stage renal disease (ESRD) can be classified into 5 stages based on the kidney functions, assessed as glomerular filtration rate (GFR). Stage one is a GFR > 90ml/ min, stage 2 is GFR between 60- 89ml/ min, stage 3 is between 30- 59 ml/min with moderate loss in kidney function. A renal GFR of 15-29 is stage 4 with a severe loss in function. Stage 5 is an end-stage renal disease requiring dialysis (Chen et al., 2019). Etiological factors implicated in ESRD in his case are hypertension and diabetes. Others include Urinary tract infections and acute kidney injury. Chronic kidney stones also contribute to developing ESRD.
Question 5: Preventive Measures
Lifestyle modifications are the hallmark of the prevention of the development of renal disease. Control of diabetes and blood pressure is key. Control of dyslipidemias with antilipemic drugs prevents disease progression to CKD. Dietary modification limited to strict salt and fat intake reduction is key. Prevention should be aimed at weight reduction by undertaking aerobic exercise (Chen et al., 2019). Adherence to medications is essential. Bariatric surgery is also a possible preventive strategy in management.
Non- acute Resources in ESRD and Multidisciplinary Approach
ESRD poses a significant challenge to the quality of life of these patients, hence impacting morbidity and mortality. Regular dialysis is a possible non-acute service available for these patients, aimed at improving kidney function. Personal monitoring of blood pressure and glucose levels using insulin pumps and personal BP machines prove to be useful. These patients are over- dependent, hence care should be diversified. A multi-disciplinary approach, involving nephrologists, physicians, nutritionists, and urologists, should, therefore, be adopted. (Collister et al., 2019)
Obesity is a significant health determinant, predisposing to several chronic illnesses, including but not limited to ESRD. Nursing care should be aimed at wholesomely evaluating the patient and providing preventive measures. Patient education also plays important role in preventing disease progression. Non-acute resources should be included in their management.
Chatterjee, S., & Davies, M. J. (2018). Accurate diagnosis of diabetes mellitus and new paradigms of classification. Nature Reviews. Endocrinology, 14(7), 386–387. https://doi.org/10.1038/s41574-018-0025-1
Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: A review: A review. JAMA: The Journal of the American Medical Association, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745
Collister, D., Pyne, L., Cunningham, J., Donald, M., Molnar, A., Beaulieu, M., Levin, A., & Brimble, K. S. (2019). Multidisciplinary chronic kidney disease clinic practices: A scoping review. Canadian Journal of Kidney Health and Disease, 6, 2054358119882667. https://doi.org/10.1177/2054358119882667
Khatiban, M., Tohidi, S., & Shahdoust, M. (2019). The effects of applying an assessment form based on the health functional patterns on nursing student’s attitudes and skills in developing the nursing process. International Journal of Nursing Sciences, 6(3), 329–333. https://doi.org/10.1016/j.ijnss.2019.06.004
Shan, M.-J., Zou, Y.-F., Guo, P., Weng, J.-X., Wang, Q.-Q., Dai, Y.-L., Liu, H.-B., Zhang, Y.-M., Jiang, G.-Y., Xie, Q., & Meng, L.-B. (2019). Systematic estimation of BMI: A novel insight into predicting overweight/obesity in undergraduates: A novel insight into predicting overweight/obesity in undergraduates. Medicine, 98(21), e15810. https://doi.org/10.1097/MD.0000000000015810
Song, N., Liu, F., Han, M., Zhao, Q., Zhao, Q., Zhai, H., Li, X.-M., Du, G.-L., Li, X.-M., & Yang, Y.-N. (2019). Prevalence of overweight and obesity and associated risk factors among adult residents of northwest China: a cross-sectional study. BMJ Open, 9(9), e028131. https://doi.org/10.1136/bmjopen-2018-028131
Case Study: Mr. C.
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
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.
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 clinical manifestations present in Mr. C.
Describe the potential health risks for obesity that are of concern for Mr. C. Discuss 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 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.)
Case Study Mr.C
The health complications and various diseases that impact populations across life span mean that appropriate strategies should be used to mitigate such problems. Therefore, an RN-BSN-prepared nurse needs to possess a sufficient understanding and demonstrate advanced understanding of the disease pathophysiological process, the disease clinical manifestations in the form of signs and symptoms, the possible treatment guidelines and strategies, and how these conditions impact individuals across the life span (Sole et al.,2020). Therefore, the purpose of this assignment is to evaluate the health history and medical information of a patient, Mr.C, and formulate a critical thinking essay based on the information obtained. Various aspects will be explored including the subjective and objective clinical manifestation, potential health risks, functional health patterns, stages of renal disease, health promotion opportunities, and the available resources for ESRD patients.
The Subjective and Objective Clinical Manifestations Present in Mr.C
The patient is a thirty-two-year-old single male patient who visited the facility to inquire about the possibilities of treating his obesity condition through bariatric surgery. The patient indicated that he has always had a high body mass from childhood and recently gained close to one hundred pounds. The patient also indicated that he had high blood pressure, which he had been managing through the use of a low-sodium diet. He has also been experiencing sleep apnea pruritus, swollen ankles, and consistently worsening breath shortness during activity. The blood pressure is 172/98 which is high. The HR and RR are also 88 and 26, respectively, which are extremely high. The patient’s fasting glucose level is 146, which is twice the minimum value. The patient’s cholesterol level is 250, above the recommended 200 maximum. The HDL is 30, which is lower than the normal (50). His triglycerides are also 132, which is lower than the normal levels (150)
Potential Health Risks for Obesity That are A Concern for Mr.C
From the clinical manifestations of Mr.C, there are various potential health risks for obesity. The risks include fatty liver diseases, higher levels of blood sugar, enhanced LDL cholesterol, type 2 diabetes, and cardiovascular conditions (Cercato & Fonseca, 2019). It is evident that the patient has been bordering obesity since he was a child. Therefore, there are various treatment options that can be used in this patient’s case. One such option is bariatric surgery. Even though this option can be effective, there are various aspects that a patient needs to meet before being considered for bariatric surgery. The patient must weigh less than 450 pounds, the option is also used in cases where exercise and dietary attempts to lose weight have proven unsuccessful when an individual is also having other comorbidities related to obesity. The patient meets these standards as he has hypertension and a BMI of over 40. Therefore, bariatric surgery can be helpful to this patient.
Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
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.
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.
One prevalent perceptual, neurological, or cognitive condition is dementia. A deterioration in cognitive faculties, such as memory, problem-solving, and language, is referred to as dementia (O’Brien et al., 2020). Although aging is a major contributor, it may also be brought on by things like a concussion or a bout with the flu, or even a persistent condition like Alzheimer’s disease. Age, heredity, and lifestyle factors such as an unhealthy diet, lack of physical exercise, and smoking all contribute to dementia. Other risk factors for dementia include hypertension, high cholesterol, and diabetes (O’Brien et al., 2020). Each of these is known to raise the likelihood of acquiring dementia.
People must participate in healthy lifestyle practices to improve brain health and avoid cognitive decline. This involves consuming a diet abundant in fruits, vegetables, and whole grains, regular physical exercise, and refraining from smoking (Xu et al., 2020). To further lower the risk of cognitive decline, it is essential to control any underlying chronic medical disorders, such as hypertension and diabetes.
For patients and families who have dementia, it is essential to establish a supportive atmosphere that promotes socializing and cognitively stimulating activities. This may involve reading, playing games, and participating in art and music programs. Furthermore, it is essential to give emotional support and care to the person, as well as education and assistance to the family (Xu et al., 2020). It is also essential to consider the early diagnosis since it enables early interventions and therapies that may limit the disease’s course. Regular cognitive examinations and approved cognitive tests may assist in identifying the first indications of cognitive deterioration, allowing for prompt referral to a specialist for further evaluations and therapy.
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Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
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One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
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Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
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I highly recommend using the APA Publication Manual, 6th edition.
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I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
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