Assignment: Case Study: Mr. C.

The case study concerns Mr. C., a 32-year-old man inquiring about having bariatric surgery to manage obesity. The patient has a history of overweight since childhood and has had a weight gain of about 100 lbs over the last 2-3 years. He has no metabolic diseases but reports experiencing sleep apnea and high blood pressure, which he manages through a low-sodium diet. The purpose of this paper is to discuss the patient’s health risks and medical interventions.

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Clinical Manifestations of Mr. C.

The subjective data show clinical manifestations of sleep apnea, high blood pressure, dyspnea with exertion, pruritus, and ankle edema. Clinical manifestations in the objective data include obesity based on a BMI of 46.4, tachypnea, high blood pressure of 172/98, and 3+ pitting ankle edema bilaterally. Furthermore, lab tests show the patient has hyperlipidemia, hyperglycemia, and elevated creatinine and BUN levels, possibly due to impaired kidney function.

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Potential Health Risks for Obesity and Bariatric Surgery

Obesity increases the risks of various chronic illnesses in multiple body systems. In the respiratory system, obesity affects lung expansion and chest wall compliance, which reduces lung capacity causing obesity hypoventilation syndrome and obstructive sleep apnea. Reduced lung capacity contributes to a reduced oxygen supply, which makes the heart pump blood harder and faster to meet the body’s metabolic needs (Jehan et al., 2020). This increases cardiac output and myocardium hypertrophy resulting in high BP and increased risk of heart failure. Furthermore, high BP and heart failure caused by obesity increase the risk of kidney failure due to a reduced blood supply to the kidneys (Jehan et al., 2020). Obese persons have a high risk for type 2 diabetes due to high total cholesterol and triglycerides levels and low HDL that increase the resistance of body cells to insulin, causing hyperglycemia.

Bariatric surgery is considered effective for persons with severe obesity (BMI > 40) and those with comorbidities. Therefore, bariatric surgery is appropriate for Mr. C since he has severe obesity with a BMI of 46.4 (Arterburn et al., 2020). He also has evident obesity comorbidities like high BP, hyperglycemia, hyperlipidemia, sleep apnea, and signs of renal impairment and heart failure.

Functional Health Patterns

In the nutritional-metabolic pattern, the patient has severe obesity (BMI of 46.4) and high weight gain (100 lbs in 2-3 years), possibly due to a mismatch between energy intake and output. Problems in the sleep-rest pattern include sleep disturbance due to obstructive sleep apnea caused by reduced lung capacity. In the activity-exercise pattern, the patient has tachypnea (RR-26) and activity intolerance, which is caused by the reduced blood supply to body tissues that affect tissue perfusion. Problems in the elimination pattern include impaired kidney function, as seen with high BUN and creatinine levels. This could be due to high BP and reduced blood supply to the kidneys. Furthermore, a potential problem in the self-perception pattern is the risk of low self-esteem in the patient due to obesity and body size, which could be why he is inquiring about bariatric surgery.

Staging and Contributing Factors of End-Stage Renal Disease (ESRD)

The ESRD stage is based on a patient’s glomerular filtration rate (GFR). Stage 1 has a GFR of 90 ml/min or higher, signifying mild kidney damage. Stage 2 has a GFR of 60-89 ml/min, indicating mild loss of kidney function. Stage 3a has GFR of 45-59 ml/min indicating mild to moderate loss of kidney function, while stage 3b has a GFR of 30-44 ml/min signifying moderate to severe loss of kidney function (Kovesdy, 2022). Stage 4 has a GFR 15-29 ml/min indicating severe loss of kidney function with. Lastly, stage 5 has a GFR below 15 ml/min, indicating kidney failure or close to failure. Risk factors for ESRD include aging, diabetes mellitus, high blood pressure, proteinuria, hyperlipidemia, heart disease, African American race, increased serum creatinine level, smoking, drug abuse, overweight/obesity, and family history of ESRD (Kovesdy, 2022). Factors that may have contributed to ESRD in Mr. C include obesity, hyperlipidemia, high blood pressure, and elevated serum creatinine level.

Health Promotion and Prevention Opportunities for ESRD

Prevention interventions for ESRD include controlling BP, managing glycemic levels, weight management, taking a healthy diet, quitting smoking, and engaging in physical exercises. Patient education for Mr. C should be tailored to lifestyle modification practices to improve his health and avoid worsening kidney function. Mr. C should be educated on lifestyle modification, like adopting healthy diet plans like the Mediterranean and DASH Diet, which lowers BP, lowers lipid levels, and promotes weight loss (Asmelash et al., 2020). He should be advised to engage in moderate-intense aerobic exercises and strength training to promote a healthy weight and control blood pressure, blood sugar, and cholesterol levels (Asmelash et al., 2020). Besides, he should be advised to avoid long-term NSAIDs use since high doses decrease blood flow to the kidney.

Resources for ESRD Patients for Non-acute Care and Multidisciplinary Approach

Resources available for ESRD patients include health education materials on self-management and treatment, kidney transplant coordination services, financing, and medical jewelry to help in recognition. Besides, patient-to-patient support programs are available where patients speak with a peer mentor and share their experiences with transplant, dialysis, or living kidney donation (Collister et al., 2019). Management of patients with ESRD is best achieved with holistic care, which is provided by a multidisciplinary team. According to Collister et al. (2019), a typical multidisciplinary ESRD team should have a nephrologist, nurse, pharmacist, dietician, and social worker. Each team member should have specific skills to prevent ESRD progression, manage complications, and improve the transition process to dialysis, transplant, or conservative care.

Conclusion

Mr. C’s obesity puts him at risk of obstructive sleep apnea, hypertension, kidney failure, and diabetes mellitus. He is suitable for bariatric surgery due to his high BMI and obesity comorbidities. The patient may develop ESRD due to obesity, hyperlipidemia, high blood pressure, and high serum creatinine level. Health education should focus on lifestyle interventions like adopting a healthy diet, controlling blood sugar and blood pressure, exercising, losing weight, and avoiding nephrotoxic drugs.

References

Arterburn, D. E., Telem, D. A., Kushner, R. F., & Courcoulas, A. P. (2020). Benefits and risks of bariatric surgery in adults: a review. Jama, 324(9), 879-887. doi:10.1001/jama.2020.12567

Asmelash, D., Chane, E., Desalegn, G., Assefa, S., Aynalem, G. L., & Fasil, A. (2020). Knowledge and Practices towards Prevention and Early Detection of Chronic Kidney Disease and Associated Factors among Hypertensive Patients in Gondar Town, North West Ethiopia. International journal of hypertension, 2020, 2860143. https://doi.org/10.1155/2020/2860143

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

Jehan, S., Zizi, F., Pandi-Perumal, S. R., McFarlane, S. I., Jean-Louis, G., & Myers, A. K. (2020). Energy imbalance: obesity, associated comorbidities, prevention, management and public health implications. Advances in obesity, weight management & control, 10(5), 146–161.

Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney international supplements, 12(1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003

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Assignment: Case Study: Mr. C.