NRS 410 Assignment: Case Study: Mr. C.

NRS 410 Assignment: Case Study: Mr. C.

Clinical Manifestations

    One of the clinical manifestations that Mr. C presented to the outpatient center is being always heavy. He reports that he gained approximately 100 pounds in the last 2-3 years. The other clinical manifestation is sleep apnea and high blood pressure. He also reports increasing shortness of breath in engaging in activity, pruritus over the last six months, and swollen ankles.

Potential Health Risks for Obesity

One of the potential health risks for obesity in the patient is type 2 diabetes. Obesity increases the risk of type 2 diabetes due to high insulin resistance. As a result, there is an increased risk of developing the disease due to obesity. The other health risk is elevated blood pressure. The patient is at a risk of hypertension due to the thickening of the blood vessels and increased cardiac workload for the heart. This is likely to increase the patient’s risk for cerebrovascular accidents and heart disease. These complications arise from the worsening situation of the cardiac muscles. There is also the increased risk for coronary artery disease. This is likely to result from the deposition of fatty streaks on the blood vessels. The consequences including the thickening of the vessels, increased resistance in the blood vessels, and occlusion of blood supply to tissues. The other potential health risk for the patient is cancer. The patient is also at a risk of developing kidney disease. This is likely to arise from the complications of diabetes type 2 and heart disease. The patient is also at a risk of bone problems such as fractures and osteoarthritis (Shekar & Popkin, 2020). Bone fractures are likely to occur due to large body weight that the bones cannot bear.

Bariatric surgery is appropriate for the patient. He meets all the indications that should be considered for this management approach. Firstly, the patient weighs more than 100 pounds. Besides the BMI, he also has other co-morbidities such as sleep apnea and hypertension. The patient reports that he has tried weight management approach that has been unsuccessful. These conditions are the indications for bariatric surgery, hence, its appropriateness for the patient (Gordeladze, 2017).

Functional Health Patterns

Functional health patterns allows for the accurate assessment of the patient’s problems in nursing. The patient’s health perception pattern is unaltered since he understands his problems and ways of managing it. His nutrition metabolic health pattern is unaltered since food and fluid intake is normal. However, there is an increased risk for metabolic disorders such as diabetes type 2. The patient’s elimination pattern is unaltered. The patient’s activity exercise pattern is altered as evidenced by his difficulty in breathing while engaging in activity. The sleep-rest pattern is altered as evidenced by sleep apnea. The self-perception pattern is also altered since being obese has affected patient’s perception of self. The coping-stress pattern has also been altered as evidenced by patient’s need for additional care due to failure of his adopted weight management interventions.

Actual or Potential Health Problems from the Functional Health Patterns

One of the actual problems facing the patient is negative perception of self. The obesity has significantly altered patient’s perception of self. He is at a risk of developing low self-esteem due to his physical appearance. The other actual health problem is altered sleep-rest pattern as evidenced by sleep apnea. The patient’s ability to get adequate sleep is likely to be altered if the current health problem is not addressed. The third actual health problem that the patient faces is activity intolerance. The patient reports that he experiences shortness of breath in engaging in activity. This is likely to limit his ability to live a healthy lifestyle. The fourth potential health problem he faces is the increased risk for metabolic disorders such as type 2 diabetes. This is likely to occur due to high insulin resistance. The last health problem that the patient is at a risk of developing is poor coping with the stressful health needs due to his condition. The patient has tried sodium diet restriction as part of managing his weight gain but unsuccessful (Gordeladze, 2017). He is therefore at a risk of developing poor coping skills with his stress should the adopted interventions prove ineffective.

Staging of End Stage Renal Failure and Factors to Consider

End stage renal disease is classified into five stages. The staging takes into consideration the glomerular filtration rate, which reflects the level of kidney function. Stage 1 end stage kidney disease is characterized by glomerular filtration rate (GFR) of 90 and above with normal or almost normal kidney function. Stage 2 is characterized by GFR of 60-89 with mild loss of the desired kidney function. Stage 3 is characterized by GFR of 30 to 59 with mild to moderate loss of the kidney function. Stage 4 is GRL of 15-29 with severe loss of the kidney function. Stage 5 is GFR less than 15 with kidney failure.

Patient Education

The patient should be educated on the causes and risk factors for end stage renal failure. This will help him come up with ways of minimizing them in his life. He should also be educated on the signs and symptoms of end stage renal disease and the need for reporting them to the physician. He should also be educated on lifestyle and behavioral changes that he needs to adopt. This includes dietary modifications and engaging in physical activity to reduce the risk of obesity and its associated complications. He should also be educated on the importance of medication adherence to prevent deterioration of the kidney function (Stanhope et al., 2019).

Resources

Non-acute patients suffering from end stage renal disease require a number of resources for their health and wellbeing. One of them is the social support from the family and the community. The family and community should provide the patient with the physical, social, and emotional support he needs. The community should support his needs by incorporating him into the existing social support systems for patients with chronic illnesses. The community should also be supportive by discouraging discrimination of patients with chronic illnesses. The patient also requires multidisciplinary interventions. They include active collaboration between physicians, nutritionist, physiotherapist, counselors, and nephrologist. Active collaboration is needed to optimize the health outcomes of care for the patient (Stanhope et al., 2019). The patient should be educated on delayed return to his normal activities such as resumption of job and normal activities of the daily living.

References

Gordeladze, J. (Ed.). (2017). Adiposity: Epidemiology and Treatment Modalities. BoD–Books on Demand.

Shekar, M., & Popkin, B. (Eds.). (2020). Obesity: Health and Economic Consequences of an Impending Global Challenge.

Stanhope, M., Faan, R. D., Lancaster, J., & Faan, R. P. (2019). Public Health Nursing E-Book: Population-Centered Health Care in the Community. Elsevier Health Sciences.

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:

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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.)
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.

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

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

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Case Study: Mr. C. – Rubric

Criteria Description

Clinical Manifestations of Mr. C.

5. Excellent

12 points

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

4. Good

10.68 points

Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.

3. Satisfactory

9.48 points

Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.

2. Less Than Satisfactory

9 points

Clinical manifestations are partially presented. There are major omissions and inaccuracies.

1. Unsatisfactory

0 points

Clinical manifestations are omitted.

Criteria Description

Potential Health Risks for Obesity and Bariatric Surgery

5. Excellent

12 points

A detailed discussion of the potential health risks for obesity is presented. A through and compelling discussion on whether bariatric surgery is an appropriate intervention is presented. The discussion is well-developed and supported by evidence and additional rationale.

4. Good

10.68 points

A discussion on the potential health risks for obesity is presented. A discussion on whether bariatric surgery is an appropriate intervention is presented but needs some evidence or rationale for support.

3. Satisfactory

9.48 points

A summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are some inaccuracies. More evidence or rationale is needed to support discussion.

2. Less Than Satisfactory

9 points

A partial summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are major inaccuracies. More information is needed. No evidence or rationale is provided to support discussion.

1. Unsatisfactory

0 points

Potential health risks for obesity and whether bariatric surgery is an appropriate intervention are not discussed.

Criteria Description

Functional Health Patterns

5. Excellent

18 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The discussion is insightful, and the identified problems are highly relevant for the patient and his condition. The discussion is well-supported by rationale and evidence.

4. Good

16.02 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The identified problems are relevant for the patient and his condition. Overall, the discussion is supported by rationale and evidence. Some detail is needed for clarity or accuracy.

3. Satisfactory

14.22 points

At least five actual or potential problems identified from the functional health patterns are summarized. The identified problems are generally relevant for the patient and his condition. Some rationale and evidence is required for support.

2. Less Than Satisfactory

13.5 points

At least four actual or potential problems identified from the functional health patterns are presented. The identified problems are not entirely relevant for the patient and his condition. Rationale or evidence is required for support.

1. Unsatisfactory

0 points

Actual or potential problems based on the assessment of functional health patterns of the patient are omitted or are irrelevant for the patient and his condition. The overall criteria for this assignment are not met.

Criteria Description

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

5. Excellent

12 points

The staging of ESRD and the contributing factors for ESRD are explained. The information is accurate and reflects contemporary practice and research.

4. Good

10.68 points

The staging of ESRD and the contributing factors for ESRD are explained. Some information or detail is needed for clarity or detail.

3. Satisfactory

9.48 points

The staging of ESRD and the contributing factors for ESRD are generally explained. Some information is required; there are minor inaccuracies.

2. Less Than Satisfactory

9 points

Staging of ESRD is partially summarized. The contributing factors for ESRD are vague. There are inaccuracies.

1. Unsatisfactory

0 points

Staging and contributing factors for ESRD are omitted or inaccurate.

Criteria Description

Health Promotion and Prevention for ESRD

5. Excellent

24 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is thoroughly described. The proposed items are clearly presented and highly relevant and supportive of patient and his health status. Strong evidence and rationale generally support the discussion.

4. Good

21.36 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is described. The proposed items are relevant and appropriate for the patient and his health status. Evidence and rationale generally support the discussion.

3. Satisfactory

18.96 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is generally described. There are minor inaccuracies. Overall, the proposed items are relevant for the patient and his health status. Some evidence and rationale are needed to support the discussion.

2. Less Than Satisfactory

18 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is partially summarized. There are inaccuracies. Some aspects are not relevant for the patient and his health status.

1. Unsatisfactory

0 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is omitted.

Criteria Description

Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach

5. Excellent

18 points

A clear and detailed explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. The explanation demonstrates insight into both resources and multidisciplinary approaches for nonacute care for ESRD patients.

4. Good

16.02 points

An explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. Some detail is required for clarity.

3. Satisfactory

14.22 points

A general explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are minor inaccuracies. Some additional information is required.

2. Less Than Satisfactory

13.5 points

An incomplete explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are major inaccuracies.

1. Unsatisfactory

0 points

Types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, are not discussed.

Criteria Description

Thesis Development and Purpose

5. Excellent

6 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. Good

5.34 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. Satisfactory

4.74 points

Thesis is apparent and appropriate to purpose.

2. Less Than Satisfactory

4.5 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Criteria Description

Argument Logic and Construction

5. Excellent

6 points

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. Good

5.34 points

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. Satisfactory

4.74 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. Less Than Satisfactory

4.5 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5. Excellent

6 points

Writer is clearly in command of standard, written, academic English.

4. Good

5.34 points

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

3. Satisfactory

4.74 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. Less Than Satisfactory

4.5 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

1. Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

5. Excellent

2.4 points

All format elements are correct.

4. Good

2.14 points

Appropriate template is fully used. There are virtually no errors in formatting style.

3. Satisfactory

1.9 points

Appropriate template is used. Formatting is correct, although some minor errors may be present.

2. Less Than Satisfactory

1.8 points

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

1. Unsatisfactory

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5. Excellent

3.6 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4. Good

3.2 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3. Satisfactory

2.84 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2. Less Than Satisfactory

2.7 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1. Unsatisfactory

0 points

Sources are not documented.

Total 120 points