Clinical Manifestations
Mr. C exhibits several clinical manifestations that may raise a healthcare professional’s concern. He is obese (body mass index = 44.9), has a high cholesterol level, elevated blood pressure, abnormal respiratory rate, edema on his feet and ankles, pruritus, and sleep apnea. His fasting blood glucose amount (more than 125 mg/dL) suggests that the patient has diabetes. Both total cholesterol and triglycerides are high, putting Mr. C at risk of cardiovascular disease and stroke. Meanwhile, the high-density lipoprotein level is low, further increasing the probability of the described consequences. Mr. C’s serum creatinine level is elevated, implying issues with the kidney. The patient’s blood urea nitrogen level suggests the same, although other reasons may exist. Overall, Mr. C’s obesity is connected with diabetes and furthered by kidney disease.
Health Risks and Surgery
Obesity is associated with multiple risks and complications affecting other body systems. It can be linked to cancer, stroke, and cardiovascular disease, and people with the condition generally have a shorter life span (Da Luz et al., 2018). Dissatisfaction with one’s weight and discriminatory behavior directed towards an obese individual lead to eating disorders and mental health problems, respectively (Da Luz et al., 2018). It is difficult to recommend bariatric surgery due to its various complication, such as weight regain, vitamin deficiency, and abnormal bone metabolism (Lupoli et al., 2017). Moreover, the procedure targets one’s hunger and satiety, and they are not at the core of the patient’s issues, as his kidney disease and diabetes should be addressed first (Lupoli et al., 2017). Thus, other interventions targeting the causes of obesity are to be prioritized.
Functional Health Patterns
The patient appears to recognize he has a health issue and wants to manage it with surgery. Due to diabetes, Mr. C is likely to have an increased appetite and consume more food the body requires. Similarly, his metabolism is affected by the disease, although he previously did not have any. The elimination pattern is difficult to determine, but the patient, perhaps, has to urinate frequently, as it is one of the diabetic manifestations (Zou et al., 2018). As Mr. C experiences shortness of breath, activity appears challenging, eliminating this aspect of self-care. Apnea is likely to disturb the patient’s sleep, not allowing him to rest properly. As far as the cognitive-perceptual pattern is concerned, diabetes may cause blurry vision (Zou et al., 2018). The patient could experience negative feelings regarding his condition, either due to internal or external factors (Da Luz et al., 2018). As for Mr. C’s role-relationship factor, he is single but may communicate with colleagues at work. Considering his condition, the patient may experience difficulties in sexual life and have fertility issues (Meldrum, 2017). Lastly, he could feel stressed due to health issues.
End-Stage Renal Disease and Contributing Factors
The patient’s manifestations indicate that he has chronic kidney disease, which consists of five stages. Each is characterized by a certain glomerular filtration rate (GFR), which decreases as the organ deteriorates (Webster et al., 2017). Simultaneously, its ability to remove creatinine weakens, so it is another indicator to use while determining the patient’s condition (Webster et al., 2017). Starting from the third stage, the GFR becomes lower than 60 ml/min, and the organ acquires markers of damage, such as albuminuria or urinary abnormalities, which gradually increase (Webster et al., 2017). Therefore, one can diagnose chronic kidney disease at this point (Webster et al., 2017). The final stage is kidney failure (end-stage renal disease as such), associated with a GFR lower than 15 ml/min and multiple complications (Romagnani et al., 2017). Such factors as diabetes and hypertension significantly contribute to end-stage renal disease, and both are present in the patient (Romagnani et al., 2017). Altogether, the disease requires attention, posing more health risks than the associated conditions.
Prevention and Health Promotion
Considering the patient’s circumstances, he requires secondary prevention to slow the disease’s progression. It involves controlling the ongoing nephron injury, normalizing single-nephron hyperfiltration, and addressing the complications through dialysis or kidney transplantation (Romagnani et al., 2017). However, besides these interventions, the patient should consult a dietician to avoid having a relapse in the future, as a specialist can recommend a specific diet (Romagnani et al., 2017). Educational materials may also be provided to Mr. C to ensure that he remembers what to do. They can include videos, illustrative brochures, and calendars for marking daily rations and making reminders. The dietician may also focus on what is recommendable rather than directly prohibiting food, as it is likely to make the patient more stressed. Immediately removing his favorite food from the ration can be harmful, so a step-by-step plan should be developed to address such pitfalls. Remaining at a patient-care center, for the time being, might be beneficial for health restoration and avoidance of further deterioration.
Resources and Multidisciplinary Approach
Various resources are available to help end-stage renal disease patients. They include dialysis facility finders, data systems, educational programs, funds, non-profit organizations, and websites with recommendations regarding all aspects of the condition. The patient may require such specialists as a dietician, a nephrologist, an endocrinologist, a nurse, and a cardiologist, all of which will work towards minimizing health complications. He will require devices for measuring his weight, blood pressure, blood glucose, and other relevant values. While visiting the specialists, which are not necessarily in one facility, Mr. C. might need help with transportation, including elevators and a bariatric ambulance. If he remains in the patient-care center, his room should be equipped accordingly with a special bed and an intravenous pole. Lastly, a psychologist may help the patient re-socialize after the treatment, and a lawyer can handle legal issues.
References
Da Luz, F., Hay, P., Touyz, S., & Sainsbury, A. (2018). Obesity with comorbid eating disorders: Associated health risks and treatment approaches. Nutrients, 10(7), 829-839. Web.
Lupoli, R., Lembo, E., Saldalamacchia, G., Avola, C. K., Angrisani, L., & Capaldo, B. (2017). Bariatric surgery and long-term nutritional issues. World Journal of Diabetes, 8(11), 464-474. Web.
Meldrum, D. R. (2017). Introduction: Obesity and reproduction. Fertility and Sterility, 107(4), 831–832. Web.
Romagnani, P., Remuzzi, G., Glassock, R., Levin, A., Jager, K. J., Tonelli, M., Massy, Z., Wanner, C., & Anders, H.-J. (2017). Chronic kidney disease. Nature Reviews Disease Primers, 3, 17088. Web.
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The Lancet, 389(10075), 1238–1252. Web.
Zou, Q., Qu, K., Luo, Y., Yin, D., Ju, Y., & Tang, H. (2018). Predicting diabetes mellitus with machine learning techniques. Frontiers in Genetics, 9, 115. Web.