Bariatric Surgery and End-Stage Renal Disease Prevention in an Obese Patient

Introduction

People might need bariatric surgery for different reasons despite the intention to maintain healthy habits and lifestyles. In the case under analysis, Mr. C is a 32-year-old single man who works at a catalog telephone center and has gained about 100 pounds during the last 2-3 years. The patient admits he has always been heavy and wants to get more information about bariatric surgery for his obesity at the local outpatient center. This paper will focus on the patient’s clinical manifestations, potential health risks, and end-stage renal disease (ESRD) factors to promote health and choose the resources for ESRD prevention in a non-acute care and interdisciplinary approach.

Clinical Manifestations

Mr. C’s health history and objective data contribute to the identification of several clinical manifestations. The patient’s height is 68 inches, and his weight is 134.5 kg, showing his high Body Mass Index (BMI, 45.1) and proving his obesity and indication for a bariatric procedure (Arterburn et al., 2020). In addition, Mr. C also has sleep apnea, high blood pressure (172/98), and high fasting blood glucose (146 mg/dL), although no metabolic diseases have been indicated.

His major intervention is restricting dietary sodium, but it is not enough to predict other complications, including shortness of breath, swollen ankles (3+ pitting bilateral edema), and pruritus. The association between high triglycerides (312 mg/dL) and low high-density lipoprotein (HDL, 30 mg/dL), or dyslipidemia, is evident. Finally, Mr. C has high levels of serum creatinine (1.8 mg/dL) and blood urea nitrogen (BUN, 32 mg/dL). All these subjective and objective indications are necessary to continue working with the patient.

Potential Health Risks for Obesity and Bariatric Surgery

Considering the patient’s clinical presentation, there are several critical health risks related to obesity. According to Evans et al. (2021), high blood pressure and fasting blood glucose levels might increase the possibility of diabetes and cardiovascular disease. Dyslipidemia, developed from high BMI, can lead to coronary atherosclerotic disease (CAD) (Caselli et al., 2021).

Additional causes include smoking, alcohol intake, and genetics, which also play a crucial role, but no clear information is given in the case. High BUM and serum creatinine mean there could be some kidney problems and ESRD risks (Asif et al., 2020). The National Institutes of Health guidelines (1991, as cited in Arterburn et al., 2020) underline that patients with a BMI of over 40 are predisposed to obesity-related comorbidities, like heart failure, cancer, and CAD. Thus, bariatric surgery is a suitable treatment option for patients with such clinical manifestations, allowing them to predict the risks and improve their quality of life.

Functional Health Patterns

Each individual can develop various functional health patterns depending on the health problem and the patient’s attitudes toward its progress. At the end of the 1900s, Gordon introduced a clear model that clearly described the main needs of patients, from basic perceptions to coping patterns (Butcher & Jones, 2021):

• Health perception: Mr. C is aware of his obesity-related problems and considers bariatric surgery as his option.
• Health management: Mr. C states that he tries to restrict sodium intake to manage his sleep apnea and hypertension.
• Nutrition: Mr. C’s high cholesterol levels can be a sign of eating products with saturated fats and limited sodium.
• Metabolic: Mr. C has no indicated metabolic diseases.
• Elimination: not mentioned.
• Activity-exercise: regarding the nature of Mr. C’s work, it is possible to assume that he prefers a sedentary lifestyle.
• Sleep-rest: Sleep apnea is the primary health concern.
• Cognitive-perceptual: No specific issues are mentioned.
• Self-perception/self-concept: Mr. C knows that he has obesity problems and needs professional treatment.
• Role-relationship: This information is minimal, and the patient is known to be single.
• Sexuality/Reproductive: not covered.
• Coping-stress tolerance: No coping strategies except the intention to reduce sodium intake are discussed.

Based on these functional health patterns, Mr. C’s case can be associated with several potential problems. Firstly, despite the intention to limit sodium products, the patient has gained about 100 pounds in 2-3 years, meaning that additional food issues (nutritional and metabolic patterns) bother him (Khalesi et al., 2022). Secondly, Mr. C has sleep problems due to shortness of breath, and poor sleep quality (sleep-rest pattern) negatively affects his daily activities.

Thirdly, the patient does not try to change his sedentary lifestyle and continues working at the telephone center, challenging his activity-exercise patterns. Fourthly, he does not have a good support system as he is single. Finally, Mr. C addresses the center to get professional help and use bariatric surgery as the only intervention to manage his weight, which proves his actual health problem, ESRD, and readiness to cooperate.

Staging and Contributing Factors of End-Stage Renal Disease

There are five stages of ESRD and specific contributing factors when the patient is at risk of losing their proper kidney functioning. Diagnosis and kidney damage levels depend on glomerular filtration rates (GFR):

1. normal GFR,
2. mild GFR reduction,
3. moderate GFR reduction,
4. severe GFR reduction,
5. renal failure.

The patients should be careful with certain health risks, including prediabetic conditions, hypertension, and a family history of kidney problems (Asif et al., 2020). Regular urine analysis to reveal serum creatinine level changes is recommended.

Health Promotion and Prevention Opportunities

At this moment, Mr. C has a good chance to improve his health and prevent ESRD complications. Patient education plays a vital role in covering his dietary and physical needs. Future events include improving fasting blood glucose, cholesterol, and triglyceride levels through establishing healthy dietary habits and regular physical exercise (Caselli et al., 2021).

Health restoration cannot be immediate, but slowing the progress of ESRD through burning calories is expected. Hypertension has high remission rates, and it is important to control medication intake as a part of the intervention to avoid deterioration of renal status (Arterburn et al., 2020). Patient-nurse communication is critical in this case to help the patient understand what areas of improvement are integral.

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

The choice of resources for ESRD patients is an integral part of non-acute care and a multidisciplinary approach. In this case, a team of healthcare professionals, including nutritionists, surgeons, anesthesiologists, and therapists, should cooperate to educate the patient and monitor his vital signs. Internet resources can help develop a specific physical exercise plan without high financial costs.

The patient does not talk about his family’s role and interpersonal relationships. Still, these interventions are necessary to reduce stress and obtain moral support (Butcher & Jones, 2021). Employment issues are also critical because his status allows the patient to cover medical bills and medications.

Conclusion

In general, evaluating Mr. C’s clinical manifestations and functional health patterns is necessary to prove that bariatric surgery is an appropriate intervention. The patient is obese, and his lab test results prove that urgent diet and physical exercise changes can no longer be ignored. In addition to his obesity-related problems, Mr. C is at risk of diabetes, CAD, and renal problems. Therefore, the best solution is to cooperate with a multidisciplinary team as part of patient education to manage his weight and blood pressure.

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. Web.

Asif, A. A., Hussain, H., & Chatterjee, T. (2020). Extraordinary creatinine level: A case report. Cureus, 12(7). Web.

Butcher, R. D. C. G., & Jones, D. A. (2021). An integrative review of comprehensive nursing assessment tools developed based on Gordon’s eleven functional health patterns. International Journal of Nursing Knowledge, 32, 294-307. Web.

Caselli, C., De Caterina, R., Smit, J. M., Campolo, J., El Mahdiui, M., Ragusa, R., Clemente, A., Sampierto, T., Clerico, A., Liga, R., Pelosi, G., Rocchiccioli, S., Parodi, O., Scholte, A., Knuuti, J., & Neglia, D. (2021). Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina. Scientific Reports, 11(1). Web.

Evans, M., Morgan, A. R., Patel, D., Dhatariya, K., Greenwood, S., Newland-Jones, P., Hicks, D., Yousef, Z., Moore, J., Kelly, B., Davies, S., & Dashora, U. (2021). Risk prediction of the diabetes missing million: Identifying individuals at high risk of diabetes and related complications. Diabetes Therapy, 12(1), 87-105. Web.

Khalesi, S., Williams, E., Irwin, C., Johnson, D. W., Webster, J., McCartney, D., Jamshidi, A., & Vandelanotte, C. (2022). Reducing salt intake: A systematic review and meta-analysis of behavior change interventions in adults. Nutrition Reviews, 80(4), 723-740. Web.