Clinical Manifestations Present in Mr. C.
Mr. C. is morbidly obese with a BMI of 47.9 based on the height of 68 inches and weight of 134.5 kg, which is one of the major predisposing factors to high blood pressure, type II diabetes, and various heart diseases. He also has hypertension according to the provided information concerning his vital organs, such as blood pressure (BP) of 172/98, heart rate (HR) 88, and respiratory rate (RR) 26. His hypertension is uncontrolled, given that he attempts to control his blood pressure through dietary restriction. Additionally, he is diabetic according to his fasting blood glucose of 146 mg/dL. The total cholesterol of 250 mg/dL, HDL of 30 mg/dL, and triglycerides of 312 mg/dL indicate that he has hyperlipidemia. Mr. C. also has signs of chronic kidney disease (CKD) based on the following data: – BUN 32 mg/dL, serum creatinine 1.8 mg/dL, and 3+ pitting edema bilateral feet and ankles.
Potential Health Risks for Obesity
Some of the potential health risk factors for obesity include development and progression of diabetes type II due to insulin resistance, hypertension, various heart diseases, such as coronary heart disease, sleep apnea, and CKD, gastrointestinal disorder, psychological and respiratory problems, and joint and muscular disorders (Fruh, 2017). Mr. C. already has most of the health conditions associated with obesity. The patient is morbidly obese, and thus bariatric surgery is an appropriate intervention to address this problem. According to Wolfe et al. (2016), “Specific criteria established by the NIH consensus panel indicated that bariatric surgery is appropriate for all patients with BMI (kg/m2) >40 and for patients with BMI 35-40 with associated comorbid conditions” (p. 1844). This client is eligible for bariatric surgery as an intervention measure to prevent the progression of the mentioned risk factors of obesity. However, before the surgery could take place, a comprehensive assessment should be conducted to ensure that other presenting comorbidities do not interfere with the outcome.
Mr. C.’s Functional Health Patterns
The patient perceives himself as unhealthy based on the information he has provided. He notes that he has been obese since his childhood, and he is aware that this condition is causing a myriad of other problems. He has also been managing his health by restricting dietary sodium intake to manage hypertension. Nutritionally, it appears that Mr. C. is eating unhealthily due to the high fasting blood glucose, total cholesterol, triglycerides, and high-density lipoprotein. Additionally, he has an elimination problem based on the high serum creatinine levels. Similarly, his sleep-rest pattern is affected by sleep apnea. Given that he is morbidly obese, he is not physically active to exercise effectively. Mr. C.’s self-perception or self-concept is that he is unhealthy, which explains why he is seeking help.
Staging of End-Stage Renal Disease (ESRD) and Contributing Factors
Kidney failure is a progressive health condition, and it occurs in five distinct stages – 1, 2, 3A and 3B, 4, and 5, with ESRD being the final phase. In stage 1, the glomerular filtration rate (GFR), measured in ml/min/1.73m2, is ≥90, and while the kidney functions normally, the initial signs of kidney disease start presenting. In stage 2, the GFR is between 60 and 89 with slightly impaired kidney function. In stages 3A and 3B, the GFR is 45-59 and 30-44, respectively, and kidney functioning is reduced significantly. In stage 4, the GFR is between 15 and 29 with extremely reduced kidney function. In the last phase, stage 5, the GFR is less than 15, and at this point, a patient is said to have ESRD or renal failure (DiMaria et al., 2017). The contributing factors to ESRD include family history, hypertension, diabetes, polycystic kidney disease (PKD), Alport syndrome, interstitial nephritis, pyelonephritis, and some autoimmune diseases, including lupus.
ESRD Prevention and Health Education for Mr. C.
Mr. C. has several ESRD risk factors, such as diabetes, hypertension, and CVD. Therefore, to prevent the progression of ESRD, he should control his blood glucose to address the diabetes issue, maintain healthy blood pressure through keeping a low-fat and low-salt diet, exercise frequently, observe healthy weight, avoid smoking, and limit alcohol intake. The patient should be educated on how to achieve the aforementioned aspects of his health. He should be informed on how to maintain a healthy diet low in carbohydrates, salt, and fat. Additionally, the patient needs a realistic and executable workout plan to ensure that he is physically active. The education program should focus specifically on addressing the obesity problem because it is the major predisposing factor in his case.
Resources for ESRD Patients
ESRD patients could access information on this condition from the Centers for Disease Control and Prevention – Chronic Kidney Disease; Renal Disease Networks; Home Dialysis Central; Mayo Clinic – Chronic Kidney Disease; and Polycystic Kidney Disease. The management of ESRD requires an interdisciplinary approach with physicians, nephrologists, patients, and family members working together to address the problem. Social workers also play an important role in helping patients with ESRD to manage and cope with the condition. Some devices, such as portable hemodialysis devices including wearable ultrafiltration and artificial kidney, could be useful to ESRD patients (Castro et al., 2018). Transportation for these patients is available through public means, taxis, the subway, and private cars. With enough support from all the involved parties, ESRD patients could return to work based on the nature of their occupation.
References
Castro, A. C., Neri, M., Nayak Karopadi, A., Lorenzin, A., Marchionna, N., & Ronco, C. (2018). Wearable artificial kidney and wearable ultrafiltration device vascular access-future directions. Clinical kidney journal, 12(2), 300–307.
DiMaria, C., Leonard, M., & Jewell, T. (2017). What you need to know about end-stage kidney disease (ESRD). Healthline.
Fruh S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. Journal of the American Association of Nurse Practitioners, 29(1), 3-14.
Wolfe, B. M., Kvach, E., & Eckel, R. H. (2016). Treatment of obesity: Weight loss and bariatric surgery. Circulation Research, 118(11), 1844-1855.