Mr. C is a patient in the hospital for consultation for bariatric surgery but is displaying many other concerning clinical manifestations that highlight his health status. At his height and weight, Mr. C. has a high BMI of 45, which indicates morbid obesity but could be expected considering the initial goal of the visit. Mr. C has an elevated heart rate and a high blood pressure of 172/98 which may be an indicator of hypertension and potentially other cardiovascular issues. Cholesterol levels at 250 whilst healthy individuals maintain < 200 are indicative of this. Triglyceride levels are extremely high, double the normal amount at 312 mg/dL. However, the HDL levels are below standards at 30 with health levels usually being around 60 mg/dL. Patient history indicates sleep apnea that is a clinical contributor to both obesity and cardiovascular diseases. Fasting glucose from Mr. C is 146 mg/dL suggests a possibility of type 2 diabetes, as it is far above the normal threshold of 100 mg/dL.
Mr. C. is suffering from obesity, exacerbated by a sedentary job and lifestyle, and has gained significant weight both recently and in the past. Rapid weight gain of over 100 pounds within 2 years is dangerous to health and is a likely indicator of unhealthy habits. Obesity poses a risk of forming comorbidities, some of which are seen in clinical manifestations from Mr. C. There are critical indicators that the patient’s cardiovascular system is under pressure, leading to risk factors of heart disease and stroke. Type 2 diabetes is directly correlated with diabetes as a metabolic disease, creating insulin resistance and requiring consistent treatment. Several other conditions ranging from cancer and kidney disease to gout and osteoarthritis are directly associated with the prevalence of obesity (Sattar & Preiss, 2018). Bariatric surgery is a good possibility for Mr. C considering that he has been unable to lose weight on his own, and his existing conditions of pruritus, swollen ankles and breathing issues prevent him from actively exercising. Bariatric surgery is recommended given that Mr. C can demonstrate the ability to maintain a healthy diet for at least 3 months, and his other conditions do not prevent surgical intervention.
In terms of functional health, Mr. C is showing problems. Health perception may be considered to be positive in a manner that the patient is identifying and choosing to address his underlying health problem. Nevertheless, health management is poor since there is little effort to manage health other than minor restrictions on sodium in diet. Other elements such as regulation of caloric intake, physical activity, or medical treatment for his cardiovascular or metabolic diseases are missing. Metabolic indicators highlight that Mr. C. is diabetic or at the very least pre-diabetic, negatively affecting metabolic functions in other parts of the body. Nutritional functions are unknown other than minor dietary regulation, but rapid weight gain may be an indicator of unhealthy diets. Due to physical issues, activity-exercise patterns are non-existent, as it is difficult and painful for the patient to engage in strenuous exercise, contributing to obesity. Sleep-rest patterns are likely disturbed due to the presence of sleep apnea which may lead to fatigue and irregular sleep patterns. Self-perception of the patient is likely highly negative due to physical shape and health problems affecting functionality.
End-stage renal disease (ESRD) sometimes also called end-stage kidney disease occurs as the last stage of chronic kidney disease (CKD) when kidney function is lost. The primary function of kidneys is to filter waste and fluid by excreting it through urine. Without a filter system in place, the body begins to build up to dangerous thresholds of waste and other elements such as electrolytes that can lead to death without proper treatment. One of the most common treatments for late-stage kidney disease is dialysis which serves to artificially filter out the waste, but eventually, that becomes less helpful and a kidney transplant is needed. It is possible to live with CKD for some time, but with ESRD, without an urgent kidney transplant, the prognosis is not optimistic. People that have CKD are at risk of reaching ESRD with certain risk factors such as obesity, diabetes, and high blood pressure that exacerbate the disease and injure kidney function. Obesity is particularly concerning given that a high BMI is correlated with proteinuria and a low glomerular filtration rate (GFR) which serve as indicators of the severity of CKD and contribute to its progression (Locke et al.).
Prevention for ESRD is best achieved through healthy lifestyle changes. Mr. C can be guided in achieving a weight loss and health management plan after the surgery to prevent a negative renal status in the future given that the patient is at high risk. Patient education includes nutritional and physical activity guidelines that are fitting for the patient with his physical and financial capabilities. Awareness of potential health consequences for the patient is key to stimulating his recovery. Interdisciplinary care resources are available to non-acute patients to prevent the onset of ERD. A combination of physicians, dietitians, mental health workers, and social workers collaborate to treat and adjust patient lifestyles. Interdisciplinary approaches are highly effective in creating change through patient education and prevention of ESRD by offering the necessary information, guidance, and facilities to transition to a healthy life at home (Johns et al., 2015).
References
Johns, T. S., Yee, J., Smith-Jules, T., Campbell, R. C., & Bauer, C. (2015). Interdisciplinary care clinics in chronic kidney disease. BMC Nephrology, 16(1), 1-10.
Locke, J. E., Reed, R. D., Massie, A., Maclennan, P. A., Sawinski, D., Kumar, V., … Segev, D. L. (2017). Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney International, 91(3), 699–703.
Sattar, N., & Preiss, D. (2018). Research digest: assessment and risks of obesity. The Lancet Diabetes & Endocrinology, 6(6), 442.