It Is Necessary For An RN-BSN-Prepared Nurse To Demonstrate ✓ Solved

It is necessary for an RN-BSN-prepared nurse to demonstrate

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of pathophysiological processes, clinical manifestations, and treatments across the lifespan. Evaluate the Health History and Medical Information for Mr. C. based on the information below. Formulate a conclusion based on your evaluation and complete the Critical Thinking Essay as instructed.

Health History

Mr. C., a 32-year-old single male, seeks information at an outpatient center regarding possible bariatric surgery for obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, gaining approximately 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated metabolic diseases, but he reports 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

1. Height: 68 inches; weight: 134.5 kg
2. BP: 172/98 mmHg; HR: 88 bpm; RR: 26/min
3. 3+ pitting edema, bilateral feet and ankles
4. Fasting blood glucose: 146 mg/dL
5. Total cholesterol: 250 mg/dL
6. Triglycerides: 312 mg/dL
7. HDL: 30 mg/dL
8. Serum creatinine: 1.8 mg/dL
9. BUN: 32 mg/dL

Critical Thinking Essay Instructions

In 750–1,000 words, critically evaluate Mr. C.'s potential diagnosis and interventions. Address the following:

1. Describe the clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
3. Assess each of Mr. C.'s functional health patterns using the information given. Identify at least five actual or potential problems from the functional health patterns and provide the rationale for each. (Functional health patterns: health-perception/management, nutritional/metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4. Explain staging of end-stage renal disease (ESRD) and contributing factors to consider.
5. Consider ESRD prevention and health promotion opportunities. Describe patient education for prevention of future events, health restoration, and avoidance of renal deterioration.
6. Explain resources available for ESRD patients for nonacute care and the multidisciplinary approach beneficial for these patients (devices, transportation, living conditions, return-to-employment issues).

Cite a minimum of two credible sources (preferably recent) in your response.

Paper For Above Instructions

Introduction

Mr. C. presents with severe obesity and multiple metabolic and cardiovascular derangements. Objective data indicate poorly controlled hypertension, hyperglycemia, dyslipidemia, edema, and impaired renal function. The clinical picture suggests that obesity-related cardiometabolic disease and evolving chronic kidney disease (CKD) are the principal concerns. This essay synthesizes the clinical manifestations, evaluates bariatric surgery appropriateness, assesses functional health patterns identifying five priority problems, explains ESRD staging and contributors, outlines prevention and patient education strategies, and describes multidisciplinary resources for long-term care (CDC, 2021; NKF, 2022).

Clinical Manifestations

Mr. C.’s presenting manifestations include severe obesity (BMI ≈ 45.8 kg/m2), elevated BP (172/98 mmHg), exertional dyspnea, 3+ bilateral pitting edema, pruritus, fasting hyperglycemia (146 mg/dL), atherogenic dyslipidemia (total cholesterol 250 mg/dL, triglycerides 312 mg/dL, HDL 30 mg/dL), and renal impairment (serum creatinine 1.8 mg/dL, BUN 32 mg/dL). Sleep apnea and progressive weight gain are also noted. Collectively these signs indicate cardiovascular strain, fluid overload, insulin resistance/diabetes, and possible progression of CKD (Levey et al., 2020; American Diabetes Association, 2023).

Potential Health Risks and Bariatric Surgery Consideration

Risks related to Mr. C.’s obesity include type 2 diabetes progression, uncontrolled hypertension leading to cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, venous stasis/edema, and CKD progression toward ESRD (Winnicki et al., 2021). The degree of renal impairment (elevated creatinine and BUN) may represent CKD stage 3 (moderately decreased GFR) but requires eGFR calculation and urinalysis for albuminuria to stage accurately (KDIGO, 2012/updated guidance 2021). Bariatric surgery can be effective for weight reduction and metabolic improvement, often improving glycemic control and blood pressure and slowing CKD progression in appropriate candidates (Patel et al., 2020; Cohen et al., 2022). However, preoperative renal function, cardiovascular risk, sleep apnea management, nutritional status, and psychosocial stability must be optimized. Given Mr. C.’s uncontrolled hypertension and renal impairment, multidisciplinary preoperative assessment is essential; if cleared, bariatric surgery may be appropriate as part of comprehensive management (ASMBS, 2020).

Functional Health Pattern Assessment and Priority Problems

Using Gordon’s functional patterns, assess key areas:

• Health-perception/management: Poor control of hypertension and hyperglycemia suggests inadequate disease management and healthcare engagement. Problem: uncontrolled hypertension increasing CV and renal risk (CDC, 2021).
• Nutritional/metabolic: Excess caloric intake and weight gain with dyslipidemia and hyperglycemia. Problem: metabolic syndrome and insulin resistance increasing CKD progression risk (Sacks et al., 2021).
• Activity-exercise: Exertional dyspnea and deconditioning from obesity. Problem: reduced mobility increasing thromboembolic and cardiovascular risk and impairing weight loss efforts.
• Sleep-rest: Reported sleep apnea. Problem: untreated obstructive sleep apnea exacerbates hypertension and metabolic dysfunction.
• Elimination: Evidence of renal dysfunction (elevated creatinine/BUN, pruritus, edema). Problem: progressive CKD with fluid retention and uremic symptoms requiring early nephrology referral.

Each problem has clear rationale: uncontrolled hemodynamics and metabolic derangements accelerate end-organ damage including kidneys, heart, and liver; limited physical activity perpetuates obesity; sleep apnea worsens BP and insulin resistance; and renal impairment manifests as edema and pruritus needing targeted management (NKF, 2022; ADA, 2023).

ESRD Staging and Contributing Factors

CKD staging is primarily based on estimated glomerular filtration rate (eGFR) and albuminuria categories. eGFR 3 months indicates CKD; stages 1–5 indicate progressive decline, with stage 5 (eGFR

Prevention, Health Promotion, and Patient Education

Prevention and education should focus on: strict BP control (target individualized but generally

Resources and Multidisciplinary Approach

Nonacute resources include nephrology clinics, renal dietitians, bariatric programs, behavioral health services, physical therapy, sleep medicine, social work, and vocational rehabilitation. Devices and aids (compression stockings, mobility aids) and arrangements for transportation to appointments must be addressed. A coordinated team—primary care, bariatric surgeon, nephrologist, cardiologist, endocrinologist, dietitian, social worker, and mental health provider—optimizes outcomes, supports return-to-employment planning, and addresses living-condition adaptations (ASMBS, 2020; NKF, 2022).

Conclusion

Mr. C. demonstrates multiple high-risk features: severe obesity, poorly controlled hypertension, dysglycemia, dyslipidemia, edema, and renal impairment. Immediate priorities are accurate CKD staging with eGFR and albuminuria measurement, aggressive BP and glycemic control, sleep apnea management, lifestyle intervention, and multidisciplinary evaluation for potential bariatric surgery. Timely education and coordinated long-term resources can slow renal decline and improve cardiometabolic outcomes.

References

• American Diabetes Association. Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023.
• American Society for Metabolic and Bariatric Surgery (ASMBS). Clinical Practice Guidelines. 2020.
• Centers for Disease Control and Prevention (CDC). Adult Obesity Facts. 2021. https://www.cdc.gov/obesity
• Cohen, E. et al. Bariatric surgery and kidney outcomes: systematic review. Obesity Reviews. 2022.
• KDIGO. 2021 Clinical Practice Guideline for the Management of Chronic Kidney Disease. Kidney Int Suppl. 2021.
• Levey, A.S., et al. Global Kidney Disease: definitions and staging. Journal of Nephrology. 2020.
• National Kidney Foundation (NKF). Chronic Kidney Disease (CKD) Information. 2022. https://www.kidney.org
• Patel, S. et al. Metabolic surgery and renal outcomes in obesity: a cohort study. JAMA Surgery. 2020.
• Sacks, F.M., et al. Metabolic syndrome, dyslipidemia, and renal risk in obesity. Lancet Diabetes Endocrinol. 2021.
• Winnicki, M., et al. Obesity and CKD progression: mechanisms and interventions. Nephrology Dialysis Transplantation. 2021.