This case study discusses the clinical manifestation of obesity and risk of kidney failure in Mr C. It also highlights the potential health risks associated with obesity and the appropriate intervention to prevent it. The study also covers the functional health patterns of Mr C and preventive measures for ESRD.
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Running head: CASE STUDY CASE STUDY Name of Student: Name of University: Author’s Note:
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1CASE STUDY Answer number 1. It is evident from the case study that Mr C is obese and looking to go for the bariatric surgery. The clinical manifestation that can be observed in Mr C linked to obesity are sleep apnoea, high blood pressure, shortness of breath, swollen ankles and pruritus. Concerning his objective data, he has the weight of 134.5 kg and height of 68 inches. According to the study of Depczynski, Young and White (2018) BMI above 25 is regarded as obese, and on calculating his BMI is 45.5 which proves for obesity in Mr C. Normal blood glucose level in human lies in the range of 100mg/l, and as per the objective data he has 146mg/l blood glucose level, which indicates that Mr C is diabetic. Further, the functioning of his kidney is impaired as he has high serum creatinine of 1.8mg/l and Blood Urea Nitrogen of 32mg/dl (Pandya, Nagrajappa & Ravi, 2016). Such dysfunction of the kidney is also associated with his obesity which is related to his high total cholesterol level, triglyceride and low HDL. Due to increased weight, his respiratory rate is also high which accounts to 21/min. Therefore, the clinical manifestation indicates obesity and risk of kidney failure in Mr C. Answer number 2. Mr C is reported to be obese and is associated with various health risk. According to the study of Mandviwala, Khalid and Deswal (2016) people who are diagnosed with obesity are at high risk of diabetes, hypertension and other health complication. As per the laboratory data of Mr C, he has high blood glucose level and high blood pressure, thus have the potential to acquire type 2 diabetes. It is evident from the study of Kovesdy, Furth and Zoccali (2017) that in the person affected by obesity, there is the occurrence of compensatory hyperfiltration in order to
2CASE STUDY meetthemetabolicdemandoftheincreasingbodyweight.This,inturn,increasesthe intraglomerular pressure and have the potential to damage the kidney. It is seen that Mr C has high serum creatinine and elevated blood urea nitrogen, he is also at the risk of kidney failure. It is noted that he has high total cholesterol and high triglyceride and low HDL, which can cause coronary blockage, thus can lead to cardiovascular complication (Chuengsamarn et al., 2017). Williams et al. (2015) have stated that bariatric surgery is performed in a person who has a BMI above 40 and however it is associated with severe health risk. Thus, concerning his case and health risk, bariatric surgery is proved to be an appropriate intervention to prevent obesity in Mr C. Answer number 3. Concerning to the case study, the five functional health patterns of Mr C observed are health management, health perception, nutritional, metabolic and elimination. It is noted that Mr C has health perception is potential problem because as he does not have sleep apnea and high bloodpressurebutstilltakelowsodiumdietanditcouldleadtodehydration.Health management is also potential problem because without being suggested for bariatric surgery he seeking information regarding it, hence it could lead to severe health complication like heart failure. Nutrition being another functional health pattern is other actual problem because as it is evident from the study of Batsis et al. (2015) that due to low sodium intake, there is electrolyte imbalance, and there is the release of renin is obstructed which causes low blood pressure. Metabolic is regarded as potential problem as change in diet lead to low blood volume that causes dysfunction in pulmonary and systematic circulation leading to heart failure. Elimination is viewed as actual problem because low absorption of sodium can impact the glomerular
3CASE STUDY filtration and increases the arteriole pressure thus may lead to kidney failure (Ray et al., 2015). Electrolyte imbalance causes release of high ADH level; thus, have the potential to cause dehydration and dizziness. Answer number 4. In stage one, there is mild damage to kidney with EGFR of 90ml/min and above. In second stage, the EGFR is in the range of 60ml/min to 80ml/min, which shows initial period of damage of kidney function. The third stage, the GFR get decreased to 45-59ml/min where there is a need to consider the build of the waste product which shows a sign of the change of urination color. The fourth stage has GFR of 15-30ml/min and needs dialysis or kidney transplantation. In the last stage, the GFR become less than 15ml/min which is the advanced stage of kidney failure. The contributing factor for each of the stages is advanced age, hypertension, diabetes, obesity and low oxygen saturation level respectively (Ayav et al., 2016). Answer number 5. ESRD is the lethal disease which can lead to kidney damage. Patient education is one of a preventive measure for ESRD. The patient will be given education-related to self-management and implementation of precautions for health promotion. The patient will be given the education to control diabetes and maintain high blood pressure (Devoe et al., 2016).Education about the healthy diet and physical activity will also be provided so that management of health is done effectively. Further, patient will be taught to maintain a healthy weight by performing physical exercise for 30 min. The patient will be given education about the side effect of ESRD and sign and symptoms, so that patient can immediately contact in emergency department.
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4CASE STUDY Answer number 6. The resource available for the ESRD patients is ambulance service, community service like domestic service to help the patient with daily living activities, availability of dialysis device and instrument and community diver for secure transportation of ESRD patient in need. The multidisciplinary approach also has a benefit to the ESRD patient (Mercado‐Martinez et al., 2017). By the involvement of the psychologist, the patient will be able to cope with the illness. They also motivate the patient towards their daily life and also address the return-to-employment issues. The presence of physiotherapist also helps the patient to manage weight effectively. A nutritionistcanassistthepatientregardingthemaintenanceofahealthydiet.Sucha multidisciplinary approach helps to maintain the health of the ESRD patient and thus promote their wellness.
5CASE STUDY Reference Ayav, C., Beuscart, J. B., Briançon, S., Duhamel, A., Frimat, L., & Kessler, M. (2016). Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5): the EPIRAN community-based study.BMC nephrology,17(1), 174. Batsis, J. A., Mackenzie, T. A., Lopez-Jimenez, F., & Bartels, S. J. (2015). Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999-2004.Nutrition research,35(12), 1031-1039. Chuengsamarn, S., Rattanamongkolgul, S., Sittithumcharee, G., & Jirawatnotai, S. (2017). Association of serum high-sensitivity C-reactive protein with metabolic control and diabetic chronic vascular complications in patients with type 2 diabetes.Diabetes & Metabolic Syndrome: Clinical Research & Reviews,11(2), 103-108. Depczynski, B., Young, T., & White, C. (2018). A high ankle-brachial index is associated with obesity and low serum 25-hydroxyvitamin D in patients with diabetes.Journal of clinical & translational endocrinology,11, 7-10. Devoe, D. J., Wong, B., James, M. T., Ravani, P., Oliver, M. J., Barnieh, L., ... & Quinn, R. R. (2016). Patient education and peritoneal dialysis modality selection: a systematic review and meta-analysis.American Journal of Kidney Diseases,68(3), 422-433. Kovesdy,C.P.,Furth,S.,&Zoccali,C.(2017).ObesityandKidneyDiseaseHidden Consequences of the Epidemic (Special Report). Mandviwala, T., Khalid, U., & Deswal, A. (2016). Obesity and cardiovascular disease: a risk factor or a risk marker?.Current atherosclerosis reports,18(5), 21.
6CASE STUDY Mercado‐Martinez, F. J., da Silva, D. G. V., & Correa‐Mauricio, M. E. (2017). A comparative study of renal care in Brazil and Mexico: hemodialysis treatment from the perspective of ESRD sufferers.Nursing inquiry,24(2), e12163. Pandya, D., Nagrajappa, A. K., & Ravi, K. S. (2016). Assessment and correlation of urea and creatinine levels in saliva and serum of patients with chronic kidney disease, diabetes and hypertension–aresearchstudy.Journalofclinicalanddiagnosticresearch: JCDR,10(10), ZC58. Ray, E. C., Rondon-Berrios, H., Boyd, C. R., & Kleyman, T. R. (2015). Sodium retention and volume expansion in nephrotic syndrome: implications for hypertension.Advances in chronic kidney disease,22(3), 179-184. Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight andobesity:prevalence,consequences,andcausesofagrowingpublichealth problem.Current obesity reports,4(3), 363-370.