Clinical Manifestations
Mr. C. demonstrates clinical manifestations which are commonplace among patients with obesity and health complications that are associated with co-morbidities in obese individuals. The first is rapid weight gain, characterized by an increase of over 100lbs in mass over a short period of 2-3 years, and significantly exceeding the normal body-mass index (BMI). Mr. C. complains of sleep issues and a diagnosis of sleep apnea. A number of cardiovascular problems are evident such as high blood pressure and heart rate when measured. Fasting blood glucose is extremely high, suggestive of diabetes. Furthermore, cholesterol and triglyceride levels are greatly elevated as well.
Health Risks of Obesity
The primary health risks of obesity identified for Mr. C. are the potential for metabolic disorders and cardiovascular issues. Metabolic disorders such as diabetes are associated with elevated levels of blood glucose. Obesity-related diabetes mellitus is the second leading cause of death for abnormal BMI levels. In the long-term mismanaged diabetes causes disability and negatively affects the quality of life, impacting everything from fatigue to hormone production. Meanwhile, cardiovascular disease is the leading cause of death and disease for obese individuals. Obesity symptoms such as high cholesterol levels increased blood pressure, and fatty tissue in the heart creates an elevated risk for chronic cardiovascular disease. In turn, this is associated with heart attacks and strokes in patients that may lead to poor health and death (Manna & Jain, 2015).
Bariatric surgery is recommended for those with a BMI ≥ of 40, one or more obesity-related co-morbidities such as hypertension, Type II diabetes, sleep apnea, or heart disease, and the inability to achieve weight loss through other means over a sustained period of time prior to surgery discussions (ASMBS, n.d.). While Mr. C. fits the parameters for bariatric surgery, this visit to a medical professional seems to be his first regarding specifically addressing his obesity. It would beneficial to educate the patient and instigate a lifestyle change in the attempt to observe weight progression over a period of 1-3 months in order to determine if there are alternatives to the surgery.
Functional Health Patterns
The first functional health problem is with health management. Mr. C. has indicated little engagement with his health and has a myriad of health issues that are not actively managed or treated, leading to the deterioration of health along with obesity. Nutritional and potentially metabolic functions are problematic. Mr. C. has high levels of blood glucose as well as increased levels of weight gain over a short period of time without a potential explanation. It can be argued that his dietary intake is most likely unhealthy in the levels of caloric intake that his organism requires and expends.
The activity-exercise functionality is potentially problematic as Mr. C. works a sedentary job. Any levels of physical activity are described to cause fatigue and shortness of breath, which leads to the conclusion that the patient engages in very little physical activity. Sleep and rest are unhealthy as well, considering the presence of sleep apnea which is a serious health concern leading to fatigue, poor sleep, and additional problems with the heart. Finally, health perception is a potential issue since the patient is seeking information for a potential bariatric surgery as a solution to his obesity problem. It can be argued that his perception as to the causes of his obesity is not accurate.
ESRD
End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD) which commonly progresses over the years. Staging is determined by the glomerular filtration rate (GFR) which measures the level of serum creatinine level, a waste product produced by functioning kidneys. Patients with ESRD have GFR levels of <15 mL/min. Certain contributing factors in patients can lead to a more rapid progression of CKD to arrive at the ESRD stage. Diabetes leads to high glucose levels in the body on a consistent level which damages nephrons. Meanwhile, hypertension creates pressure on blood vessels in the kidneys leading to damage and the inability to effectively filter. Inflammation in the body, including the kidneys, can also contribute to ESRD (Latif, 2018).
Prevention and Health Promotion
Obesity and CKD are inherently interconnected, and measures should be taken by obese patients such as Mr. C. to avoid reaching the ESRD stage. Early identification of CKD is vital and imposing health interventions, and metabolic dysfunctions lead to much rapid progression. Lifestyle interventions such as caloric restrictions and increased physical activity are the first step to prevention. Education on managing blood glucose and sustainable diabetes treatment is effective. Both these interventions reduce weight, HbA1c, and systolic blood pressure that negatively impacts kidney function over the long term. If CKD is identified, bariatric surgery is a potential intervention for significant weight reduction. Any health promotions that focus on bodyweight reduction and overall management of type-2 diabetes and hypertension are justified as successful interventions to increase survival and reduce the progression of CKD to ESRD (Kovesdy, Furth, Zoccali, & World Kidney Day Steering Committee, 2017).
Available Resources
Patients with ESRD have access to resources to manage the condition. Devices such as the surgically implanted renal assist device can mimic the functions of a healthy kidney. National organizations and local volunteers arrange services for transportation for CKD patients. CKD patients may require constant medical care and dialysis, resulting in the need for sanitary and accessible living conditions which can be subsidized through various government disability programs and non-profit help. Due to medical issues and co-morbidities, ESRD patients will experience changes in employment levels. Public assistance along with legally required accommodations for disabilities can allow ESRD patients to continue working. A multidisciplinary approach with health professionals such as dieticians, nephrologists, and therapists may be beneficial in instituting the complex lifestyle and pharmaceutical interventions necessary for ESRD management.
References
ASMBS. (n.d.). Who is a candidate for bariatric surgery? Web.
Kovesdy, C. P., Furth, S. L., Zoccali, C., & World Kidney Day Steering Committee (2017). Obesity and kidney disease: Hidden consequences of the epidemic. Canadian Journal of Kidney Health and Disease, 4, 1-10. Web.
Manna, P., & Jain, S. K. (2015). Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: Causes and therapeutic strategies. Metabolic Syndrome and Related Disorders, 13(10), 423-444. Web.
Latif, W. (2018). End-stage kidney disease. Web.