The nurse’s professional activity is related not only to the provision of appropriate care for the patient but also to the establishment of the primary diagnosis, confirmed by analysis of laboratory data and information on the pathophysiology. In this case, Mr. C. has overweight problems, which at first glance, appear to cause complications. The signs of respiratory and cardiovascular dysfunctions observed during the history collection may be additional evidence of the obesity seen in Mr. C. This work is reduced to a detailed discussion of the described scenario in the context of the nurse’s RN-BSN professional activity.
Description of a Clinical Case
The study of health threats and prescription of a particular treatment should be preceded by a comprehensive analysis of Mr. C’s current health state. According to the attached clinical history, the man has high blood pressure: at the norm of 120/80 mmHg, 172/98 mmHg was registered (“High blood pressure symptoms and causes,” 2020). During physical activity, whether climbing stairs or moving around the room, Mr. C. begins to suffocate: this is due to increased breathing. Problems with the kidneys or the cardiovascular system can be recorded indirectly: the examination of the patient found that he suffers from 3+ pitting edema bilateral feet and ankles. Finally, a biochemical blood test of the man showed overestimated results in glucose and cholesterol levels. According to “Diabetes” (2020) and “Cholesterol levels” (2020), the norm for healthy middle-aged men is glucose concentration lower than 140 mg/dL and lipophilic alcohol content not more than 200 mg/dL. These clinical manifestations can lead to serious health risks for Mr. C.
In general, it should be recognized that several clinical signs can confirm a disappointing diagnosis for the patient. Excessive blood pressure, in combination with cholesterol and triglyceride, indicates the potential for coronary heart disease. On the other hand, excess glucose concentration may indicate a previous stage of diabetes. Anxiety caused by cognitive stress due to the development of serious diseases, and probably physical pain due to ulcers, leads to a disturbance of habitual activity, including expressed as night apnea. The man has the final stage of renal failure, as evidenced by high creatinine levels in the blood and increased levels of urea in the blood. Indirect confirmation of the diagnosis is also dictated by the presence of bilateral foot edema: the body’s tissues contain an excess of fluids. Finally, it is well known that a high body mass index is associated with the development of serious chronic diseases, including cancer (Greenlee et al., 2017). The calculated patient index exceeds the mark of 44 kg/m2, which is an indicator of undesirable consequences. Given the dynamics of weight gain and the patient’s predisposition to obesity, bariatric medicine is a suitable strategy for therapy.
Meanwhile, Mr. C.’s functional health is at risk in several ways. The cognitive perception of the circumstances in which he has been placed makes the man worry and seek a solution to the problem; for example, he tries to limit the consumption of sodium. Although no data are available, it is difficult to say whether the patient considers himself sexually active: most likely, due to obesity problems, he has not had a relationship for a long time. The physical component of health is also in decline since the patient suffers from breathlessness even under elementary efforts. His sleep is disturbed by periodic apnea seizures, which can cause insomnia and anxiety. Finally, there is no doubt that the patient will benefit from a change in diet: it is necessary to add more water and fiber and reduce the consumption of trans fats and carbohydrates, and then Mr. C. will go for the correction.
Serious attention should be paid to the discussion of kidney failure, probably developed in a patient against the background of obesity associated with diabetes. The final stage of the failure is a dynamic process of urinary system dysfunction, which includes: (i) asymptomatic destruction of the nephron by 70% and (ii) almost complete destruction of the kidneys with loss of ability to concentrate urine. The opportunistic sources of the disease contributing to the development are high blood pressure, diabetes mellitus, nephritis, and renal tissue inflammation down to cysts. Although the patient shows signs of the final stage of the disease, compliance with some preventive measures may make sense. This applies to a strict diet, transparent control of sugar consumption, taking antihypertensive drugs, including diuretics. The man will have to get used to the new rules of physical activity and strict compliance with the doctor’s instructions.
A serious step to maintain the dynamics of recovery is the training provided by the nurse. The health care provider must tell the patient about the necessity and relevance of following the rules and bans, to offer alternatives to bad habits or certain foods. For instance, this applies to meat products such as fatty bacon, sausages, or ham: the main objective is to reduce sodium levels in the menu (Medical Advisory Committee, 2020). Mr. C. should be aware of the prohibition of taking any medication not prescribed by a doctor, even if they are necessary to eliminate pain. To control the disease and study the problem, the man can use some resources available: (i) insurance coverage, (ii) dialysis department, (iii) informational training programs, (iv), and local patient support funds.
While there are many examples of people living with ESRD, the presence of a diagnosis does somewhat limit the patient’s freedom of life. This applies to both adherence to a strict diet and movement. Patients change their eating habits and control sodium consumption (Michishita et al., 2017). Although the usual lifestyle is modified by regular visits to the dialysis department, people can continue to work, and any travel must be planned in advance. A person with a diagnosis should watch their health more closely and consult a doctor.
Cholesterol levels: What you need to know. (2020). Medicine Plus. Web.
Diabetes. (2020). Mayo Clinic. Web.
End-stage renal disease. (2019). Mayo Clinic. Web.
End stage renal disease (ESRD). (2019). Johns Hopkins. Web.
Greenlee, H., Unger, J. M., LeBlanc, M., Ramsey, S., & Hershman, D. L. (2017). Association between body mass index and cancer survival in a pooled analysis of 22 clinical trials [PDF document]. Web.
High blood pressure symptoms and causes. (2020). CDC. Web.
Medical Advisory Committee. (2020). Kidney-friendly diet for CKD. American Kidney Fund. Web.
Michishita, R., Matsuda, T., Kawakami, S., Tanaka, S., Kiyonaga, A., Tanaka, H.,… & Higaki, Y. (2017). The association between changes in lifestyle behaviors and the incidence of chronic kidney disease (CKD) in middle-aged and older men. Journal of Epidemiology, 27(8), 389-397. Web.