Case Study: Mr. C
Obesity is a common health problem among the modern population, including men, women, and children. Being poorly treated or managed, this condition could provoke heart diseases, strokes, diabetes, and even cancer (Centers for Disease Control and Prevention, 2020). There are many methods to help people reduce serious health complications, and bariatric surgery is one of them if a patient meets several critical factors. The case of Mr. C will be analyzed in terms of his clinical manifestations and functional patterns to clarify if bariatric surgery is an alternative and to discuss the development of end-stage renal disease.
A 32-year-old patient addresses a local outpatient center with obesity as his main problem and considers his bariatric surgery options. At the moment of assessment, Mr. C informs that he is a catalog telephone center manager, which proves a sedentary lifestyle as one of his risk factors. However, he defines obesity as a regular problem, even in his childhood, and the patient has gained about 100 pounds within 2-3 years. Subjective information includes the intention to control weight and hypertension by restricting dietary sodium. Mr. C has hadshortness of breath, sleep apnea, swollen ankles, and pruritus during the last six months. Objective information is gathered from lab work and shows that the man has high blood pressure and an increased number of breaths (high respiratory rate). Also, abnormal levels are obtained in fasting blood glucose, cholesterol, triglycerides, serum creatinine, and blood urea nitrogen (BUN). After his feet and ankles are pressed, there is a 3+ pitting edema, meaning that 5-6 mm depression is observed within the next 10-30 seconds. The patient has not yet decided about bariatric surgery and wants to gather information to make sure this procedure can help.
Potential Health Risks for Obesity and Bariatric Surgery
In the case under analysis, the patient has such symptoms as a high body mass index (BMI) that proves the presence of excessive body fat. As cited in De Lorenzo et al. (2019), obesity is a multifactorial pathology that is observed in metabolic pathways’ dysregulation. Mr. C has swollen ankles and edema that signalizes fluid excess. High fasting glob glucose is a sign of his prediabetic condition. Besides, high blood pressure, cholesterol, and triglycerides identify potential risks for heart problems and kidney diseases (Koch, 2019). However, the list of possible complications because of obesity continues growing because of its impact on different body systems. De Lorenzo et al. (2019) mention the risks of dyslipidemia, arthropathy, and some neoplasms. Therefore, as soon as the patient feels changes in his health, he should think about available treatment options.
Bariatric surgery, also known as weight loss surgery, is characterized by a number of positive outcomes, including the possibility of taking off unnecessary pounds and predicting dangerous medical conditions. It is an effective treatment method for obesity and metabolic disorders (Dagan et al., 2017). Its main idea is to change the digestive system and help a patient lose weight. At this moment, hospitals offer several types of bariatric surgeries: sleeve gastrectomy, gastric bypass, laparoscopic biliopancreatic diversion with/without duodenal switch (Dagan et al., 2017). However, as well as any operative intervention, postoperative bariatric patients may experience such complications as bleeding, stenosis, or venous thrombosis (Lim et al., 2018). It is necessary to consider the potential risks of obesity. At this moment, Mr. C remains a good candidate for this type of operative treatment with his BMI around 45.1 and several comorbidities (hypertension, sleep apnea, and shortness of breath) (Westerveld & Yang, 2016). When diets and physical exercises do not bring any positive results, surgery is used to limit the amount of food that can be eaten. However, in this case, Mr. C says nothing about his attempt to use physical interventions.
Functional Health Patterns
An understanding of functional health patterns plays an important role in the development of a treatment plan for Mr. C. Firstly, the patient is aware of his obesity-related problems and tries to control them by restricting dietary sodium. According to Oh et al. (2017), sodium excretion is associated with obesity by increased thirst and appetite, which leads to increased energy intake. Secondly, Mr. C admits that he works at a call center, which means that his lifestyle is usually sedentary, which could provoke potential cardiovascular risks and evident weight-related problems (González et al., 2017). Thirdly, metabolic patterns cannot be ignored because the patient’s obesity remains to be a problem today, as well as when he was a child. Fourthly, his self-perception and the desire to use bariatric surgery to improve his weight may be a problem because the case does not provide a description of his true reasons and maybe a sign of new psychological issues. Finally, no information about family or work support is given, and it is mentioned that the patient is single. Any surgery requires postoperative care, and its absence may cause psychological and emotional challenges.
Staging and Contributing Factors of End-Stage Renal Disease
Renal problems and kidney disease occur when kidneys are damaged and cannot function well. The patient’s condition gets worse because this damage influences different organs. According to the American Kidney Fund (2020), there are five stages of kidney damage, depending on presenting symptoms, glomerular filtration rate (GFR), and available interventions. The GFR shows the level of creatinine in the blood (American Kidney Fund, 2020). During the first two stages, the kidneys work well but need additional help to avoid complications. The third stage means that kidney damage occurs, causing back pain and swelling. The next stages, when the level of GFR is between 15 and 29, show that all precautionary methods have to be taken seriously. The final stage is characterized by sleeping and breathing problems, itching, and feeling sick. End-stage renal disease (ESRD) is the condition when kidneys can no longer work effectively and meet the needs of the organism. Dialysis and kidney transplantation are required at this stage, especially if such contributing factors as poor blood sugar control and high blood pressure are recognized. Male sex and age are also the risk factors of ESRD in patients.
Health Promotion and Prevention of ESRD
Instead of using bariatric surgery as an intervention to control weight, the patient has to understand how to prevent ESRD and promote health. In Mr. C’s case, education and behavioral changes are considered the main steps in kidney disease control. Kovesdy et al. (2017) state that obesity is associated with serious metabolic abnormalities that may affect kidneys because of oxidative stress. First, Mr. C should understand that the deterioration of renal status in his case may lead to his death. Therefore, the goal is not to provoke new damage and support certain habits like physical activities and healthy eating. It is not enough to control sodium intake but to use vegetables, fruits, and other elements of a healthy diet (American Kidney Fund, 2020). Secondly, Mr. C needs to learn that health restoration is predetermined by a number of stressful events. As a result, anxiety, depression, and other mood concerns must be eliminated.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
In addition to the education that can be offered to ESRD patients, it is important to consider other available resources for nonacute care. First, regarding the quality of technological progress, the use of the Internet is frequently applied for educational purposes. However, patients should realize that this resource contains much unprofessional and non-credible information, and people have to ask their doctors to check the reliability of the material. Communication with healthcare experts, including nurses and doctors, is another resource that cannot be ignored. It is based on a multidisciplinary care approach when collaboration and management are considered. In this case, ESRD patients must cooperate with therapists (to control vital signs), nutritionists (to choose a diet), nephrologists (to check the condition of kidneys), and pharmacists (to use medications) (Shi et al., 2018). Nurses are also important for the development of a multidisciplinary approach because their care and support for patients determine the quality of treatment.
In general, the case under analysis represents a number of crucial issues in ESRD care. In his desire to understand the appropriateness of bariatric surgery, the patient finds out that more serious problems threaten his health. In-time diagnoses, tests, and communication are necessary to predict the growth of health complications. Obesity is a critical condition that leads to new diseases, and people must be aware of how to manage self-care and follow professional recommendations and prescriptions.
American Kidney Fund. (2020). Stages of chronic kidney disease (CKD). KidneyFund. Web.
Centers for Disease Control and Prevention. (2020). Adult obesity facts. CDC. Web.
Dagan, S. S., Goldenshluger, A., Globus, I., Schweiger, C., Kessler, Y., Sandbank, G. K., Ben-Porat, T., & Sinai, T. (2017). Nutritional recommendations for adult bariatric surgery patients: Clinical practice. Advances in Nutrition, 6(2), 382-394.
De Lorenzo, Antonino, Santo Gratteri, Paola Gualtieri, Andrea Cammarano, Pierfrancesco Bertucci, & Laura Di Renzo. (2019). Why primary obesity is a disease? Journal of translational medicine 17(1).
González, K., Fuentes, J., & Márquez, J. L. (2017). Physical inactivity, sedentary behavior and chronic diseases. Korean Journal of Family Medicine, 38(3), 111-115.
Koch, V. H. (2019). The effects of obesity on kidney functions: A challenge for nephrologists. Brazilian Journal of Nephrology, 41(2), 162-165.
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.
Lim, R., Beekley, A., Johnson, D. C., & Davis, K. A. (2018). Early and late complications of bariatric operation. Trauma Surgery & Acute Care Open, 3(1).
Oh, S.W., Koo, H. S., Han, K. H., Han, S. Y., & Chin, H. J. (2017). Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS One, 12(12).
Shi, Y., Xiog, J., Chen, Y., Deng, J., Peng, H., Zhao, J., & He, J. (2018). The effectiveness of multidisciplinary care models for patients with chronic kidney disease: A systematic review and meta-analysis. International Urology and Nephrology, 50(2), 301-12.
Westerveld, D., & Yang, D. (2016). Through thick and thin: Identifying barriers to bariatric surgery, weight loss maintenance, and tailoring obesity treatment for the future. Surgery Research and Practice, 2016.