Case Study: Mr. C. RN-BSN-prepared Nurse

Case Study: Mr. C.

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

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

Height: 68 inches; weight 134.5 kg

BP: 172/98, HR 88, RR 26

3+ pitting edema bilateral feet and ankles

Fasting blood glucose: 146 mg/dL

Total cholesterol: 250 mg/dL

Triglycerides: 312 mg/dL

HDL: 30 mg/dL

Serum creatinine 1.8 mg/dL

BUN 32 mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

Describe the clinical manifestations present in Mr. C.

Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.

Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)

Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.

Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.

Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Case Study: Mr. C. – Rubric

Criteria Description

Clinical Manifestations of Mr. C.

5. Excellent

12 points

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

4. Good

10.68 points

Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.

3. Satisfactory

9.48 points

Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.

2. Less Than Satisfactory

9 points

Clinical manifestations are partially presented. There are major omissions and inaccuracies.

1. Unsatisfactory

0 points

Clinical manifestations are omitted.

Criteria Description

Potential Health Risks for Obesity and Bariatric Surgery

5. Excellent

12 points

A detailed discussion of the potential health risks for obesity is presented. A through and compelling discussion on whether bariatric surgery is an appropriate intervention is presented. The discussion is well-developed and supported by evidence and additional rationale.

4. Good

10.68 points

A discussion on the potential health risks for obesity is presented. A discussion on whether bariatric surgery is an appropriate intervention is presented but needs some evidence or rationale for support.

3. Satisfactory

9.48 points

A summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are some inaccuracies. More evidence or rationale is needed to support discussion.

2. Less Than Satisfactory

9 points

A partial summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are major inaccuracies. More information is needed. No evidence or rationale is provided to support discussion.

1. Unsatisfactory

0 points

Potential health risks for obesity and whether bariatric surgery is an appropriate intervention are not discussed.

Criteria Description

Functional Health Patterns

5. Excellent

18 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The discussion is insightful, and the identified problems are highly relevant for the patient and his condition. The discussion is well-supported by rationale and evidence.

4. Good

16.02 points

Five or more actual or potential problems identified from the functional health patterns are discussed. The identified problems are relevant for the patient and his condition. Overall, the discussion is supported by rationale and evidence. Some detail is needed for clarity or accuracy.

3. Satisfactory

14.22 points

At least five actual or potential problems identified from the functional health patterns are summarized. The identified problems are generally relevant for the patient and his condition. Some rationale and evidence is required for support.

2. Less Than Satisfactory

13.5 points

At least four actual or potential problems identified from the functional health patterns are presented. The identified problems are not entirely relevant for the patient and his condition. Rationale or evidence is required for support.

1. Unsatisfactory

0 points

Actual or potential problems based on the assessment of functional health patterns of the patient are omitted or are irrelevant for the patient and his condition. The overall criteria for this assignment are not met.

Criteria Description

Staging and Contributing Factors of End-Stage Renal Disease (ESRD)

5. Excellent

12 points

The staging of ESRD and the contributing factors for ESRD are explained. The information is accurate and reflects contemporary practice and research.

4. Good

10.68 points

The staging of ESRD and the contributing factors for ESRD are explained. Some information or detail is needed for clarity or detail.

3. Satisfactory

9.48 points

The staging of ESRD and the contributing factors for ESRD are generally explained. Some information is required; there are minor inaccuracies.

2. Less Than Satisfactory

9 points

Staging of ESRD is partially summarized. The contributing factors for ESRD are vague. There are inaccuracies.

1. Unsatisfactory

0 points

Staging and contributing factors for ESRD are omitted or inaccurate.

Criteria Description

Health Promotion and Prevention for ESRD

5. Excellent

24 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is thoroughly described. The proposed items are clearly presented and highly relevant and supportive of patient and his health status. Strong evidence and rationale generally support the discussion.

4. Good

21.36 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is described. The proposed items are relevant and appropriate for the patient and his health status. Evidence and rationale generally support the discussion.

3. Satisfactory

18.96 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is generally described. There are minor inaccuracies. Overall, the proposed items are relevant for the patient and his health status. Some evidence and rationale are needed to support the discussion.

2. Less Than Satisfactory

18 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is partially summarized. There are inaccuracies. Some aspects are not relevant for the patient and his health status.

1. Unsatisfactory

0 points

Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is omitted.

Criteria Description

Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach

5. Excellent

18 points

A clear and detailed explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. The explanation demonstrates insight into both resources and multidisciplinary approaches for nonacute care for ESRD patients.

4. Good

16.02 points

An explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. Some detail is required for clarity.

3. Satisfactory

14.22 points

A general explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are minor inaccuracies. Some additional information is required.

2. Less Than Satisfactory

13.5 points

An incomplete explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are major inaccuracies.

1. Unsatisfactory

0 points

Types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, are not discussed.

Criteria Description

Thesis Development and Purpose

5. Excellent

6 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. Good

5.34 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. Satisfactory

4.74 points

Thesis is apparent and appropriate to purpose.

2. Less Than Satisfactory

4.5 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Criteria Description

Argument Logic and Construction

5. Excellent

6 points

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. Good

5.34 points

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. Satisfactory

4.74 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. Less Than Satisfactory

4.5 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5. Excellent

6 points

Writer is clearly in command of standard, written, academic English.

4. Good

5.34 points

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

3. Satisfactory

4.74 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. Less Than Satisfactory

4.5 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

1. Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

5. Excellent

2.4 points

All format elements are correct.

4. Good

2.14 points

Appropriate template is fully used. There are virtually no errors in formatting style.

3. Satisfactory

1.9 points

Appropriate template is used. Formatting is correct, although some minor errors may be present.

2. Less Than Satisfactory

1.8 points

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

1. Unsatisfactory

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5. Excellent

3.6 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4. Good

3.2 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3. Satisfactory

2.84 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2. Less Than Satisfactory

2.7 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1. Unsatisfactory

0 points

Sources are not documented.

Total 120 points

Case Study MR C

The assigned case study demonstrates a male patient, Mr. C, who is 32 years old, seeking information regarding bariatric surgery as the best medical intervention for his obesity. The patient’s overweight puts him at high risk of cardiac arrest, hypertension, and diabetes. However, with bariatric surgery, the amount of food that the patient’s stomach will be able to comfortably accommodate will be reduced hence helping with weight reduction (Jakobsen et al., 2018). The purpose of this paper is to evaluate the provided health history and medical information of Mr. C and suggest the most appropriate cause of action.

Clinical Manifestations

From the provided information, the patient mainly presents with symptoms caused by his overweight nature. Even though the patient has not been diagnosed with metabolic disorders, he stands a great chance of developing this condition, if timely intervention is not taken. The collected objective data indicate that the patient’s blood pressure is elevated and heart rate and respiratory rate increased (Ryan & Kahan, 2018). He also reports suffering from sleep apnea which might be attributed to the accumulation of fats on the neck. His idyllic HDL levels are very low, while his cholesterol levels and triglycerides are surprisingly high.

Potential Health Risks

Mr. C is at great risk of developing several obesity-related health complications like kidney disease, sleep apnea, diabetes mellitus, hypertension, hyperlipidemia, and stroke among others. The patient has however made the right choice to consider bariatric surgery as the most effective intervention to avoid these complications. Evidence-based practice has proven great effectiveness in reducing the risks of obesity-related complications among patients who have undergone bariatric surgery (Jakobsen et al., 2018). Studies also report that the effectiveness of bariatric surgery in helping patients manage their obesity can best be realized with patients who integrate physical activity and dietary interventions as part of their care plan.

Functional Health Patterns

From the provided information, the patient’s functional health patterns that need to be accessed include his metabolic function, self-perception, stress coping and tolerance, sleep rest cycle, and health management. From the assessment, it is clear that the patient perceives himself as unhealthy due to his obesity, and even considers bariatric surgery to promote his health (Veroux et al., 2021). He also seems to adopt a sedentary lifestyle, with limited activity/exercise and a poor diet, with high calories since he gained about 100 pounds over the past 2 to 3 years, and his objective data reveal high cholesterol levels. The patient also reports sleep apnea, which affects his sleep-wake cycle. His shortness of breath also affects his respiratory function finally. As such, the patient needs to adopt life modification strategies such as engaging in physical activity and consuming a healthy diet to promote appropriate functional health patterns

Staging and Contributing Factors of ESRD

Renal disease is usually classified into 5 main categories, based on kidney function. Clinical guidelines recommend the use of the glomerular filtration rate (GFR) of the patient to determine the kidney functioning for diagnosing and staging the renal disease. End-stage renal disease is normally diagnosed when the kidney function of the patient drops to less than 10% of its normal functioning, with a GFR of less than 15 mL/min (Lin et al., 2018). Some of the contributing factors to ESRD include low hemoglobin levels, hypertension, alcoholism, smoking, high cholesterol level, advanced age, and low education among others.

Health Promotion and Prevention Measures for ESRD

To date, no cure has been discovered for ESRD. However, through evidence-based practice, several interventions like kidney transplants and dialysis have proven to be effective in promoting the health of the patient, hence prolonging their life (Veroux et al., 2021). Consequently, patients are educated on appropriate health promotion and prevention measures such as engaging in physical activity and a healthy diet to prevent complications associated with the disease. Patients are also advised to attend to their comorbid conditions to promote their health once diagnosed with ESRD.

Resources for ESRD Patient for Nonacute Care and Multidisciplinary Approach

Many resources have been provided for patients diagnosed with ESRD, to help them understand the condition better and the available course of action needed to help manage the condition. Such resources include support groups for ESRD survivors, and multidisciplinary approaches with procedures helping in tracking down the patient’s diet and exercise plans (Lin et al., 2018). Dialysis centers have also been established in most clinics to promote care for patients with CKD. Additional sources include internet sources like USDA Nutrient Database, The DASH Diet Eating Plan, American Dietetic Association, Renal Support Network (RSN), and FitDay among others.

Conclusion

Mr. C presents with obesity which predisposes him to several health complications such as hypertension, diabetes, sleep apnea, and kidney disease among others. However, he considers bariatric surgery as the most appropriate intervention to prevent these comorbidities and promote his health. Studies have displayed great effectiveness with the use of bariatric surgery in addition to physical exercise and dietary intervention in the management of obesity and associated comorbidities.

References

Jakobsen, G. S., Småstuen, M. C., Sandbu, R., Nordstrand, N., Hofsø, D., Lindberg, M., … & Hjelmesæth, J. (2018). Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. Jama, 319(3), 291-301. doi:10.1001/jama.2017.21055

Lin, T. Y., Liu, J. S., & Hung, S. C. (2018). Obesity and risk of end-stage renal disease in patients with chronic kidney disease: a cohort study. The American Journal of Clinical Nutrition, 108(5), 1145-1153. DOI:

Ryan, D. H., & Kahan, S. (2018). Guideline recommendations for obesity management. Medical Clinics, 102(1), 49-63.

Veroux, M., Mattone, E., Cavallo, M., Gioco, R., Corona, D., Volpicelli, A., & Veroux, P. (2021). Obesity and bariatric surgery in kidney transplantation: A clinical review. World Journal of Diabetes, 12(9), 1563. DOI:

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