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,
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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.
Case Study
According to the symptoms that Mr. C presents with, the plausible diagnosis for his case entails
peptic ulcer disease that necessitates a series of interventions aimed at managing the condition
and minimizing the effects. These interventions include the prescription of magnesium or
aluminum hydroxide (Mylanta) at 15 mL PO one hour before bedtime and three hours after
mealtime as well as at bedtime. These should be combined with Ranitidine (Zantac) at 300 mg
PO at bedtime and sucralfate/carafate 1 g or 10 ml suspension (500mg/5mL) one hour before
meals and at bedtime. Most fundamentally, based on the clinical manifestations highlighted in
the case study, Mr. C is susceptible to various health risks associated with his obesity condition.
These health risks include increase blood pressure (hypertension), sleep apnea, elevated
cholesterol, and triglycerides (Gowda & Gowda, 2016). These conditions are primarily indicative
of the onset of diabetes particularly due to the increased blood glucose levels (146 mg/gl). As
such, it is recommendable for Mr. C to lose weight lest he develops diabetes or other
cardiovascular disorders.
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Moreover, Mr. C should consider losing weight to prevent the outcomes highlighted
herein and decrease his level of hypertension. Similarly, Mr. C would significantly benefit from
bariatric surgery, especially due to the fact that he is morbidly obese. If Mr. C was to lose
weight, he could decrease the likelihood of developing diabetes or a potential heart attack. As
such, bariatric surgery is associated with a high reduction of mortality rates and a significant
improvement in health conditions brought about or exacerbated by obesity. Some of these
conditions include blood pressure, diabetes, heart diseases, and stroke (Lahsen, Berry, & Lamoz,
2012). On the one hand, Mr. C is at an increased risk of diabetes due to factors such as fasting
glucose at 147 which is indicative that he is pre-diabetic or has diabetes already (Gowda &
Gowda, 2016). As such, further diagnostic tests such as an A1C would be carried out to
determine the functionality and levels of his blood sugar. Similarly, Mr. C is at an increased risk
for a heart attack, stroke, and other cardiovascular conditions based on the high levels of
cholesterol. These are coupled with an increased susceptibility to kidney disease that may occur
as a result of the development of diabetes. Ultimately, Mr. C could potentially die at an early age
if he does not lose weight or consider a healthy diet to rectify the risk factors.
The assessment of Mr. C functional health patterns necessitates the consideration of
factors such as the actual and potential problems identified from the clinical manifestations. On
the one hand, regarding health perception and/or management, it is evident that Mr. C is at risk
for severe conditions. He thus needs to be sensitized and educated on a good and healthy diet.
Similarly, Mr. C would benefit from counseling that focuses on helping him make better lifestyle
choices. Besides, with respect to nutrition, it would be beneficial for Mr. C to follow a healthy
diet that comprises of vegetables, proteins, whole grains, and one that includes controlled
portions. This way, adherence to this balanced diet would facilitate the maintenance of a proper
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weight and improve his LDL, HDL’s, and triglycerides (Gowda & Gowda, 2016). These would
be coupled with elimination that provide appropriate information on how Mr. C would increase
his water intake and consumption of foods rich in fiber, all of which facilitate elimination of
undigested products. Consequently, these factors would help to keep Mr. C on a relatively more
regular bowel movement schedule.
According to the description given in the case study, it is evident that Mr. C does not
engage in any form of physical activity. Therefore, the inclusion and adherence to an exercise
program that starts out slowly and gradually increases would provide significant benefits to his
welfare. The achievement of this objective would involve getting him accustomed to an exercise
routine that fits his schedule and day-to-day schedule. It would further facilitate the regulation
and reduction of his cholesterol problems. Additionally, ample sleep and rest would significantly
contribute towards the reduction weight and sleep apnea problems (Gowda & Gowda, 2016).
The achievement of this objective would involve the development of a routine sleeping habit
coupled with a C-PAP machine in case the sleep apnea problem persists.
Cognitively, Mr. C understands that he has a considerable problem characterized by bad
choices, lack of exercise, and unhealthy eating habits. Therefore, he has taken appropriate action
by seeking help to reduce his weight and lead a healthy life. Similarly, with regards to self-
perceptions and conception, Mr. C stated that he has been overweight his entire life, which has
made him feel abnormal. It is, therefore, possible that he feels depressed and or has developed
negative attitude about himself. Nonetheless, counseling would be beneficial for Mr. C as it
would facilitate the rectification of his attitude through the development of a healthy habit or
pattern that promotes a sustainable welfare. Since he did not state whether or not he was in any
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relationship, there is no indication of family support. Similarly, it is not clear whether he is
sexually productive but undergoing bariatric surgery would boost his self-confidence.
References
Gowda, S., & Gowda, J. (2016). Medical Surgical Nursing: Clinical Assessment Format. A to Z
Guideline Manual in Nursing Performance Evaluation Tool (for Practitioners and
Students), 182-182.
Lahsen, R., Berry, M., & Lamoz, P. (2012). Diabetes Improvement Following Bariatric and
Metabolic Surgery. Advanced Bariatric and Metabolic Surgery.