Comprehensive Health History and Medical Evaluation of Mr. D.- Pathophysiological Insights and Clinical Management

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 lifespan.

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

Health History and Medical Information

Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5 years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. The patient’s previous medical evaluation includes end-stage renal disease (ESRD) on dialysis and referral for recommendations for initiating an exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. The patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. 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: 140/94, HR 84, RR 22
2+ 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
GRF (glomerular filtration rate)-13mL/min

Clinical Manifestations Describe the clinical manifestations present in Mr. D., focusing on the normal and abnormal findings and how this relates to his current condition.
Subjective	Mr. D complains of pruritus, decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living. These symptoms are a result of the dialysis treatment and indicate musculoskeletal and neurological issues. One of the complications of dialysis is that it causes intradialytic hypotension, which presents with nausea, dizziness, light-headedness, or subtle symptoms. Moreover, dialysis causes muscle cramps due to hypotension, low-sodium dialysis solution, and hypovolemia (Murdeshwar & Anjum, 2020). This may explain decreased endurance, decreased balance, and fear of falling. Loss of sensation on the hand can be explained by the patient’s diabetes type II diagnosis. Diabetes patients are prone to neuropathy and vasculopathy, causing loss of sensation (Sapra & Bhandari, 2023). Pruritis, also referred to as itching, is a common symptom associated with end-stage renal disease. The itching is caused by elevated blood urea, vitamin A, beta-2 macroglobulin, and magnesium (Osakwe & Hashmi, 2022). Also, the patient reports increased shortness of breath with activity, swollen ankles, and pruritus. The increased shortness of breath with activity and swollen ankles may be caused by hypertension and compromised renal function, leading to fluid overload in the tissues and lungs (Murdeshwar & Anjum, 2020). As a result, edema in the lungs limits breathing, while edema in the tissues causes swelling of the feet.
Objective	The patient’s body mass index of the patient is 45, which is indicative of obesity, which is a co-morbidity of diabetes type II he had been diagnosed with. The blood pressure of 140/94 is elevated, and the evidence of 2+ pitting edema in both feet and ankles suggests fluid overload as a result of compromised renal function. Furthermore, the patient’s fasting blood glucose, total cholesterol, triglycerides, and High-Density lipoproteins levels are not within the normal range, which can be explained by the effect of diabetes on metabolic health (Sapra & Bhandari, 2023).
Potential Health Risks for Diabetes with End-Stage Renal Disease Identify the potential health risks for a diabetic with ESRD and the impacts of nonadherence.
Identify the potential health risks for a diabetic with end-stage renal disease (ESRD) that are of concern for Mr. D.	Mr. D faces possible health risks revolving due to his diabetes and end-stage renal disease. First, the patients have the risk of cardiovascular disease because of high levels of cholesterol of 250mg/dl and low HDL level of 30 mg/dl, which is indicative of dyslipidemia. Together, diabetes and ESRD increase the risk of cardiovascular complications like strokes and heart attacks. Secondly, the patient is at risk of fluid overload due to compromised kidney function. This may lead to strain on the cardiovascular system, which may ultimately lead to cardiac events, heart failure, and stroke. Furthermore, the patient is at risk of falls and injuries due to loss of sensation and balance issues caused by diabetic neuropathy. Neuropathy also affects the automatic nervous system and may cause urinary, digestive, and cardiovascular complications. Lastly, ESRD affects the immune system, putting one at risk of infections. If not given proper attention, this may lead to sepsis.
How does Mr. D.’s nonadherence to his diabetes self-management plan for DM Type II contribute to ESRD?	Mr. D.’s nonadherence to his diabetes self-management plan contributes to ESRD because of uncontrolled blood glucose levels. Unmanaged diabetes accelerates the progression of diabetic neuropathy (Natesan & Kim, 2021). First, diabetic neuropathy causes the thickening of the glomerular basement membrane. Afterward, there is mild to severe mesangial enlargement followed by damaged glomerular and increased microalbuminuria (Natesan & Kim, 2021). Finally, there is progressive diabetic glomerulosclerosis, where the vascular and tubulointerstitial lesions are evident. The end stage is achieved when the kidney shuts down with the glomerular filtration rate below 15mL/min per 1.71m2 (Natesan & Kim, 2021).
Describe the common considerations with insulin use for practicing Muslims.	Common considerations with insulin use for practicing Muslims are dependent on their religious beliefs. As part of Muslim’s religious beliefs, they strictly observe fasting, which sometimes impacts their decisions on insulin therapy. This is because of possible interference with their religious requirement. Furthermore, Muslim patients question insulin’s origin and mostly believe it is a derivative of porcine (Rohan et al. et al., 2023).
Pathophysiology of Renal Dialysis Explain the pathophysiology of renal dialysis.
Explain the pathophysiology of renal dialysis. Compare peritoneal dialysis and hemodialysis.	Also referred to as continuous renal replacement therapy, renal dialysis is a therapeutic intervention to replicate kidney function. Renal dialysis is done by the use of Ven venous extracorporeal circuits that are driven by a pump and serve as renal support that purifies the blood to allow fluid and solute homeostasis (Saunders & Sanghavi, 2023). The indication of renal dialysis includes volume overload, uremia, hyponatremia, progressive or persistent acute kidney injury, and others. Hemodialysis involves circulating blood outside the body through a machine, while peritoneal dialysis uses the peritoneal membrane in the abdomen as a filter. Both methods aim to remove waste products and excess fluid from the blood (Saunders & Sanghavi, 2023).
Describe in detail the pathophysiological explanation and stages of renal disease that lead to ESRD.	Five stages of renal disease lead to ESRD. In the first stage, diabetic neuropathy thickens the glomerular basement membrane (Natesan & Kim, 2021). The glomerular filtration rate is greater than 90ml/min in the first stage. The second stage entails the advance of mild to severe mesangial enlargement. The glomerular filtration rate ranges between 60-89 mL/min (Natesan & Kim, 2021). The third stage has a moderate reduction in glomerular filtration rate of 30-59 mL/min. At this stage, the glomerular is damaged, and microalbuminuria is elevated. The fourth stage has a severe decrease in glomerular filtration rate ranging between 15-29 mL/min, which is attributed to advanced diabetic glomerulosclerosis and prominence of vascular and tubulointerstitial lesions. In the last stage, the kidneys are unable to function with the glomerular filtration rate below 15mL/min. Ultimately, end-stage renal disease results (Natesan & Kim, 2021).
Explain the potential factors that contributed to Mr. D.’s ESRD.	Mr. D.’s ESRD can be attributed to potential factors. First, long-term, poorly controlled type II diabetes results in persistent hyperglycemia, which damages small blood vessels in the kidneys, leading to impaired filtration and, ultimately, renal failure (Natesan & Kim, 2021). Secondly, hypertension causes damage to blood vessels in the kidneys, affecting their ability to filter waste and excess fluid normally. The combination of hypertension and diabetes accelerates the decrease in renal function (Natesan & Kim, 2021). Also, obesity contributes to insulin resistance, metabolic abnormalities, and inflammation, which affects renal health. Furthermore, obesity is a risk factor for the development and progression of ESRD and chronic kidney disease (Lin & Li, 2021).
Functional Health Problems Evaluate Mr. D.’s functional health patterns.
Evaluate each of Mr. D.’s functional health patterns using the information given.	Evaluation of Mr. D.’s functional health patterns shows several areas of concern. The functional health patterns include health perception and management, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, and cognitive-perceptual pattern.
Discuss at least five actual or potential problems you can identify from the “Functional Health Patterns Assessment Guide,” located in the Topic 3 Resources. Provide a rationale for each.	First, on the grounds of health perception and health management, Mr. D may lack motivation for self-care because he reports a lack of family support and depression. The nutritional-metabolic pattern is affected by obesity and elevated cholesterol levels, posing cardiovascular risks. Based on the activity-exercise pattern is compromised by reduced balance and endurance, affecting daily activities. Lastly, the cognitive-perceptual pattern is impacted by diabetic neuropathy, contributing to the loss of sensation.
Nursing Health Management and Health Promotion Provide ESRD nursing management and health promotion opportunities.
Provide ESRD nursing management and health promotion opportunities.	Nursing management for ESRD first involves monitoring and managing metabolic parameters. The blood glucose levels, blood pressure, and cholesterol levels are key. Medications and treatments should be adjusted appropriately to maintain optimal metabolic control. Secondly, fluid and electrolyte balance should be monitored. Patients should be educated on fluid restrictions, monitoring fluid intake, and managing electrolyte imbalances through medications and dietary modification. Health promotions include encouraging and educating on the importance of moderate and regular physical activity. Also, collaborating with mental health professionals to address psychological symptoms like loneliness and helplessness feelings. Another opportunity is offering nutritional education to the patient on eating a balanced diet that is renal-friendly. Furthermore, the patient may be educated on dialysis, the process, possible complications, and the importance of adhering to scheduled dialysis sessions.
Develop a patient education plan for ESRD that could be offered to Mr. D. for prevention of future events, health restoration, and maintaining renal status.	First, the patient is offered a detailed overview of ESRD, its causes, and its effect on general health. After that, Mr. D is made to understand the purpose and the importance of the prescribed medications. The patient is then educated on dietary modifications to support renal health. Dietary education is done in collaboration with a dietitian to come up with a special renal diet plan. The education plan will also involve lifestyle modification by encouraging positive lifestyle changes to improve overall well-being. Also, the plan will involve encouraging monitoring and self-care, which will nurture active participation in self-monitoring and timely reporting of changes. Lastly, the patient will be offered mental health support to address the psychological impact of chronic illness and provide coping strategies. The plan will involve collaboration with other medical professionals like mental health specialists, dieticians, nephrologists, and others to ensure seamless patient understanding.
Assume Mr. D. lives in your community. Include community resources and supportive care available for Mr. D. for ESRD care and management at home.	In my community, some of the resources and supportive care that Mr. D can use are offered by the American Kidney Fund. The American Kidney Fund helps patients with kidney disease, including ESRD, to get assistance near them. This organization helps cover medical bills, access health care, obtain emergency aid, and look for support groups for patients (AKF, 2024).
Discuss the nurse’s role in using the holistic multidisciplinary care approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence.	The nurse’s role in a holistic multidisciplinary care approach is working in collaboration with dietitians, nephrologists, and mental health professionals. The nurse should provide guidance on the use of self-monitoring devices like glucometers and blood pressure machines. Transportation needs for dialysis appointments and medical visits should be assessed. Mr. D should have access to transplant evaluation by coordination with transplant coordinators. The patient will receive comprehensive information on the transplantation process, potential benefits, and eligibility criteria. The nurse should further assess the living conditions of the patient and identify possible environmental challenges. Collaborating with social services to solve housing concerns may help ensure a safe and supportive living environment. Furthermore, the nurse may help recognize and address Mr. D.’s psychosocial needs by promoting resiliency through supporting counseling, groups, and education. Lastly, the nurse may promote independence and empowerment by making the patient part of the decision-making process. The nurse offers education and resources to empower him to actively take part in self-management and make informed choices about his health.

References

AKF. (2024). Community Resource Finder | American Kidney Fund. Www.kidneyfund.org. https://www.kidneyfund.org/community-resource-finder

Lin, X., & Li, H. (2021). Obesity: Epidemiology, Pathophysiology, and Therapeutics. Frontiers in Endocrinology, 12(1). https://doi.org/10.3389/fendo.2021.706978

Murdeshwar, H. N., & Anjum, F. (2020). Hemodialysis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563296/

Natesan, V., & Kim, S.-J. (2021). Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management. Biomolecules & Therapeutics, 29(4). https://doi.org/10.4062/biomolther.2020.204

Osakwe, N., & Hashmi, M. F. (2022). Uremic Pruritus Evaluation and Treatment. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK587340/

Rohan Kumar Ochani, Shaikh, A., Batra, S., Pikale, G. S., & Surani, S. (2023). Diabetes among Muslims during Ramadan: A narrative review. World Journal of Clinical Cases, 11(26), 6031–6039. https://doi.org/10.12998/wjcc.v11.i26.6031

Sapra, A., & Bhandari, P. (2023, June 21). Diabetes mellitus. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551501/

Saunders, H., & Sanghavi, D. (2023, May 8). Continuous Renal Replacement Therapy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556028/

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Question

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.

Case Study: Mr. D.

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

Comprehensive Health History and Medical Evaluation of Mr. D.- Pathophysiological Insights and Clinical Management