Interdisciplinary Care Clinics in Chronic Kidney Disease: Mr. C.
Table of Contents Introduction Main body Conclusion References Introduction Mr. C. is a patient seeking consultation regarding a possible bariatric surgery to address his obesity. There are several clinical manifestations present which describe his health status. His weight obviously indicates obesity, with a BMI of approximately 45. He has a high blood pressure of 172/98 with a slightly elevated heart rate which may indicate cardiovascular problems that the patient has not sought treatment for.
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The patient is experiencing sleep apnea as well. Mr. C’s fasting glucose is 146 mg/dL which is higher than the normal range of below 100 mg/dL and can be a symptom of diabetes. The patient’s total cholesterol is elevated at 250 when below 200 is expected for a healthy individual. Triglyceride levels are elevated as well with 312 mg/dL above the healthy level of below 150 mg/dL. Meanwhile, HDL is below normal at 30 while the healthy level is above 60 mg/dL. Main body Mr. C. leads a sedentary lifestyle and job, with seemingly little success in managing his weight. Such a rapid gain of over 100 pounds in a 2-3-year period is extremely unhealthy and poses significant risks to health. Obesity commonly leads to other comorbidities, some of which Mr. C is beginning to experience. Type 2 diabetes is commonplace, a metabolic disease that leads to insulin resistance and may require a lifetime of treatment. The patient’s fasting blood glucose levels are already an indicator. Heart disease and a stroke are risk factors, with the patient’s blood pressure and heart rate showing a burden on the cardiovascular system. Other conditions associated with obesity include some form of cancers, gallbladder disease, gout, osteoarthritis, and fatty liver or kidney disease (Sattar & Preiss, 2018). It should be noted that the patient is experiencing issues with his shortness of breath, swollen ankles, and pruritus which limit the ability to perform physical activity and lose weight in that manner. Bariatric surgery seems to be a viable solution given that Mr. C is able to maintain a proper diet and his health is stable enough for surgery. Mr. C’s functional health has potential and identifiable problems based on his health history and examination. Health perception is positive as the patient obviously sees his health issues and is seeking medical aid in resolving them. His health management is lacking however as the patient does little to manage his health other than restricting dietary sodium. There is no evidence of the patient attempting to regulate caloric intake, engage in increased physical activity, or seek medical help for issues such as blood pressure and increased glucose levels. Nutritional functions are little known other than the patient suggest restricting sodium intake, but such rapid weight gain suggests unhealthy eating patterns. Metabolic indicators suggest the patient is diabetic or at least borderline, with other metabolic bodily functions showing problems as well. No information is available regarding elimination patterns. Activity-exercise patterns are virtually non-existent due to the sedentary lifestyle and physical health problems of the patient which is highly problematic and contributing to his obesity. Sleep-rest patterns are not known but there is a diagnosis of sleep apnea which most likely disrupts normal sleep patterns and makes the patient feel fatigued among other things. Self-perception is also not known, but obesity and health problems most likely negatively affect the self-image of the patient and his confidence. Nothing is known regarding his cognitive, role-relationship, sexual, or coping-stress tolerance patterns.
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End-stage renal disease (ESRD) is also known as end-stage kidney disease or kidney failure occurs at the end of chronic kidney disease when it reaches an advanced state and kidney function is lost. Kidneys filter waste and fluid allowing it to then be excreted through urine. When that capability is lost, dangerous levels of waste and electrolytes are built up in the body eventually resulting in death if not treated. A person with ESRD cannot live without continuous dialysis or a kidney transplant, but if those options are present, it is possible to continue a relatively productive life. Risk factors for ESRD include obesity, diabetes, and high blood pressure, and issues with kidneys such as acute kidney injury, kidney stones, or glomerulonephritis. Obesity, in particular, affects kidney function as a higher BMI is associated with the development of proteinuria and a low estimated glomerular filtration rate (GFR) that are indicators of chronic kidney disease (CKD) and a much more rapid progression of it (Kovesdy, Furth, & Zoccali., 2017). One of the primaries of healthcare and prevention strategies for ESRD is promoting a healthier lifestyle in patients. For Mr. C. in particular this would apply strongly as well as establishing a plan to manage and treat his conditions such as high blood pressure and diabetes in order to prevent the deterioration of his renal status. Mr. C. is evidently at risk of experiencing kidney disease and eventual ESRD if his current lifestyle and health issues persist. Patient education regarding his lifestyle, particularly proper and healthy nutritional intake, modest exercise, and a change of daily routines to improve his weight loss and overall health can be the focus. The patient should be made aware of the possible consequences and future adverse events of his current obesity status and other co-morbidities. Conclusion Interdisciplinary care clinics (IDC) emerged in recent years as a solution to improving CKD care to prevent the onset of ESRD. In the IDC, the interdisciplinary staff includes physicians, advanced practicians, nurses, dieticians, social workers, and pharmacists working together to treat the patient and help them adjust to new lifestyles. The interdisciplinary approach has been shown to improve patient education and preparedness for ESRD leading to changes and treatments with improved health outcomes. IDC services are cost-effective but are often not covered by insurance providers (Johns, Yee, Smith-Jules, Campbell, & Bauer, 2015). These centers provide the necessary facilities, guidance, information, and staff for patients to receive both hospitalized treatment as well as transition to life at home and outpatient treatment including transportation to treatments, healthy living conditions, and return to employment. References Johns, T. S., Yee, J., Smith-Jules, T., Campbell, R. C., & Bauer, C. (2015). Interdisciplinary care clinics in chronic kidney disease. BMC Nephrology, 16(1), 1-10. Web.
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Kovesdy, C. P., Furth, S. L., & Zoccali, C. (2017). Obesity and kidney disease. Canadian Journal of Kidney Health and Disease, 4, 205435811769866. Web. Sattar, N., & Preiss, D. (2018). Research digest: assessment and risks of obesity. The Lancet Diabetes & Endocrinology, 6(6), 442. Web.