Health History and Medical Information

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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.

Sample Solution

that contain migrated oil and gas) through horizontal wells. Although there is still an on-going debate on the precise definition of unconventional oil, in this essay we use the definition made by the IEA World Energy Outlook (WEO) in its 2011 report: “[u]nconventional oil include[d] extra-heavy oil, natural bitumen (oil sands), kerogen oil, liquids and gases arising from chemical processing of natural gas (GTL), coal-to-liquids (CTL) and additives.(https://www.iea.org/publications/freepublications/publication/WEO2011_WEB.pdf) Unconventional oil and gas are harder and more expensive to exploit, however, due to the increasing demand of oil and the continuous shift from coal to natural gas in electricity production, companies and governments have invested heavily in developing unconventional drilling methods.

The most typical unconventional drilling method is the implementation of horizontal wells. They are drilled vertically downwards until reaching the target source layer and curve into a horizontal direction which runs a long distance laterally to give the wellbores extended contact with the formation. The advantage of horizontal wells is the long and constant exposure to source rocks. For example, a vertical well piercing a 30m-thick layer would only have 30m of exposure to the oil and gas interval, whereas a horizontal well would have several hundreds of exposures.

Figure. The cartoon shows the difference between conventional (right) and unconventional (left) drilling methods. The branches extended on the horizontal well are the representatives of hydraulic fracturing.

https://www.croftsystems.net/oil-gas-blog/conventional-vs.-unconventional

Hydraulic fracturing, commonly known as fracking, further extends the drainage pattern around horizontal wellbores by creating fracture patterns that facilitate flow. Fracking injects a high-pressure ‘fracking fluid’ (primarily water, sand and chemicals) into a wellbore to create cracks in the rock formations which release the oil and gas inside. (https://ec.europa.eu/jrc/en/publication/eur-scientific-and-technical-research-reports/overview-hydraulic-fracturing-and-other-formation-stimulation-technologies-shale-gas-0) This method is now wide

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