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. ELIMINATION COMPLEXITIES

Objective Data:

1. Height: 68 inches; weight 134.5 kg

2. BP: 172/98, HR 88, RR 26

3. 3+ pitting edema bilateral feet and ankles

4. Fasting blood glucose: 146 mg/dL

5. Total cholesterol: 250 mg/dL

6. Triglycerides: 312 mg/dL

7. HDL: 30 mg/dL

8. Serum creatinine 1.8 mg/dL

9. BUN 32 mg/dl

Critical Thinking Essay

In 900-words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe the clinical manifestations present in Mr. C.

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

3. 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.)

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

5. 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. ELIMINATION COMPLEXITIES

6. 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 three sources to complete this assignment. Sources must be published within the last 5 years. Also, you must have an abstract and a conclusion with a minimum of 5 sentences to wrap up this case study.


Assisting patients with elimination is an essential aspect of the nurse’s role and has important medical significance as well as psychosocial effects on the client’s quality of life. As the pattern of healthy bowel movements and urination vary in different patient groups, the management for each patient population may differ. Nurses need to assist with healthy elimination patterns to ensure patients are having regular soft bowel movements and adequate urination and to identify abnormal patterns such as flatulence, constipation, diarrhea, incontinence, fecal impaction, hemorrhoids as well as polyuria, anuria, and other abnormalities which can be signs of underlying medical conditions. ELIMINATION COMPLEXITIES

While there are pharmacologic alternatives to assist with elimination issues, assistance by nurses is often required. For instance, in abdominal pain syndrome and constipation, studies show that abdominal massage appears to increase bowel function, but without the negative effects of laxatives.

Conversely, certain medications can cause constipation, diarrhea, and hinder or exacerbate elimination. Opioids, NSAIDs, antibiotics, anticoagulants, can all induce constipation. It is vital nurses know which patients are at risk for bowel and bladder disruption and monitor them for these issues.

The nursing team must provide strong supportive communication when assisting clients with elimination. A study found that the nurse’s attitudes toward excretion-related nursing care strongly influenced the use of a toilet and physical functions of the elderly. Patients may be reluctant to discuss their bowel and bladder problems due to embarrassment. It is vital that nurses maintain open communication and empathy with their clients and ask questions as well as physically assess patients for signs of bladder and bowel irregularities. ELIMINATION COMPLEXITIES

Elimination issues may occur due to a variety of different medical conditions; for instance, post-surgical patients are at risk for ileus, congenital malformations in infants can cause bowel and bladder disruption, and cancer patients and the elderly can have altered elimination secondary to drugs and therapy.

The inability to effectively eliminate waste products from the bowel and bladder may lead to serious medical conditions and can be a psychosocial factor contributing to decreased quality of living.Special consideration is necessary for patients at risk for bowel and bladder dysfunction such as patients with decreased fiber or fluid intake, or those with decreased bulk in their diet, patients on bed rest, those with kidney, CNS, or heart disease, the elderly, infants and cancer patients ELIMINATION COMPLEXITIES.

Also check: Therapeutic Communication