R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.
Case Study Questions
In your own words define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have.
Based on the clinical manifestations on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?
Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions
In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
Submission Instructions:
You Must complete both case studies when there are more than one.
Your initial post should be at least 500 words, formatted using the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.
R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment
**Constipation Definition and Risk Factors**
Constipation is defined as infrequent bowel movements or difficulty in passing stools, typically accompanied by hard stools or straining during bowel movements. Risk factors that may lead to the development of constipation include:
**Dietary Factors:** Lack of fiber in the diet, inadequate fluid intake, and excessive consumption of processed or low-fiber foods can contribute to constipation.
**Lifestyle Factors:** Sedentary lifestyle, lack of physical activity, and ignoring the urge to have a bowel movement can lead to constipation.
**Medications:** Certain medications, such as opioids, antacids containing aluminum or calcium, antidepressants, and antispasmodics, can cause constipation as a side effect.
**Medical Conditions:** Conditions like irritable bowel syndrome (IBS), hypothyroidism, diabetes, and neurological disorders can affect bowel function and lead to constipation.
**Age:** Older adults are more prone to constipation due to decreased mobility, reduced bowel motility, and changes in diet and lifestyle.
**Recommendations for Managing Constipation**
**Increase Fiber Intake:** Encourage consuming more fruits, vegetables, whole grains, and legumes to add bulk to stools and facilitate bowel movements.
**Hydration:** Ensure an adequate intake of fluids, particularly water, to soften stools and prevent dehydration, which can worsen constipation.
**Regular Exercise:** Promote regular physical activity to stimulate bowel motility and improve overall gastrointestinal function.
**Establish Bowel Routine:** Encourage establishing a regular bowel routine by attempting to have a bowel movement at the same time each day, preferably after meals.
**Over-the-Counter Remedies:** Suggest the use of over-the-counter laxatives or stool softeners, such as psyllium husk, docusate sodium, or polyethylene glycol, if dietary and lifestyle modifications alone are insufficient.
**Medication Review:** Review current medications with a healthcare provider to identify any potential contributors to constipation and explore alternative options if necessary.
In my experience as a nurse, I have found that a combination of dietary modifications, increased fluid intake, and regular exercise often yields significant improvement in constipation symptoms for patients. Additionally, educating patients about the importance of adhering to a bowel routine and the appropriate use of over-the-counter remedies can empower them to manage their symptoms effectively.
**Signs and Symptoms of Constipation in R.H.’s Case**
**Infrequent Bowel Movements:** R.H. reports going an entire week with only one bowel movement, indicating reduced frequency compared to her usual pattern.
**Hard Stools and Straining:** R.H. describes stools as extremely hard and reports straining most of the time during bowel movements, which are classic symptoms of constipation.
**Heartburn:** Although not directly related to constipation, frequent heartburn may indicate gastrointestinal issues or altered digestive function, which can contribute to constipation indirectly.
Additional Signs and Symptoms:
**Abdominal Discomfort or Bloating:** Patients with constipation may experience abdominal discomfort, bloating, or a sensation of fullness due to retained stool in the colon.
**Rectal Bleeding:** In severe cases, constipation can lead to rectal bleeding or fissures due to the passage of hard stools.
**Consideration of Anemia in Constipation Patients**
While constipation itself may not directly cause anemia, chronic constipation can lead to complications such as hemorrhoids or rectal bleeding, which may result in iron deficiency anemia over time. Since R.H. does not report any symptoms suggestive of anemia, such as fatigue, weakness, or pallor, anemia may not be a concern in her case. However, it is essential to monitor patients with chronic constipation for signs of gastrointestinal bleeding and evaluate for anemia if indicated.
R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment
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