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.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
**Case Study 1: R.H.**
**Definition of Constipation:**
Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements, difficulty passing stool, and/or hard or dry stool consistency. Risk factors for constipation include inadequate fiber intake, sedentary lifestyle, dehydration, certain medications (e.g., opioids, anticholinergics), and medical conditions such as irritable bowel syndrome (IBS) or hypothyroidism.
**Recommendations for Managing Constipation:**
Increase Fiber Intake: Encourage the patient to consume more fiber-rich foods such as fruits, vegetables, whole grains, and legumes.
Stay Hydrated: Drink plenty of water throughout the day to soften stool and facilitate bowel movements.
Exercise Regularly: Engage in regular physical activity to promote bowel motility and overall gastrointestinal health.
Establish Regular Bowel Habits: Encourage the patient to set aside time each day for bowel movements, preferably after meals.
Consider Over-the-Counter (OTC) Remedies: Suggest OTC options such as fiber supplements, stool softeners, or osmotic laxatives if dietary and lifestyle modifications are insufficient.
**Clinical Manifestations Compatible with Constipation:**
Infrequent Bowel Movements: R.H. reports going an entire week with only one bowel movement, indicating reduced bowel frequency.
Straining: R.H. reports straining during bowel movements, a common symptom of constipation.
Hard Stool Consistency: R.H. describes extremely hard stools, indicative of constipation.
Heartburn: Although not directly related to constipation, heartburn may suggest underlying gastrointestinal issues or medication side effects.
Arthritic Pain and Stiffness: While not specific to constipation, reduced physical activity due to arthritis can contribute to constipation by slowing bowel motility.
**Consideration of Anemia as a Complication:**
While constipation itself does not directly cause anemia, chronic constipation may lead to complications such as hemorrhoids or anal fissures, which could result in blood loss and iron-deficiency anemia. However, based on the information provided in the case study, there are no indications of anemia. Further assessment, including laboratory tests, would be needed to confirm or rule out anemia as a complication of constipation.
**Case Study 2: C.B.**
**Prevalence of DM in Race and Ethnic Groups:**
Diabetes Mellitus Type 2 (DM2) is more prevalent among certain racial and ethnic groups, including African Americans, Hispanic/Latino Americans, Native Americans (including the Winnebago tribe), and Asian Americans. These populations are at higher risk due to genetic predisposition, lifestyle factors, and disparities in healthcare access and resources.
**Clinical Manifestations of DM2 in C.B.:**
Weakness and Numbness in Foot: Peripheral neuropathy, characterized by numbness, tingling, and weakness in the extremities, is a common complication of DM2.
Increased Thirst and Polyuria: Polydipsia (increased thirst) and polyuria (frequent urination) are classic symptoms of hyperglycemia and may indicate uncontrolled diabetes.
Recent Weight Gain: Weight gain, especially central obesity, is a risk factor for DM2 and may contribute to insulin resistance.
Fatigue and Nocturia: These symptoms may also be associated with DM2, reflecting metabolic disturbances and poor glycemic control.
**Effect of Bacterial Pneumonia on Glycemia:**
During an acute infection such as bacterial pneumonia, stress hormones such as cortisol and catecholamines are released, leading to increased insulin resistance and elevated blood glucose levels. Therefore, in the presence of bacterial pneumonia, CB’s glycemia values would likely be elevated, reflecting the stress-induced hyperglycemia.
**Initial Therapy for CB:**
Non-pharmacologic interventions:
Lifestyle Modification: Emphasize the importance of healthy eating, regular physical activity, and weight management to improve glycemic control.
Blood Glucose Monitoring: Encourage CB to monitor her blood glucose levels regularly to track progress and identify patterns.
Pharmacologic interventions:
Oral Antidiabetic Agents: Initiate therapy with oral antidiabetic medications such as metformin to improve insulin sensitivity and lower blood glucose levels.
Consider Insulin Therapy: Depending on CB’s glycemic control and individualized treatment goals, insulin therapy may be initiated to achieve optimal blood glucose levels.
In conclusion, addressing constipation and managing DM2 require a multifaceted approach, including lifestyle modifications, pharmacologic interventions, and regular monitoring. By addressing these conditions comprehensively, healthcare providers can improve patient outcomes and enhance quality of life.
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