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Define Constipation and Name Risk Factors

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Gastrointestinal Function:
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

  1. 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.
  2. 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.
  3. 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

  1. 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.
  2. 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.
  3. 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.

Define Constipation and Name Risk Factors

Constipation Definition and Risk Factors:

Constipation is a condition characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. Risk factors for developing constipation include:

  1. Dietary Factors: Low intake of fiber-rich foods such as fruits, vegetables, and whole grains can contribute to constipation. Inadequate fluid intake can also lead to dry, hard stools.
  2. Lifestyle Factors: Lack of physical activity or exercise can slow down bowel movements. Ignoring the urge to have a bowel movement or having irregular bathroom habits can also contribute to constipation.
  3. Medications: Certain medications, including opioids, antacids containing aluminum or calcium, some antidepressants, and iron supplements, can cause constipation as a side effect.
  4. Medical Conditions: Chronic conditions such as irritable bowel syndrome (IBS), diabetes, thyroid disorders, and neurological conditions like Parkinson’s disease can affect gastrointestinal motility and lead to constipation.
  5. Age and Gender: Older adults, especially women, are more prone to constipation due to age-related changes in bowel function and hormonal influences.

Recommendations for managing constipation:

  1. Increase Fiber Intake: Encourage consuming fiber-rich foods such as fruits, vegetables, whole grains, and legumes to add bulk to stools and promote regular bowel movements.
  2. Stay Hydrated: Ensure adequate fluid intake, preferably water, throughout the day to soften stools and facilitate bowel movements.
  3. Regular Physical Activity: Encourage regular exercise or physical activity to stimulate bowel motility and maintain overall gastrointestinal health.
  4. Establish Regular Bathroom Habits: Encourage the patient to heed the urge to have a bowel movement and establish a consistent schedule for bathroom visits.
  5. Review Medications: Review the patient’s medication list to identify any potential constipation-inducing drugs and consider alternatives or adjustments if possible.
  6. Over-the-Counter Remedies: Depending on the severity of constipation, over-the-counter laxatives or stool softeners may be recommended for short-term relief. However, long-term use should be avoided without medical supervision.
  7. Address Underlying Conditions: If constipation is related to an underlying medical condition, such as hypothyroidism or diabetes, appropriate management of the primary condition is crucial.

In a previous clinical encounter, I encountered a patient with similar symptoms of constipation. Through dietary modifications, increased fluid intake, and regular exercise, the patient experienced significant improvement in bowel habits within a few weeks. Additionally, counseling on proper bathroom habits and medication review helped alleviate the symptoms effectively.

Clinical Manifestations Compatible with Constipation in R.H.’s Case:

Signs and symptoms presented in R.H.’s case compatible with constipation include:

  1. Infrequent Bowel Movements: Going an entire week with only one bowel movement, contrary to her regular daily or every-other-day pattern.
  2. Straining and Difficulty Initiating Bowel Movements: Spending a minimum of 10 minutes to initiate a bowel movement, accompanied by straining and hard stools.
  3. Stools Characteristics: Extremely hard stools, indicating decreased bowel motility and difficulty passing stools.

Additional signs and symptoms not present in the case study but commonly associated with constipation include:

  1. Abdominal Discomfort or Pain: Patients may experience abdominal bloating, discomfort, or even pain due to the buildup of stool in the intestines.
  2. Rectal Bleeding or Hemorrhoids: Straining during bowel movements can lead to the development of hemorrhoids or cause minor tears in the anal tissue, resulting in rectal bleeding.
  3. Feeling of Incomplete Evacuation: Even after passing stools, patients may feel as though they haven’t fully emptied their bowels, leading to a persistent sensation of discomfort.

Considering R.H.’s age, gender, and symptoms, anemia might be a possibility, especially if chronic constipation has led to fecal impaction or intestinal bleeding. However, further evaluation, including laboratory tests such as complete blood count (CBC) and fecal occult blood testing, would be necessary to confirm or rule out anemia in this case. Anemia could exacerbate symptoms such as fatigue and weakness, further impacting R.H.’s quality of life.

Diabetes Mellitus (DM) Prevalence by Race and Ethnicity:

Diabetes Mellitus Type 2 (DM2) is more prevalent in certain racial and ethnic groups, including:

  1. Native American and Alaska Native Populations: Individuals belonging to Native American and Alaska Native communities, such as C.B. from the Winnebago Indian tribe, have a higher prevalence of DM2 compared to other racial and ethnic groups.
  2. African American and Hispanic/Latino Populations: These groups also have an increased risk of developing DM2 compared to non-Hispanic whites.
  3. Asian American and Pacific Islander Populations: Certain subgroups within the Asian American and Pacific Islander communities, such as South Asians, Filipinos, and Pacific Islanders, have a higher prevalence of DM2.

Clinical Manifestations Compatible with DM2 in C.B.’s Case:

  1. Hyperglycemia and Polyuria: C.B. reports increased thirst and nocturia, which are classic symptoms of hyperglycemia leading to increased urine production.
  2. Neuropathy: Weakness and numbness in the left foot, along with difficulty flexing the foot, suggest peripheral neuropathy, a common complication of long-standing diabetes.
  3. Weight Gain and Obesity: C.B. has gained a significant amount of weight, particularly in the last 6 months, which is a risk factor for developing insulin resistance and DM2.
  4. Hyperlipidemia: C.B. had elevated cholesterol levels during a previous health screening, indicating dyslipidemia, another common comorbidity associated with DM2.

If C.B. were to develop bacterial pneumonia on her right lower lobe, her glycemia values would likely be elevated. This is because acute illness, such as infection or inflammation, can trigger a stress response in the body, leading to increased release of counterregulatory hormones like cortisol and catecholamines. These hormones promote gluconeogenesis and glycogenolysis, resulting in elevated blood glucose levels, even in individuals without diabetes. Therefore, C.B.’s glycemia values may be higher than usual during the episode of bacterial pneumonia.

Best Initial Therapy for C.B.:

Non-pharmacologic therapy:

  1. Dietary Modification: Implementing a balanced diet rich in whole grains, fruits, vegetables, and lean proteins while limiting intake of refined carbohydrates and saturated fats can help improve glycemic control and promote weight loss.
  2. Physical Activity: Encourage regular physical activity tailored to C.B.’s abilities and preferences, aiming for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or swimming.
  3. Weight Management: Support C.B. in setting realistic weight loss goals and adopting healthy lifestyle habits to achieve and maintain a healthy weight, which can improve insulin sensitivity and glycemic control.

Pharmacologic therapy:

  1. Oral Antidiabetic Medications: Depending on C.B.’s glycemic control and individualized treatment goals, initiation of oral antidiabetic medications such as metformin, sulfonylureas, or dipeptidyl peptidase-4 (DPP-4) inhibitors may be considered to improve glycemic control.
  2. Lipid-lowering Therapy: Given C.B.’s elevated cholesterol levels, initiation of statin therapy may be indicated to manage dyslipidemia and reduce cardiovascular risk.
  3. Symptomatic Treatment: Address symptoms of neuropathy, such as pain or discomfort in the affected foot, with appropriate pain management strategies, which may include analgesics or neuropathic pain medications.

In summary, comprehensive management of DM2 in C.B. should involve a combination of lifestyle modifications, pharmacologic therapy, and regular monitoring to achieve optimal glycemic control, prevent complications, and improve overall health outcomes.

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