Posted: June 11th, 2023

Gastrointestinal Function: R.H. is a 74-year-old black woman

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

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:

Include both case studies in your post.
Your initial post should be at least 250 words per case study, a total of 500 words for both, formatted and cited in current APA style with support from at least 2 academic sources per case study. Your initial post is worth 8 points.
You should respond to at least two of your peers, by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response before 11:59 PM ET Thursday, and comment on the posts of two classmates before 11:59 PM ET Sunday. NB: Responses to peers can be done on the same day, but not on the day the initial post is made.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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Case Study 1:
Constipation is defined as infrequent bowel movements or difficulty in passing stools. Risk factors for constipation include age, lack of physical activity, low-fiber diet, dehydration, and certain medications. Recommendations for patients suffering from constipation include increasing fiber intake, staying hydrated, exercising regularly, and establishing a regular bowel movement routine.
In R.H.’s case, the signs and symptoms compatible with constipation diagnosis include bloating, infrequent bowel movements (once a week), straining during bowel movements, and hard stools. Other signs and symptoms not mentioned in the case study but associated with constipation include abdominal pain, feeling of incomplete evacuation, and nausea.
Anemia could be a possible complication in patients with constipation, but there is no information provided in the case study to suggest that R.H. has anemia.
Case Study 2:
Diabetes Mellitus (DM) is more prevalent in certain race and ethnic groups, including African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans. In C.B.’s case, the signs and symptoms compatible with Diabetes Mellitus Type 2 diagnosis include high fasting blood sugar (141), recent weight gain, increased thirst, frequent urination, and numbness and weakness in the left foot.
If C.B. develops bacterial pneumonia in her right lower lobe, her glycemia values might be expected to increase. Infections can cause stress on the body, leading to increased blood sugar levels due to the release of stress hormones and increased insulin resistance.
The best initial non-pharmacologic therapy for C.B. would be lifestyle modifications, including a healthy diet, regular exercise, and weight loss. Pharmacologic therapy could include starting with metformin, which is the first-line medication for type 2 diabetes. However, it is essential to consult a healthcare professional for personalized treatment recommendations.
References:
American Diabetes Association. (2021). Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement 1), S1-S232. https://doi.org/10.2337/dc21-Sint01
Bharucha, A. E., Pemberton, J. H., & Locke, G. R. (2013). American Gastroenterological Association technical review on constipation. Gastroenterology, 144(1), 218-238. https://doi.org/10.1053/j.gastro.2012.10.028

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