Case Study 1 Gastrointestinal Function
University:
St. Thomas University
Case Study 1 Gastrointestinal Function
Paper Instructions
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?
Case Study 2 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(250 per case study) words, formatted and cited in current APA style with support from at least 2 academic sources for each case study.
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Sample Answer
Case Study 1 Gastrointestinal Function
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.
Constipation is a delay or difficulty in defecation that is present for two weeks or more and sufficient to cause significant distress to the patient. It can also be defined as a period of eight weeks with at least two of the following symptoms defecation frequency less than 3 times per week, the passage of large stools that clog the toilet, palpable abdominal or rectal fecal mass, stool withholding behavior, or painful defecation.
The risk factors for constipation include Changes in routine, changes in diet, stressful events, postponing defecation, too-early toilet training, voluntary withholding, prolonged bed rest, anal stenosis, and spinal injuries (Jani & Marsicano, 2018). Drugs can also cause constipation, like Antimotility drugs, Anticholinergics, Antidepressants, Opiates, Antacids, Phenothiazines, and Methylphenidate.
A patient with constipation should take a balanced diet containing whole grains, fruits, vegetables, and a high-residue diet (Jani & Marsicano, 2018). I also recommend increasing fluid intake with at least 2l of water daily and increasing physical activity.
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 in the case study.
The patient has signs and symptoms consistent with constipation, like abdominal bloating, less than 2 bowel movements per week, hard bowel movements, and straining during defecation. Other clinical features of constipation not present in the case study include large fecal mass in the rectum, passing large stool obstructing the toilet, abdominal distention, pain when passing stool, flatulence, anorexia, and tenesmus (Jani & Marsicano, 2018).
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?
Anemia is associated with gross or occult rectal bleeding. Fecal occult blood is usually tested in chronically constipated middle-aged or elderly adults to rule out an obstructing neoplasm of the colon (Forootan et al., 2018). The patient has no history of rectal bleeding, and her colonoscopy was negative for tumors or other lesions. This rule out the possibility of anemia in the patient.
Case Study 2 Endocrine Function
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.
According to the CDC 2022 National Diabetes Statistics Report, American Indians/Alaskan Natives adults had the highest prevalence of diabetes mellitus in 2019, with a rate of 14.5%. Signs and symptoms present in C.B. compatible with T2DM include being overweight, numbness in the lower extremity, acute thirst, increased urine production, and weight gain (Banday et al., 2020). Besides, the patient’s history of high blood sugar and cholesterol levels are a risk factor for T2DM.
2. If C.B. develops a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
Hyperglycemia is common in patients with community-acquired pneumonia and is a predictor of severe outcomes. During an infection, hyperglycemia can be triggered by stress. Stress-induced hyperglycemia is caused by a complex interplay of hormones like catecholamines, cortisol, growth hormone, and cytokines, which contribute to producing hepatic glucose and insulin resistance (Jensen et al., 2019).
Systemic bacterial infections are potent triggers of stress hyperglycemia which is thought to be the case for pneumonia. Thus, if C.B. develops bacterial pneumonia, her glycemic levels are expected to escalate.
3. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
C.B.’s initial non-pharmacologic therapy should include lifestyle modification to promote weight gain. This includes limiting caloric intake and increasing physical activity by engaging in aerobic exercises. Pharmacologic therapy will include hypoglycemic agents like Metformin which lowers blood glucose levels by reducing endogenous insulin production and does not cause weight gain (Banday et al., 2020).
References
- Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes An overview. Avicenna Journal of Medicine, 10(4), 174–188. https //doi.org/10.4103/ajm.ajm_53_20
- Centers for Disease Control and Prevention. (2022, January 20). National Diabetes statistics report. https //www.cdc.gov/diabetes/data/statistics-report/index.html
- Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation A review of literature. Medicine, 97(20), e10631. https //doi.org/10.1097/MD.0000000000010631
- Jani, B., & Marsicano, E. (2018). Constipation Evaluation and Management. Missouri medicine, 115(3), 236–240.
- Jensen, A. V., Baunbæk Egelund, G., Bang Andersen, S., Petersen, P. T., Benfield, T., Witzenrath, M., … & Faurholt-Jepsen, D. (2019). The glycemic gap and 90-day mortality in community-acquired pneumonia. A prospective cohort study. Annals of the American Thoracic Society, 16(12), 1518-1526. https //doi.org/10.1513/AnnalsATS.201901-007OC
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