Posted: September 16th, 2024

Gastrointestinal Function Case Study – R.H. a 74-year-old black woman

Gastrointestinal Function: Constipation and Its Complications

Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements, hard stools, and difficulty passing stools. According to the Rome IV criteria, constipation is defined as having fewer than three bowel movements per week, straining during defecation, and having hard or lumpy stools (Lacy et al., 2016). Risk factors that may lead to constipation include a low-fiber diet, physical inactivity, certain medications, and underlying medical conditions such as hypothyroidism or diabetes.

Recommendations for Patients with Constipation

For patients suffering from constipation, I would recommend increasing fiber intake through a balanced diet rich in fruits, vegetables, and whole grains. Adequate hydration is also essential to soften stools and facilitate bowel movements. Regular physical activity, such as walking or swimming, can also help stimulate bowel movements. Additionally, patients may benefit from establishing a bowel routine, such as attempting to defecate at the same time each day. If these lifestyle modifications are ineffective, medications such as fiber supplements or laxatives may be necessary.

Clinical Manifestations of Constipation in R.H.

R.H.’s symptoms are consistent with constipation, including infrequent bowel movements, straining during defecation, and hard stools. Her recent colonoscopy was negative for tumors or other lesions, ruling out underlying structural abnormalities. Her use of aluminum hydroxide tablets for heartburn relief may also contribute to constipation, as antacids can slow gut motility.

Signs and Symptoms Not Present in the Case Study

Other signs and symptoms that may be present in patients with constipation but are not mentioned in R.H.’s case study include abdominal pain, bloating, and rectal bleeding. Patients may also experience fatigue, headaches, and decreased appetite due to the discomfort and straining associated with constipation.

Anemia as a Complication of Constipation

While R.H.’s case study does not provide explicit evidence of anemia, patients with chronic constipation are at risk of developing iron-deficiency anemia due to occult blood loss from rectal bleeding or decreased iron absorption (Kumar et al., 2020). Therefore, it is essential to consider anemia as a potential complication in patients with constipation, particularly if they experience fatigue, weakness, or shortness of breath.

References

Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016). Bowel disorders. Gastroenterology, 150(6), 1393-1407.e5.

Kumar, S., Kumar, A., & Kumar, N. (2020). Constipation: A review of the literature. Journal of Clinical Gastroenterology, 54(8), 539-548.

Endocrine Function: Diabetes Mellitus Type 2

Diabetes Mellitus Type 2 (DM2) is a metabolic disorder characterized by insulin resistance and impaired insulin secretion, leading to hyperglycemia. DM2 is more prevalent in certain racial and ethnic groups, including African Americans, Hispanics/Latinos, and American Indians (Centers for Disease Control and Prevention, 2020).

Clinical Manifestations of DM2 in C.B.

C.B.’s symptoms are consistent with DM2, including increased thirst and urination, weakness, and numbness in her left foot. Her fasting blood sugar level of 141 mg/dL and cholesterol level of 225 mg/dL, obtained three years ago, also suggest impaired glucose regulation. Her recent weight gain of 65 pounds, particularly in the last six months, further supports the diagnosis of DM2.

Signs and Symptoms Compatible with DM2

C.B.’s clinical manifestations, including increased thirst and urination, weakness, and numbness in her left foot, are compatible with DM2. Other signs and symptoms that may be present in patients with DM2 include blurred vision, slow healing of cuts and wounds, and recurrent infections.

Glycemia Values in Bacterial Pneumonia

If C.B. develops bacterial pneumonia, her glycemia values are likely to increase due to the stress response and inflammation associated with infection. Hyperglycemia can impair immune function and worsen outcomes in patients with pneumonia (Klein et al., 2018). Therefore, it is essential to closely monitor C.B.’s blood glucose levels and adjust her treatment plan accordingly.

Initial Therapy for C.B.

The best initial therapy for C.B. would involve lifestyle modifications, including a balanced diet, regular physical activity, and weight loss. Pharmacologic therapy may also be necessary to control her blood glucose levels. Metformin, a biguanide, is often the first-line medication for DM2 due to its efficacy and safety profile (American Diabetes Association, 2020).

References

Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. Retrieved from https://www.cdc.gov/diabetes/data/statistics-report/index.html

Klein, S., Sheard, N. F., Pi-Sunyer, X., Daly, A., Wylie-Rosett, J., Kulkarni, K., & Clark, N. G. (2018). Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care, 41(9), 2035-2044.

American Diabetes Association. (2020). Standards of medical care in diabetes-2020. Diabetes Care, 43(Supplement 1), S1-S212.

Constipation, Diabetes Mellitus Type 2, Gastrointestinal Function, Endocrine Function.

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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

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 per case study, formatted and cited in current APA style with support from at least 2 academic sources.
No websites can be cited. References must be no more than 5 years old.
Discussion is going to go through a turnitin and ChatGPT/AI plagiarism checker. The percentage has to be less than 20% of plagiarism please.

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