response to cardona

Case Study: R.H.’s Constipation

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 the absence of bowel movement for a certain amount of time, a delayed in frequency of bowel movements for any given person and difficulty associated with passing stools that may be hard and lumpy. Bowel movement patterns are not the same for every person, thus obtaining a history and identifying patient’s bowel movement frequency is important when diagnosing constipation (Dlugasch & Story, 2020).

Forootan et al. (2018) explain that risk factors usually associated with constipation include:

· Age and gender: Constipation is more common on older adults and young people and also more frequent on females than males.

· Diet: A common cause of constipation includes not consuming enough fiber. In these cases, constipation is usually not a serious problem and can be controlled and treated by correcting nutritional habits and lifestyles.

· Dehydration: Not taking enough water or liquids is another risk factor for constipation.

· Constipation secondary to another disease or condition: Mechanical causes such as obstruction, psychological conditions such as depression and eating disorders, endocrine disorders such as diabetes among others could cause constipation.

· Constipation as a side effect of medications: Many medications have constipation as a side effect including analgesics such as NSAIDs and antacids.

· Physical activity: Sedentarism and lack of exercise can lead to constipation.

· Socioeconomic status: May include not having the resources to supplement a balanced nutrition.

Recommendation to relief constipation would include removal of controllable risk factors:

· Increase consumption of dietary fiber.

· Increase fluid intake.

· Increase physical activity.

· Seek alternatives to medications which cause constipation.

· Seek medical help.

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.

Signs and symptoms in this case study that are compatible with constipation include:

· Elderly female patient of 74 years of age.

· Patient reports “some-times going an entire week with only one bowel movement”.

· Patient reports “feeling bloated and constipated”.

· Patient was had regular bowel movements “every day or every other day”.

· Patient reports straining and passing hard stools.

· Reports consumption of antacids.

· Reports consumption of analgesics, NSAIDs.

· Patient reports lack of physical activity and exercise.

· Other signs and symptoms that R.H. may have and are not included in the study may be other disease or condition that may cause constipation, insufficient water or liquid intake, and socioeconomic status.

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 a possibility in this case study because this patient history of NSAIDs intake. According to Tai & McAlindon (2021) a large number of patients consuming NSAIDs develop symptoms of epigastric discomfort, bloating, post-prandial nausea, early satiety and belching as well as heartburn and regurgitation. In addition, they consider NSAIDs second to  Helicobacter pylori infection in causing peptic ulceration in the upper GI tract and associated complications such as perforation and bleeding. Patient also reports taking an antacid for her heartburn. Anemia and constipation are side effects of aluminum hydroxide (Shon et al., 2021) which is the antacid patient was taking.

Case Study: C.B. Diabetes Mellitus Type 2

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.

          The incidence and prevalence of diabetes mellitus in the United States is sadly very large. According to the CDC (2021) a great percentage of Americans, more than 10% of the US population, had diabetes (diagnosed or undiagnosed) in 2018. When referring to prevalence of diabetes mellitus, we are talking about the total number of patients with diabetes also including new cases.  Regarding ethnic groups American Indian or Alaska Native adults have the highest rates of diagnosed diabetes (14.7%) among all US racial and ethnic groups, followed by Hispanics (12.5%) and non-Hispanic blacks (11.7%) (CDC, 2021).

C.B. is experiencing the following signs and symptoms compatible with diabetes mellitus type 2.

· Patient’s fasting blood sugar three years ago was 141.

· Increase in number of “female infections”

· Foot has been weak and numb for nearly three weeks and that the foot is difficult to flex

· Increased in thirst, polydipsia

· Urinary frequency at night, polyuria

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.

            Patients with diabetes are predisposed to infections. Macrovascular disease and microvascular dysfunction may result in compromised local circulation leading to delayed response to infection and impaired wound healing besides generalized impairments of immunity. Moreover, the capability of neutrophils to perform their function is adversely affected by high levels of serum glucose. When there is an infection, it adds stress to the body which in response releases hormones such as cortisol and adrenaline. These hormones are going to negatively impact the action of insulin resulting in elevated glycemic levels (Abu-Ashour et al., 2018)

3. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

              The best initial non-pharmacological therapy for C.B. would include lifestyle modifications. Patient needs to make dietary changes, reduce weight and exercise. The American Diabetes Association (n.d.) recommends half of your plate non-starchy vegetables, a quarter protein and the last quarter carbohydrates. When it comes to carbohydrates the ADA (n.d.) specifies to choose carbs rich in fiber, vitamins and minerals, and low in added sugars, sodium and unhealthy fats. Moreover, the ADA (n.d.) recommends to incorporate a daily exercise routine to your schedule. In addition, strict follow ups with primary care physician or endocrinologist would be recommended.

            Pharmacological treatment would include oral or noninsulin injectable hyperglycemia medications, insulin, and complication management (Dlugasch & Story, 2020). Strict compliance with pharmacological and nonpharmacological treatment is paramount for patient’s well being and therapy to work.

References

Abu-Ashour, W., Twells, L.K., Valcour, J.E. et al. Diabetes and the Occurrence of Infection in Primary Care: A Matched Cohort Study.  BMC Infect Dis 18, 67 (2018). https://doi.org/10.1186/s12879-018-2975-2

ADA. (n.d.).  Healthy Living. Retrieved from Diabetes: https://www.diabetes.org/healthy-living/recipes-nutrition

1. (2021, January 4th).  Data and Statistics. Retrieved from Diabetes Home: https://www.cdc.gov/diabetes/library/reports/reportcard/national-state-diabetes-trends.html

Dlugasch, L., & Story, L. (2020).  Applied Pathophysiology for the Advanced Practice Nurse. Burlington, MA: Jones and Bartlett Learning.

Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic Constipation: A Review of Literature.  Medicine, 97(20), e10631.  https://doi.org/10.1097/MD.0000000000010631Links to an external site.

Tai, F., & McAlindon, M. E. (2021). Non-steroidal Anti-Inflammatory Drugs and the Gastrointestinal Tract.  Clinical Medicine (London, England), 21(2), 131–134.  https://doi.org/10.7861/clinmed.2021-0039Links to an external site.

Shon N.N., Yarbrough T., Shah A.D. (2021)  Aluminum Hydroxide. StatPearls Publishing, Treasure Island (FL).