Response to andrews

Case Study One: Gastrointestinal
 

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 condition in which an individual’s regularity of stool passage decreases significantly (Dlugasch & Story, 2019). There are numerous risk factors that may lead to constipation. For example, if one consumes a diet that is low in fiber or low in fluid intake. Additionally, lack of physical exercise is a risk factor for constipation (Dlugasch & Story, 2019).

     If an individual delays the urge to defecate or abuse laxatives, they also increase their chances of developing constipation (Dlugasch & Story, 2019). Enduring high stress, extended traveling, as well as bowel diseases and colon cancer can leave one at risk (Dlugasch & Story, 2019).

       Certain medications and neurological conditions, such as spinal cord issues and strokes, can also be found to lead to constipation (Dlugasch & Story, 2019).

            From personal experience, there are several effective ways to treat constipation and reestablish the patient’s frequency of stool passage. For example, improving the patient’s diet by increasing the fiber intake amount and hydration, while also decreasing the intake of meats and processed foods that cause constipation, will help alleviate the problem (Dlugasch & Story, 2019).

          Becoming more physically active will improve the patient’s situation, as well as encouraging them to defecate when the initial urge is felt (Dlugasch & Story, 2019). The patient can also take stool softeners and limit her intake of laxatives, if she has been overusing them (Dlugasch & Story, 2019). If those treatments do not work, the patient may look to see if there is an impaction that needs to be removed (Dlugasch & Story, 2019).

 

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.

        There are several signs and symptoms from the case study that make it clear that the constipation diagnosis is accurate. The patient reported having only one bowel movement a week, at times. Usually, if someone goes at least three days without a bowel movement, it is a sign that they are experiencing constipation (Dlugasch & Story, 2019).

The patient also reported that when she is able to have a bowel movement, her stools are very hard, which is also indicative of the current diagnosis (Dlugasch & Story, 2019).

She also states that her bowel movements take more than 10 minutes to start, and that she has to strain to initiate it. These are also hallmark signs of someone suffering from constipation (Dlugasch & Story, 2019). As a side note, the patient has said that she is taking aluminum hydroxide tablets to help with her heart burn, which is a medication that can contribute to constipation (Zheng & Yao, 2018). Her lack of exercise, due to her arthritis flare-up, is also a contributing to her constipation.

Other symptoms and/or signs of an individual with constipation is the reduction in the loudness or tone of the bowel sounds (Dlugasch & Story, 2019). If an individual has an anal fissure, it may be because of large stools that are tearing the mucosal membrane of the anus, caused by constipation (Dlugasch & Story, 2019). Other signs include problems with pH, hemorrhoids, diverticulitis, and more (Dlugasch & Story, 2019).

 

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?

           
 Yes, there is a strong possibility that R.H. may have anemia, as well as constipation. The primary reason that this could be the case is the patient’s use of naproxen to treat for arthritic pain. When an individual uses naproxen or other NSAIDS over a prolonged period, it can cause gastric erosion. This can eventually lead to gastrointestinal bleeding. If the bleeding is not addressed in a timely manner, it may cause anemia in the individual. Thus, it is necessary to check R.H. for this possible diagnosis.

                                                                   Case Study Two: Endocrine Function

 

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.

           
 Diabetes mellitus seems to be most prevalent among minority groups, such as Blacks, Latinos, Asians, native Hawaiians, and other Pacific Islanders (Dlugasch & Story, 2019). We also find it to be most prevalent within Native American populations, including our patient, C.B. (Dlugasch & Story, 2019). There are several signs/symptoms that C.B. is exhibiting that confirms the Diabetes Mellitus Type 2 diagnosis. Her high blood sugar and cholesterol suggests that she has glucosuria, a manifestation of DM (Dlugasch & Story, 2019). Her complaints of her left foot being weak and numb is commonly caused by neuropathy due to long-term effects of diabetes. Her reports of being more thirsty, as well as urinating more at night, suggests that she has polyuria and polydipsia, which are often found in patients with DM (Dlugasch & Story, 2019). Finally, her weight gain points to C.B. having polyphagia, which is a result of an increased appetite caused by the glucose levels being excreted from glucosuria.

 

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.

 

         The body has a unique way of combating stress during times of illness. Part of the response to infection is the production of hormones such as cortisol, catecholamines, and cytokines, as well as glucagon and growth hormone (Preiser & Thooft, 2016). The release of these hormones cause an increase in blood sugar levels so C.B. may need to check her blood sugar level more frequently during times of illness.

 

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

           
 The first line of non-pharmacologic treatment would be to have C.B. change her diet and become more physically active (Dlugasch & Story, 2019). Other non-pharmacologic treatments would include having the patient lose weight, as well as institute a habit of self-monitoring the glucose levels (Dlugasch & Story, 2019). Potential pharmacologic treatments include hyperglycemia medications, as well as insulin (Dlugasch & Story, 2019). There is bolus insulin, which is rapid and short-acting, and administered on a fixed dose around mealtimes (Dlugasch & Story, 2019). There is also basal insulin, which is long-acting and is used to keep glucose levels steady for the patient (Dlugasch & Story, 2019). As a last resort, C.B. could undergo bariatric or metabolic surgeries, which have been shown to potentially help diabetic patients in the past (Dlugasch & Story, 2019).

 

                                                                                     References

Dlugasch, L., & Story, L. (2019). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

Preiser, J. C., Thooft, A., & Tironi, R. M. (2016). Stress hyperglycemia. In The Stress Response of Critical Illness: Metabolic and Hormonal Aspects (pp. 89-94). Springer.

Zheng, S., Yao, J., & Chinese Geriatric Society, Editorial Board of Chinese Journal of Geriatrics. (2018). Expert consensus on the assessment and treatment of chronic constipation in the elderly. Aging medicine, 1(1), 8-17.