Description
Case study # 1 Gastrointestinal Function
1. In your own words define constipation and name the risk factors that might lead to developing constipation. List recommendations you would give to a patient who is suffering from constipation. Use a previous experience you might have.
Constipation is when a person has difficulty passing stool or has infrequent bowel movements. This can lead to discomfort, bloating, and abdominal pain.
Some risk factors that might lead to develop constipation are lack of fiber in the diet (a diet low in fiber can lead to constipation as fiber helps to add bulk to the stool and promotes regular bowel movements), dehydration ( insufficient fluids can lead to hard, dry stools that are difficult to pass), inactivity (sedentary lifestyle or sitting too long and slow down the digestive process and contribute to constipation), medications (certain medications such as pain relievers, antidepressants and iron supplements can cause constipation as a side effect), irritable bowel syndrome (IBS is a chronic condition that affects the large intestine and can cause abdominal pain, bloating and constipation), aging (our bodies naturally slow down as we age including the digestive system), neurological conditions (certain neurological conditions such as Parkinson’s disease and spinal cord injuries can affect the muscles used for defecation and cause constipation), and hormonal imbalances (hormonal imbalances such as those seen in pregnancy or during menopause can cause changes in the digestive system and contribute to constipation) (Forootan et al., 2018).
If an individual is suffering from constipation, some recommendations to help would be to increase fiber intake, drink more fluids (at least 2 liters a day), be more physically active to enhance peristalsis, and seek professional help with a healthcare provider because symptoms can be of an underlying condition that requires additional treatment.
2. Based on the clinical manifestations of 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.
Some of the symptoms present in Ms.RH that are compatible with constipation include feeling bloated, previous history of constipation, going an entire week with only one bowel movement, difficulty initiating bowel movement, that takes 10 minutes with increased straining, and tough stools. Other signs and symptoms of constipation that were not present in the case study include a feeling of blockage in the rectum, pain from straining, nausea, abdominal cramping, and a sense of not completely emptying the rectum.
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 in the case study?
Although there is no physical evidence of anemia stated in the case study for Ms. RH, the use of naproxen and aluminum hydroxide are of concern as the side effects of both are bleeding, specifically, GI bleeding. In addition, we have learned from the previous discussions that advanced age can cause decreased production of erythropoiesis which is necessary for red blood cell production. Despite a negative colonoscopy, she may have developed upper GI ulcers from having frequent episodes of heartburn which could cause erosion and bleeding that the patient is not aware of. Therefore, an esophagogastroduodenoscopy (EGD) would be recommended to examine the lining of the esophagus and upper parts of the small intestines due to the complaint of frequent heartburn. I would consider anemia in this case for the reason mentioned.
Case study # 2 Endocrine Function
1. In which race and ethnic groups are 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 prevalence of diabetes in the United States varies across racial and ethnic groups. According to the American Diabetic Association (ADA), as of 2022, the race and ethnic group with the highest prevalence of diabetes are 14.5% American Indians/Alaskan Natives, 12.1% of non-Hispanic blacks, 11.8% of Hispanics, 9.5% of Asians Americans and 7.4% of non-Hispanics whites.
There are three classic signs and symptoms of DM which are polydipsia, polyphagia, and polyuria (Zhu et al.,2019). The individual with DM has increased thirst causing an increased fluid intake that leads to increased urination (due to increased urine output because of osmotic effects of glucosuria and dehydration caused by increased urine output). C.B. is also experiencing increased weight gain due to increased caloric intake (appetite) that has led to gaining weight (due to energy loss as glucose is excreted). C.B. is also experiencing signs of diabetic peripheral artery disease and or diabetic neuropathy, as she reports weakness and numbness for several weeks in her left foot.
2. If C.B. develops bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
Pneumonia is a common severe respiratory infection. Diabetes weakens the immune system and leaves you at a greater risk of developing serious infections, in addition, makes it harder to fight the infections. Infections potentiate hyperglycemia because the body tries to fight the infections and this increases serum glucose (Pippitt, Li, & Gurgle, 2016). Hyperglycemia results in the impairment of immune pathways, including neutrophil migration and antibody production needed to fight an infection (Guo et al., 2021). Therefore, the glycemic values are expected to be elevated if Ms. CB develops bacterial pneumonia.
3. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
Diabetes has reached an epidemic proportion due to obesity resulting from an adverse lifestyle. Although there are many drugs for the effective management of diabetes, most patients will require insulin for control which worsens obesity and thereby diabetes. Therefore, the best initial non-pharmacological therapy to recommend Ms CB would be medical nutrition interventions such as avoiding simple carbohydrates and replacing them with complex carbohydrates. In addition, she should increase the intake of fruits and vegetables, while being aware of those fruits that have a higher glycemic index content, such as pineapples, watermelons, and overly ripe bananas. The essence of these modifications is to reduce the increased amounts of glucose in the bloodstream and cause hyperglycemic conditions (Raveendran et al., 2018)). Also, lifestyle changes include daily exercise, and bariatric surgery if she meets the criteria. Metformin is an oral hypoglycemic drug that is recommended in type 2 DM treatment as the preferred initial treatment as long as it is tolerated and not contra-indicative. It reduces the risks of hyperglycemic episodes and can be combined with dietary modifications safely.
