Case Study 1

Question 1: Constipation and the Possible Risk Factors

The condition known as constipation is characterized by having less frequent bowel movements than usual and having hard stools, which can make passage through the intestines difficult for an individual. As a result of changes in dietary routine or diet as well as inadequate fiber intake, the risk of this condition increases. It is possible to develop chronic constipation following the onset of the symptoms mentioned above for a prolonged period of time, for example, several weeks. In normal circumstances, constipation is defined as not passing more than three bowel movements in one week. The above symptoms are demonstrated in R.H.’s case because she reports that she could experience only one bowel movement in a week, indicating that she has chronic constipation (Dlugasch & Story, 2019). Constipation can be categorized into three types: pelvic floor dysfunction, regular transit, and slow transit.

Some risk factors leading to chronic constipation include being a woman, consuming a diet low in fiber, being dehydrated, being an older adult, and engaging in little or no physical activities. In addition, other factors include having an eating disorder, having mental health problems, and being under medications such as sedatives, opioids, and some antidepressants (Bharucha & Lacy, 2020).

Question 2: Pharmacological and Non-Pharmacological Recommendations to a Patient with Constipation

An individual suffering from constipation will be advised to engage in healthy physical activities, eat breakfast one hour after waking up, take three meals a day, select and include more raw vegetables and fruits in a day, drink more hot caffeine and beverages, and choose more cereals, whole grain breads, and rice in his or her diet. These are some of the non-pharmacological recommendations that will be given to a patient suffering from constipation. It should also be noted that constipation can also be treated using OTC medications, including Osmotics, stool softeners, fiber supplements, enemas, lubricants, and stimulants such as sennosides or bisacodyl.

Question 3: Signs and Symptoms Compatible with the Diagnosis of Constipation

Primarily, a healthcare provider would use a patient’s family and medical history, a physical examination, or a laboratory test to diagnose constipation and find its causes. A patient who is suspected of chronic constipation, however, will show a number of symptoms and signs that a provider can observe in him/her. The case study provides an example of some of these signs and symptoms. They include passing less than three stools weekly, straining to have a bowel movement, and having hard stools. Constipation can affect one’s health and fitness because of malabsorption.

Question 4: Additional Signs and Symptoms Not Presented In the Case Study

Other signs and symptoms which are not present in the case study include requiring help to empty one’s rectum, lethargy, lack of appetite, feeling like there is a blockage in the rectum, abdominal pain, and feeling like one cannot empty the stools from the rectum (Aziz et al., 2020). Constipated patients may feel full even without eating, gassy, and even after passing the gas, there seems to be no relief.

Question 5: Possibility of Developing Anemia As A Result Of Constipation

Sometimes, a diagnosis of anemia can be made along constipation diagnosis, either as the cause of constipation or its complication. According to current literature, about 35% of patients with inflammatory bowel disease (IBD) suffer from recurrent anemia. The patient might have developed IBD, as using naproxen increases her risk of developing the condition. Anemia is a consistent clinical feature of inflammatory bowel disease. Besides, R.H. might have an intestinal disorder, which can cause constipation and is a risk factor for anemia. Besides, the patient’s age increases her risk of developing anemia. Internal bleeding, caused by vomiting related to heartburn, may cause anemia because the patient will lose more nutrients.

Case Study 2 Questions:

In which race and ethnic groups is DM more prevalent?

Diabetes Mellitus is more prevalent among older adults. For race, males are more likely to be diagnosed with type 2 diabetes than woman (Xu, et al. 2018). Older men with a lower educational level and low family income have a higher incidence (Xu, et al. 2018). In specific, family below the poverty level and education less than a high school education (CDC, 2022). Non-Hispanics have a higher prevalence than Hispanics (Xu, et al. 2018). In addition Asians and African Americans have a higher prevalence of causing diabetes (Xu, et al. 2018). With Xu (2018) study, “Other” race had a higher prevalence number than mentioned. According to the CDC (2022), the highest race who’s most prevalent to be diagnosed with diabetes was American Indians and Alaska natives.

Based on C.B.’s clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.

C.D signs and symptoms comply well with Diabetes Mellitus Type 2. First is her fasting blood sugar to be 141. The normal range should be 60-100, and her being over is one of the many presentations of type 2 diabetes. C.D also had an elevated cholesterol level of 200 which is a significant risk influence for Diabetes (Peer, et al., 2020). In addition, she states she has been very thirsty lately. This is a typical hyperglycemia symptom called polydipsia (Peer, et al., 2020). In addition, she states she had been urinating more frequently at night. Typical symptoms of diabetes type 2 are polyuria and nocturia which contribute to her diagnosis (Peer, et al., 2020). Lastly, C.D came to the hospital due her left foot stating its weakness and numbness. Diabetic sensorimotor polyneuropathy is encountered in one third of people with diabetes (Ziegler et al., 2021). Symptoms that are typical in patients are pain, paresthesia and numbness, more specifically in distal lower limbs, in C.D case, her foot (Ziegler et al., 2021).

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.

Diabetes is thought to be a risk factor for pneumonia (Kornum, et al. 2008). This leads to an increased risk of hyperglycemia which affects your immune system (Kornum, et al. 2008). In addition, poor long term glycemic control, like C.B can increase risk of many infections and more specifically pneumonia (Kornum, et al. 2008). This is associated with abnormalities in neutrophil function and bacterial killing (Kornum, et al. 2008).

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

A combination of non-pharmacologic and pharmacologic is best for C.D recent diagnosis. Non-pharmacologic can start with a healthy diet and activity plan. Per the CDC (2022)., it’s important to incorporate a diabetic diet to prove spikes of blood sugar. Avoiding high saturated fats like high fat dairy and minimizing carbohydrates. In addition, according to the CDC (2022), reducing sugars and refined grains is important as well as incorporating more fruits and vegetables. Furthermore being physically activity can also help control sugar levels. Starting slow with a workout plan can be a great start. Just 30 minutes a day or every other day. Pharmacological interventions oral medications like metformin and injectable insulin for rapid intervention. Insulin can be used around mealtime and can be used as a fixed dose or base off glucose values (Dlugasch & Story, 2021). Lastly, it’s also best as nurse practitioners to understand C.D understanding of diabetes. The numbness and tingling in her foot should have been reported immediately, not three weeks after. It’s important for her to monitor and report any abnormal symptoms due to diabetics having a higher risk of getting other type of chronic conditions.

Reference:

Centers for Disease Control and Prevention. (2022). Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/index.html

Dlugasch, L., & Story, L. (2021).Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

Kornum, J. B., Thomsen, R. W., Riis, A., Lervang, H. H., Schønheyder, H. C., & Sørensen, H. T. (2008). Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes care, 31(8), 1541–1545. https://doi.org/10.2337/dc08-0138

Peer, N., Balakrishna, Y., & Durao, S. (2020). Screening for type 2 diabetes mellitus. The Cochrane database of systematic reviews, 5(5), CD005266. https://doi.org/10.1002/14651858.CD005266.pub2Links to an external site.

Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L. G., Hu, F. B., & Bao, W. (2018). Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ (Clinical research ed.), 362, k1497. https://doi.org/10.1136/bmj.k1497Links to an external site.

Ziegler, D., Papanas, N., Schnell, O., Nguyen, B. D. T., Nguyen, K. T., Kulkantrakorn, K., & Deerochanawong, C. (2021). Current concepts in the management of diabetic polyneuropathy. Journal of diabetes investigation, 12(4), 464–475. https://doi.org/10.1111/jdi.13401Links to an external site.