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Instructions: Response must be at least 310 words written in current APA format with at least two academic references cited. References must be within the last five years. Response must extend, correct/refute, or add additional nuance.

  1. Gastrointestinal Function: Case Study Questions

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. You might use a previous experience you might have.

 Constipation can be defined as the situation where an individual experiences less frequent bowel movements and difficulties in passing stools. Several factors have been associated with the cause of constipation ranging from exercises, diet, and use of medication. Some of the most common risk factors for constipation include lifestyle concerns that affect an individual’s bowel habits such as eating solid food with no fibers, inadequate water intake, travel, ignoring the urge to use the bathroom, and inadequate stress management (Benjamin, &Drobatz, 2020). Medications such as antacids containing aluminum or calcium, antidepressants, antispasmodics, diuretics, antihistamines, and narcotic pain medications have been associated with increased risks of constipation. Other risk factors include health conditions such as diabetes, structural conditions such as anal fissure, pelvic floor dysfunction, neurological disorders such as multiple sclerosis, cancer, advanced age, and family history among others.

 Several approaches are utilized in the management of patients suffering from constipation. For starters, I would recommend the removal of the impacted faeces with stool softeners such as Docusate, enemas, and short-acting laxatives. I would then initiate dietary changes to about 30g daily fiber intake in addition or taking lots of water (Benjamin, &Drobatz, 2020). Alternatively, the patient can take fiber supplements such as Metamucil, and engage in 30 minutes of daily exercise. If constipation is associated with an underlying condition, then it is necessary to treat the underlying disorder. The use of laxatives such as MiraLAX will be necessary for complete emptying.

Based on the clinical manifestations of R.H.’s 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.

For the diagnosis of constipation, an individual must present with the following four symptoms, such as having fewer than three bowel movements in a week, straining to initiate or complete defecation, consistency of a hard stool, and the feeling of incomplete emptying (Thakare, 2020). The patient in the provided case study presented with symptoms of constipation and bloating for about a month. She presented with one bowel movement for an entire week, with straining feelingsthat lasted for up to 10 minutes before initiating or completing a bowel movement. She also confirmed that her stool was extremely hard. Consequently, the patient complained of incidences of heartburn about three to four times every week. Looking at the causative aspects that might have contributed to the patient’s constipation, to confirm the diagnosis, she has been involved in limited exercise and physical activity, in addition to taking naproxen with can also result in constipation (Thakare, 2020). Other signs and symptoms of constipation not presented by the patient include the feeling that one has not completely emptied his or her rectum, and the need for help such as using your hands to empty your rectum.

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?

The human body normally requires vitamin B12 to synthesize red blood cells just like the way it needs iron. Consequently,the symptoms of all other types of anemia, most commonly vitamin B12 deficiency anemia can lead to symptoms of constipation or diarrhea. Consequently, the patient in the provided case study presented with worsening arthritis, whose most common complication is anemia (Auerbach, & Schrier, 2017). The patient’s advanced age also predisposes her to high risks of developing anemia. As such, the patient’s constipation symptoms may also be associated with anemia diagnosis.

  1. Endocrine Function: Case Study Questions

In which race and ethnic groups is DM more prevalent? 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.

According to the Centre for Disease Control and Prevention (CDC), the prevalence of diabetes mellitus was highest among the American Indians/Alaska Natives (14.7%) between 2017 to 2018, followed by Hispanic origin (12.5%), and non-Hispanic blacks (11.7%) in the United States (Glovaci, Fan, & Wong, 2019). Non-Hispanic Asians and non-Hispanic whites recorded a percentage of 9.2% and 7.5% respectively.

The diagnosis of Diabetes Mellitus Type 2 is normally based on the results of the glycated hemoglobin (A1C) test in addition to presenting symptoms provided in the patient history. Glycated hemoglobin (A1C) test results of less than 5.7% are normal, whereas between 5.7% and 6.4% represented prediabetes and 6.5% or higher represent diabetes diagnosis. A fasting blood glucose level of 126 mg/dL (7 mmol/L) or higher is also used to confirm a diabetes diagnosis(Glovaci, Fan, & Wong, 2019). The patient in the provided case study presented witha fasting blood sugar level of 141 mg/dL. His cholesterol levels were also 225mg/dL, higher than 40mg/dl, which also indicates complications of DM. Other diagnostic signs and symptoms displayed by the patient confirming a diabetes type 2 diagnosis include left foot weakness and numbness for about three weeks, in addition to reduced range of movement, increased thirst, increased urine frequency especially at night, and significant weight gain over the past few months. 

If C.B. develop bacterial pneumonia in her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.

Studies have confirmed the association between hyperglycemia among diabetic patients with community-acquired pneumonia. As such, when the patient in the provided case study develops bacteria pneumonia, then it means that his diabetes is not properly managed. Diabetes type 2 is associated with low immunity as it leads to a reduction in the response of T cells, disorders of humoral immunity, and decreased neutrophil function (Webber et al., 2020). As such, patients with worsening DM will exhibit increased susceptibility to infections such as bacterial pneumonia. Consequently, such infections in addition to repercussions associated with its infectivity can result in complications of DM such as ketoacidosis and hypoglycemia. The bacteria on her right lobe will consume glucose from the patient’s blood for their growth and sustaining their survival leading to decreased glycemia values.  
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

C.B presents with symptoms confirming a diagnosis of Diabetes Mellitus Type 2. The management of DM involves the incorporation of both pharmacological and non-pharmacological interventions. The pharmacological intervention will involve the initiation of Metformin which is FDA approved as the first-line medication for the management of type 2 diabetes. The drug does not cause weight gain. The patient can also be initiated on HMG-CoA reductase inhibitors, or statins, such as atorvastatin to lower her high cholesterol levels (Serbis et al., 2021). Non-pharmacological interventions will involve nutritional therapy, physical activity programs like yoga or walking, psychological interventions to promote patients’ compliance, social network interventions to promote supportive care, and diabetes self-management education and support for the patient to be able to appropriately monitor her blood sugar levels regularly to enhance treatment outcome.

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