R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled
appointment. She complains of feeling bloated and constipated for the past month, some-times
going an entire week with only one bowel movement. Until this episode, she has been very
regular all of her life, having a bowel movement every day or every other day. She reports
straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel
movement. Stools have been extremely hard. She denies pain during straining. A recent
colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to
provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each
week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a
more upright position during sleep. On a friend’s advice, she purchased a package of over-thecounter aluminum hydroxide tablets to help relieve the heartburn. She has had some
improvement since she began taking the medicine. She reports using naproxen as needed for
arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when
she rises in the morning. Because her arthritis has been getting worse, she has stopped taking
her daily walks and now gets very little exercise.
Case Study Questions
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.
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.
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
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had
high blood sugar and cholesterol levels three years ago but did not follow up with a clinical
diagnostic work-up. She had participated in the state’s annual health screening program and
noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt
“perfectly fine at the time” and could not afford any more medications. Except for a number of
“female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital
general practitioner complaining that her left foot has been weak and numb for nearly three weeks
and that the foot is difficult to flex. She denies any other weakness or numbness at this time.
However, she reports that she has been very thirsty lately and gets up more often at night to
urinate. She has attributed these symptoms to the extremely warm weather and drinking more
water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years
ago, 15 pounds in the last 6 months alone.
Case Study Questions
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.
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.
3. What would be the best initial therapy non-pharmacologic and pharmacologic to be
recommended to C.B?
Defining constipation, the risk factors, and recommendation
Constipation is a diminish in the frequency of the bowel movement to less than three per week. It can also be defined as having dry or hard bowel movements. The risk factors for constipation include being female, advanced age, low income, low educational level, the type of medication being used such as calcium channel blockers and antidepressants as well as having comorbidities (Yurtdaş et al., 2020). Other risk factors include dietary and lifestyle factors such as consuming low fiber low physical activity, low intake of fluids, excessive consumption of coffee and tea as well as low consumption of vegetables and fruits. The recommendation to reduce the risk of constipation includes a high-fiber diet of 25-40g as recommend by the World Health Organization, increased intake of fluids, staying active through,,,Click link below to purchase full tutorial at $10