Case Study: R.H.’s Constipation 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. Response To Cardona on constipation

Case Study: R.H.’s Constipation

1. Define constipation. Identify the factors that can lead to it. Give constipation-prone patients your recommendations. It is possible to draw upon any previous experiences.

        Constipation is the absence of bowel movement for a certain amount of time, a delayed in frequency of bowel movements for any given person and difficulty associated with passing stools that may be hard and lumpy. Bowel movement patterns are not the same for every person, thus obtaining a history and identifying patient’s bowel movement frequency is important when diagnosing constipation (Dlugasch & Story, 2020).

Forootan et al. (2018) highlight the following risk factors that are often linked to constipation:

· Age and gender: Constipation is more common on older adults and young people and also more frequent on females than males.

· Diet: A common cause of constipation includes not consuming enough fiber. Constipation in these situations is not usually a major problem. It can be managed and corrected by changing your lifestyle and nutrition.

· Dehydration: Not taking enough water or liquids is another risk factor for constipation.

· Constipation secondary to another disease or condition: Mechanical causes such as obstruction, psychological conditions such as depression and eating disorders, endocrine disorders such as diabetes among others could cause constipation.

· Constipation as a side effect of medications: Many medications have constipation as a side effect including analgesics such as NSAIDs and antacids.

· Physical activity: Sedentarism and lack of exercise can lead to constipation.

· Socioeconomic status: May include not having the resources to supplement a balanced nutrition.

The following recommendations would be made to relieve constipation:

· Increase consumption of dietary fiber.

· Increase fluid intake.

· Increase physical activity.

· Seek alternatives to medications which cause constipation.

· Seek medical help.

2. Based on R.H.’s clinical symptoms, identify and discuss constipation signs and symptoms. Include any additional symptoms or signs that may not be listed in the case study.

These symptoms are consistent with constipation and were identified in the case study.

· Elderly female patient of 74 years of age.

· Patient reports “some-times going an entire week with only one bowel movement”.

· Patient reports “feeling bloated and constipated”.

· Patient was had regular bowel movements “every day or every other day”.

· Patient reports straining and passing hard stools.

· Reports consumption of antacids.

· Reports consumption of analgesics, NSAIDs.

· Patient reports lack of physical activity and exercise.

· Other signs and symptoms that R.H. may have and are not included in the study may be other disease or condition that may cause constipation, insufficient water or liquid intake, and socioeconomic status.

3. As an additional diagnosis, or as a complication to a condition, constipation patients may also have anemia. Based on the details in the case study, do you think that this possibility is possible?

         Anemia is a possibility in this case study because this patient history of NSAIDs intake. According to Tai & McAlindon (2021) a large number of patients consuming NSAIDs develop symptoms of epigastric discomfort, bloating, post-prandial nausea, early satiety and belching as well as heartburn and regurgitation. In addition, they consider NSAIDs second to  Helicobacter pylori infection in causing peptic ulceration in the upper GI tract and associated complications such as perforation and bleeding. A patient reported taking an antiseptic for heartburn. Constipation and anemia are both side effects of aluminum chloride (Shon, al. 2021), which is what the patient used as an antacid.

C.B. Case Study: C.B.

1. Which races and ethnicities is DM most prevalent in? C.B. C.B.

          The incidence and prevalence of diabetes mellitus in the United States is sadly very large. The CDC (2021), more than 10% of Americans had diabetes in 2018, either diagnosed or undiagnosed. The prevalence of diabetes mellitus refers to the number of people with diabetes, as well as new cases.  The highest prevalence of diabetes in adults from American Indian and Alaska Native racial or ethnic groups is 14.7 percent. This rate was followed closely by Hispanics (12.5%), and non-Hispanic Blacks (11.7%) (CDC 2021).

C.B. Are you experiencing any of the symptoms and signs that are compatible with type 2 diabetes?

· Patient’s fasting blood sugar three years ago was 141.

· Increase in number of “female infections”

· Foot has been weak and numb for nearly three weeks and that the foot is difficult to flex

· Increased in thirst, polydipsia

· Urinary frequency at night, polyuria

2. C.B. How would C.B. Your answer should be supported.

            Patients with diabetes are predisposed to infections. A compromised microvascular system and macrovascular disease can cause impaired circulation, delayed immune response and wound healing. Serum glucose levels can adversely impact the function of neutrophils. Infections add stress to the body and release hormones, such as adrenaline or cortisol. The action of insulin will be negatively affected by these hormones, leading to elevated glucose levels (Abu Ashour et. al. 2018, 2018).

3. C.B. would like to know what non-pharmacologic treatment is best.

              The best initial non-pharmacological therapy for C.B. Lifestyle modifications are the best non-pharmacological treatment for C.B. The patient must also make changes in their diet, lose weight, and get more exercise. According to the American Diabetes Association, half your plate should be non-starchy vegetables and one quarter of it should contain protein. The last quarter must include carbohydrates. The American Diabetes Association (n.d.), suggests that carbs should be high in fiber, vitamins, minerals and low in added sugars and unhealthy fats. The ADA (n.d.), recommends adding a daily workout routine to your day. It is recommended that you have regular follow-ups with your primary physician and endocrinologist.

            Pharmacological treatment would include oral or noninsulin injectable hyperglycemia medications, insulin, and complication management (Dlugasch & Story, 2020). Strict compliance with pharmacological and nonpharmacological treatment is paramount for patient’s well being and therapy to work.

Cardona’s response on constipation



Cardona: I believe constipation can be described as a delayed frequency or difficulty in passing stool that is often lumpy and hard. Because people do not have the same pattern of bowel movements, it is essential when diagnosing constipation to collect a patient’s medical history and determine how frequently they have bowel movements. Dr. Bulsiewicz, a gastroenterologist says that most people are unaware that they may be experiencing constipation. This is because they believe that constipation occurs only when there’s a bowel movement every three days. The symptoms of constipation could be mistaken for those of other medical diseases or issues and therefore it is recommended that we always get a diagnosis from our personal physician. Cont…


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