How to treat a Gastrointestinal and Endocrine Function Case Study (Answered)

How to treat a Gastrointestinal and Endocrine Function Case Study (Answered)

Gastrointestinal Function case study prompt:

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-the-counter 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 case study?

Endocrine Function:
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?

 

SOLUTIONS TO CASE STUDY

Gastrointestinal Function

Constipation is the discomfort one feels when passing small amounts of dry and hard stool infrequently. The common risk factors for constipation include dehydration, consumption of a  low-fibre diet, lack of physical activity, depression, and taking opioid pain medications. For a patient suffering from constipation, I would recommend adequate hydration and regular physical activity. Also, consumption of a high-fibre diet and fresh green vegetables alleviates constipation. Those who use opioid medications for pain relief should minimize the duration of their use or consume a lot of fibre-rich diets and take more water while on medications.

The patient presents with bloating and passing of less than three bowel movements in one week, which are signs of constipation. Her stools are extremely hard, and she strains to pass them. Diaz, Bittar and Mendez (2022) outline other signs and symptoms to be a feeling of the presence of a blockage in the rectum that prevents the bowel movements. Also, the patient may feel as though they have not completely emptied the rectum after passing the stool. Lastly, some patients experience pain when passing the hard stool due to a larger diameter than the rectum and its hardness.

I would consider the possibility of anaemia in this patient since she has a strong risk factor that predisposes her to anaemia. According to Turner, Parsi, and Badireddy (2021), age beyond 65 years is a significant anaemia risk factor. The patent in the case study is 74 years. Therefore, there is a high likelihood that the low haemoglobin levels in her blood due to advanced age caused her constipation.

Endocrine function

Diabetes mellitus type 2 is more prevalent in African-Americans at 13.2% (Rodriguez & Campbell, 2017). more studies indicate that DM is more prevalent among the pacific islanders and American Indians in the United States (Rodriguez & Campbell, 2017). The patient manifests the following signs and symptoms which are compatible with DM type 2: being overweight, high blood sugar levels, increased thirst, frequent urination, and frequent genital infections.

Developing bacterial pneumonia would increase the patient’s blood glucose levels by increasing insulin resistance. According to the APS (2015), patients diagnosed with inflammatory lung illnesses such as pneumonia have high glucose levels and manifest high insulin resistance. These infections, coupled with being overweight and steroid treatment, increase one’s chances of developing type 2 DM.

The first initial nonpharmacological therapy is oral hydration using mineral water. Dietary modification has also demonstrated significant benefits in managing glucose levels and improving insulin resistance. Adopting the Mediterranean diet, comprising mainly olive oil, vegetables, whole grains and legumes, reduces insulin resistance and other cardiovascular risk factors such as basal metabolic index (Raveendran et al., 2018). Since achieving hydration via the oral route takes more time. The intravenous route is more efficient. According to Goyal and Jialal (2021), pharmacological therapy involves extensive intravenous fluid replacement to replace fluid loss through increased urination and assist in diluting excess glucose in the blood. Electrolyte replacement is also vital in maintaining the physiologic processes in the heart, muscles, and nerves. Third, insulin triple therapy is critical in reversing the processes leading to ketones building up in the blood.

References

American Physiological Society (APS). (2015). Lung disease may increase risk of insulin resistance, diabetes, mouse study suggests. ScienceDaily. Retrieved May 30, 2022 from www.sciencedaily.com/releases/2015/09/150930074510.htm

Diaz S, Bittar K, Mendez MD. (2022). Constipation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513291/

Goyal, R., Jialal, I., & Castano, M. (2021). Diabetes Mellitus Type 2 (Nursing). In StatPearls [Internet]. StatPearls Publishing.

Raveendran, A. V., Chacko, E. C., & Pappachan, J. M. (2018). Nonpharmacological Treatment Options in the Management of Diabetes Mellitus. European endocrinology, 14(2), 31–39. https://doi.org/10.17925/EE.2018.14.2.31

Rodríguez, J. E., & Campbell, K. M. (2017). Racial and Ethnic Disparities in Prevalence and Care of Patients With Type 2 Diabetes. Clinical diabetes : a publication of the American Diabetes Association, 35(1), 66–70. https://doi.org/10.2337/cd15-0048

Turner, J., Parsi, M., & Badireddy, M. (2022). Anemia. In StatPearls [Internet]. StatPearls Publishing.

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