Gastrointestinal Function:

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

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.

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.

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?