2023 Please follow instructions very carefully Should you have any questions please dont hesitate
2023 Nursing Week 7
Please follow instructions very carefully Should you have any questions please dont hesitate 2023
Please follow instructions very carefully. Should you have any questions please dont hesitate to contact me. NO PLAGIARISM. Similarity report should be <20%.
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
Chief complaint: “ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI: M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
Surgeries: None
Allergies: Penicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: + 1 pitting leg edema. + Varicose veins.
Skin: + rash crusted white in feet and inter-digit in feet.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Chronic Constipation, ideopathic
Secondary Diagnoses:
Incomplete Defecation
IBS-Constipation
Differential Diagnosis:
Small intestine bacterial overgrowth (SIBO)
Plan: Medications:
Miralax one packet po daily for at least 8 weeks.
Plan: Tests
Anorectal Manometry with rectal sensation/tone compliance test to evaluate if patient has dyssynergic defecation. If test positive then will consider ordering sessions of Biofeedback bowel retraining program to correct cause of incomplete defecation.
Labs: No new labs are needed.
Referrals: may refer based on effect of medication therapy given for 2 weeks.
Follow up: return to office in 8 weeks to reevaluate her symptoms.
Questions: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
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