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 pa

Submission Instructions:

· This assignment has  2 case studies. You must work and include  both case studies in your initial post.

· Your initial post  should be at least 500 words for each case study, formatted and cited in the current  APA style with support from at least  2 academic sources other than your textbook. Your initial post is worth 8 points.

I want to remind you of the specific instructions for all your discussions, as I continue to see some of you losing points for not following my instructions.

· Your assignment has two case studies. You must complete both case studies.

· Your initial post should be at least 500 words per case study, formatted and cited in the current 7th Edition APA style with support from at least two academic sources. I will count only the paragraphs, not the questions, not the references.

· Academic resources are scholarly books, journals, articles, and research papers that are peer-reviewed and credible.

· Avoid the use of non-academic resources such as pages with information for the general population like Medical News Today, Healthline, Mayo Clinic, etc., even when they are written by professionals.

· You do not need to enter your name, course, title, instructor’s name, etc. Just respond to the questions in a paragraph.

· Each question must be answered individually, not in an essay format

Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; etc. 

· You are becoming a Nurse Practitioner, when the case study asks for treatment recommendations, please investigate and provide concrete information based on current guidelines for the specific condition.  Don’t be afraid to treat your patient, and treat all their symptoms!!

· When you are asked to describe, explain, why, etc., please elaborate your response using updated literature. This is a master-level course and required quality content in your responses.

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, sometimes 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 occurring 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 in 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 1 Questions:

1. In your own words, define constipation and name the risk factors that might lead to developing constipation.

2. List recommendations you would give to a patient who is suffering from constipation. Include both pharmacological and non-pharmacological. 

3. Based on the clinical manifestations in R.H.'s case study, name and explain the signs and symptoms presented that are compatible with the constipation diagnosis.

4. Complement your list in question 3 with other signs and symptoms of constipation not present in the case study.

5. Sometimes Anemia can be present as an associated diagnosis and/or a complication for patients with constipation. Would you consider that possibility based on the information provided in the case study? Explain.

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 her 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 2 Questions:

1. In which race and ethnic groups is DM more prevalent?

2. Based on C.B.'s clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.

3. If C.B. develops bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.

4. What would be the best initial therapy (non-pharmacologic and pharmacologic) to be recommended to C.B.?

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