Case Study One: Gastrointestinal 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. Constipation is the condition in which an individual’s regularity of stool passage decreases significantly (Dlugasch & Story, 2019). There are numerous risk factors that may lead to constipation. For example, if one consumes a diet that is low in fiber or low in fluid intake. Additionally, lack of physical exercise is a risk factor for constipation (Dlugasch & Story, 2019).      If an individual delays the urge to defecate or abuse laxatives, they also increase their chances of developing constipation (Dlugasch & Story, 2019). Enduring high stress, extended traveling, as well as bowel diseases and colon cancer can leave one at risk (Dlugasch & Story, 2019).        Certain medications and neurological conditions, such as spinal cord issues and strokes, can also be found to lead to constipation (Dlugasch & Story, 2019).             From personal experience, there are several effective ways to treat constipation and reestablish the patient’s frequency of stool passage. For example, improving the patient’s diet by increasing the fiber intake amount and hydration, while also decreasing the intake of meats and processed foods that cause constipation, will help alleviate the problem (Dlugasch & Story, 2019).           Becoming more physically active will improve the patient’s situation, as well as encouraging them to defecate when the initial urge is felt (Dlugasch & Story, 2019). The patient can also take stool softeners and limit her intake of laxatives, if she has been overusing them (Dlugasch & Story, 2019). If those treatments do not work, the patient may look to see if there is an impaction that needs to be removed (Dlugasch & Story, 2019). 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.         There are several signs and symptoms from the case study that make it clear that the constipation diagnosis is accurate. The patient reported having only one bowel movement a week, at times. Usually, if someone goes at least three days without a bowel movement, it is a sign that they are experiencing constipation (Dlugasch & Story, 2019). The patient also reported that when she is able to have a bowel movement, her stools are very hard, which is also indicative of the current diagnosis (Dlugasch & Story, 2019). She also states that her bowel movements take more than 10 minutes to start, and that she has to strain to initiate it. These are also hallmark signs of someone suffering from constipation (Dlugasch & Story, 2019). As a side note, the patient has said that she is taking al.

1. Case Study One: Gastrointestinal
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.
Constipation is the condition in which an individual’s regularity
of stool passage decreases significantly (Dlugasch & Story,
2019). There are numerous risk factors that may lead to
constipation. For example, if one consumes a diet that is low in
fiber or low in fluid intake. Additionally, lack of physical
exercise is a risk factor for constipation (Dlugasch & Story,
2019).
If an individual delays the urge to defecate or abuse
laxatives, they also increase their chances of developing
constipation (Dlugasch & Story, 2019). Enduring high stress,
extended traveling, as well as bowel diseases and colon cancer
can leave one at risk (Dlugasch & Story, 2019).
Certain medications and neurological conditions, such as
spinal cord issues and strokes, can also be found to lead to
constipation (Dlugasch & Story, 2019).
From personal experience, there are several effective
ways to treat constipation and reestablish the patient’s
frequency of stool passage. For example, improving the
patient’s diet by increasing the fiber intake amount and
hydration, while also decreasing the intake of meats and
processed foods that cause constipation, will help alleviate the
problem (Dlugasch & Story, 2019).
Becoming more physically active will improve the
patient’s situation, as well as encouraging them to defecate
when the initial urge is felt (Dlugasch & Story, 2019). The
patient can also take stool softeners and limit her intake of
laxatives, if she has been overusing them (Dlugasch & Story,

2. 2019). If those treatments do not work, the patient may look to
see if there is an impaction that needs to be removed (Dlugasch
& Story, 2019).
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.
There are several signs and symptoms from the case study
that make it clear that the constipation diagnosis is accurate.
The patient reported having only one bowel movement a week,
at times. Usually, if someone goes at least three days without a
bowel movement, it is a sign that they are experiencing
constipation (Dlugasch & Story, 2019).
The patient also reported that when she is able to have a bowel
movement, her stools are very hard, which is also indicative of
the current diagnosis (Dlugasch & Story, 2019).
She also states that her bowel movements take more than 10
minutes to start, and that she has to strain to initiate it. These
are also hallmark signs of someone suffering from constipation
(Dlugasch & Story, 2019). As a side note, the patient has said
that she is taking aluminum hydroxide tablets to help with her
heart burn, which is a medication that can contribute to
constipation (Zheng & Yao, 2018). Her lack of exercise, due to
her arthritis flare-up, is also a contributing to her constipation.
Other symptoms and/or signs of an individual with constipation
is the reduction in the loudness or tone of the bowel sounds
(Dlugasch & Story, 2019). If an individual has an anal fissure,
it may be because of large stools that are tearing the mucosal
membrane of the anus, caused by constipation (Dlugasch &
Story, 2019). Other signs include problems with pH,
hemorrhoids, diverticulitis, and more (Dlugasch & Story, 2019).
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

3. the case study?
Yes, there is a strong possibility that R.H. may have anemia, as
well as constipation. The primary reason that this could be the
case is the patient’s use of naproxen to treat for arthritic pain.
When an individual uses naproxen or other NSAIDS over a
prolonged period, it can cause gastric erosion. This can
eventually lead to gastrointestinal bleeding. If the bleeding is
not addressed in a timely manner, it may cause anemia in the
individual. Thus, it is necessary to check R.H. for this possible
diagnosis.
Case Study Two:
Endocrine Function
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.
Diabetes mellitus seems to be most prevalent among minority
groups, such as Blacks, Latinos, Asians, native Hawaiians, and
other Pacific Islanders (Dlugasch & Story, 2019). We also find
it to be most prevalent within Native American populations,
including our patient, C.B. (Dlugasch & Story, 2019). There are
several signs/symptoms that C.B. is exhibiting that confirms the
Diabetes Mellitus Type 2 diagnosis. Her high blood sugar and
cholesterol suggests that she has glucosuria, a manifestation of
DM (Dlugasch & Story, 2019). Her complaints of her left foot
being weak and numb is commonly caused by neuropathy due to
long-term effects of diabetes. Her reports of being more thirsty,
as well as urinating more at night, suggests that she has
polyuria and polydipsia, which are often found in patients with
DM (Dlugasch & Story, 2019). Finally, her weight gain points
to C.B. having polyphagia, which is a result of an increased
appetite caused by the glucose levels being excreted from
glucosuria.

4. 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.
The body has a unique way of combating stress during
times of illness. Part of the response to infection is the
production of hormones such as cortisol, catecholamines, and
cytokines, as well as glucagon and growth hormone (Preiser &
Thooft, 2016). The release of these hormones cause an increase
in blood sugar levels so C.B. may need to check her blood sugar
level more frequently during times of illness.
What would be the best initial therapy non-pharmacologic and
pharmacologic to be recommended to C.B?
The first line of non-pharmacologic treatment would be to have
C.B. change her diet and become more physically active
(Dlugasch & Story, 2019). Other non-pharmacologic treatments
would include having the patient lose weight, as well as
institute a habit of self-monitoring the glucose levels (Dlugasch
& Story, 2019). Potential pharmacologic treatments include
hyperglycemia medications, as well as insulin (Dlugasch &
Story, 2019). There is bolus insulin, which is rapid and short-
acting, and administered on a fixed dose around mealtimes
(Dlugasch & Story, 2019). There is also basal insulin, which is
long-acting and is used to keep glucose levels steady for the
patient (Dlugasch & Story, 2019). As a last resort, C.B. could
undergo bariatric or metabolic surgeries, which have been
shown to potentially help diabetic patients in the past (Dlugasch
& Story, 2019).
References
Dlugasch, L., & Story, L. (2019). Applied pathophysiology for
the advanced practice nurse. Jones & Bartlett Learning.

5. Preiser, J. C., Thooft, A., & Tironi, R. M. (2016). Stress
hyperglycemia. In The Stress Response of Critical Illness:
Metabolic and Hormonal Aspects (pp. 89-94). Springer.
Zheng, S., Yao, J., & Chinese Geriatric Society, Editorial Board
of Chinese Journal of Geriatrics. (2018). Expert consensus on
the assessment and treatment of chronic constipation in the
elderly. Aging medicine, 1(1), 8-17.
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.
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) explain that risk factors usually
associated with constipation include:
· 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. In these cases, constipation is usually not a
serious problem and can be controlled and treated by correcting
nutritional habits and lifestyles.
· Dehydration: Not taking enough water or liquids is another
risk factor for constipation.
· Constipation secondary to another disease or condition:

6. 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.
Recommendation to relief constipation would include removal
of controllable risk factors:
· Increase consumption of dietary fiber.
· Increase fluid intake.
· Increase physical activity.
· Seek alternatives to medications which cause constipation.
· Seek medical help.
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.
Signs and symptoms in this case study that are compatible with
constipation include:
· 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

7. included in the study may be other disease or condition that may
cause constipation, insufficient water or liquid intake, and
socioeconomic status.
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?
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. Patient also reports taking an
antacid for her heartburn. Anemia and constipation are side
effects of aluminum hydroxide (Shon et al., 2021) which is the
antacid patient was taking.
Case Study: C.B. Diabetes Mellitus Type 2
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.
The incidence and prevalence of diabetes mellitus in the
United States is sadly very large. According to the CDC (2021)
a great percentage of Americans, more than 10% of the US
population, had diabetes (diagnosed or undiagnosed) in 2018.
When referring to prevalence of diabetes mellitus, we are
talking about the total number of patients with diabetes also
including new cases. Regarding ethnic groups American Indian
or Alaska Native adults have the highest rates of diagnosed

8. diabetes (14.7%) among all US racial and ethnic groups,
followed by Hispanics (12.5%) and non-Hispanic blacks
(11.7%) (CDC, 2021).
C.B. is experiencing the following signs and symptoms
compatible with diabetes mellitus type 2.
· 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.
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.
Patients with diabetes are predisposed to infections.
Macrovascular disease and microvascular dysfunction may
result in compromised local circulation leading to delayed
response to infection and impaired wound healing besides
generalized impairments of immunity. Moreover, the capability
of neutrophils to perform their function is adversely affected by
high levels of serum glucose. When there is an infection, it adds
stress to the body which in response releases hormones such as
cortisol and adrenaline. These hormones are going to negatively
impact the action of insulin resulting in elevated glycemic
levels (Abu-Ashour et al., 2018)
3.
What would be the best initial therapy non-
pharmacologic and pharmacologic to be recommended to C.B?
The best initial non-pharmacological therapy for C.B.
would include lifestyle modifications. Patient needs to make
dietary changes, reduce weight and exercise. The American
Diabetes Association (n.d.) recommends half of your plate non-
starchy vegetables, a quarter protein and the last quarter
carbohydrates. When it comes to carbohydrates the ADA (n.d.)
specifies to choose carbs rich in fiber, vitamins and minerals,

9. and low in added sugars, sodium and unhealthy fats. Moreover,
the ADA (n.d.) recommends to incorporate a daily exercise
routine to your schedule. In addition, strict follow ups with
primary care physician or endocrinologist would be
recommended.
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.
References
Abu-Ashour, W., Twells, L.K., Valcour, J.E. et al. Diabetes and
the Occurrence of Infection in Primary Care: A Matched Cohort
Study.
BMC Infect Dis 18, 67 (2018).
https://doi.org/10.1186/s12879-018-2975-2
ADA. (n.d.).
Healthy Living. Retrieved from Diabetes:
https://www.diabetes.org/healthy-living/recipes-nutrition
1. (2021, January 4th).
Data and Statistics. Retrieved from Diabetes Home:
https://www.cdc.gov/diabetes/library/reports/reportcard/national
-state-diabetes-trends.html
Dlugasch, L., & Story, L. (2020).
Applied Pathophysiology for the Advanced Practice
Nurse. Burlington, MA: Jones and Bartlett Learning.
Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic
Constipation: A Review of Literature.
Medicine, 97(20), e10631.
https://doi.org/10.1097/MD.0000000000010631Links to
an external site.

10. Tai, F., & McAlindon, M. E. (2021). Non-steroidal Anti-
Inflammatory Drugs and the Gastrointestinal Tract.
Clinical Medicine (London, England), 21(2), 131–134.
https://doi.org/10.7861/clinmed.2021-0039Links to an
external site.
Shon N.N., Yarbrough T., Shah A.D. (2021)
Aluminum Hydroxide. StatPearls Publishing, Treasure
Island (FL).