Week 7 Discussion Question  Worth 5 points 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 ...

1. Week 7 Discussion Question
Worth 5 points
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.

2. 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.

3. 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.

4. 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

5. 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.