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 story: She receives an annual flu shot. Last flu shot was this year Social history: gh 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. Psych
iatric: 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.