1-At little or no cost, anyone can set up a blog. A quick web search shows there are many people blogging about their personal experience of mental health problems – sharing information and experiences, and offering tips to others (Drake, & Leander, 2013, p. 270). One example is The Depressed Moose, a blog about an individual’s battle with depression, his thoughts and feelings and his ideas about improving his state of mind. His posts aim to inspire others, especially those battling depression. He emphasizes the importance of being honest and open (Drake, & Leander, 2013, p. 270).

        2-   I agree with the fact that we enter our nursing careers with the mindset of making a difference. With the help of networking we are able to achieve so much more because we could include other aspects of the health care. Having others that are readily available when their help is needed would make this impact possible. Collaborating with others can be very beneficial being that it may also open doors and gather input from others to make an even bigger impact in our profession.

3-Having gone through the benfits of joining the nursing organization which ranges from constant education to upgrade our knowledge, organizing webners, seminars that are important for our development, opportunity to interact with colleagues that share the same mission and vision which is to improve health for all, promoting awareness on matters as it relates to nursing, creating an avenue for nurses to express their feelings, having access to medical journals to stay current in the practice etc. I see no reason why i would not join the ANA organisation or its affiliate just like you as i have never been a member before so as to enjoy the benefit of being an active member

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

PLEASE USE THIS MEDICATION FOR THE CASE STUDY: LUBIPRISTONE 24 MCG TWO TIMES A DAY.

Case study sample:

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.