Please follow instructions very carefully. Should you have any questions please dont hesitate to contact me. NO PLAGIARISM. Similarity report should be <20%. 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 o ...

1. Please follow instructions very carefully. Should you have any
questions please dont hesitate to contact me. NO PLAGIARISM.
Similarity report should be <20%.
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.
mother alive and has history of atopic dermatitis, tinea corporis
and tinea pedis.

3. 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.

4. 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)

5. 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.