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History of Present Illness
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R.M., a 43-year-old obese female, presented to the hospital emergency department with complaints of atypical chest pain, stomach discomfort/nausea, vomiting and constipation. The patient has a PHM of pulmonary embolism, hypertension, iron deficiency anemia, gastric by-pass surgery, polysubstance use disorder and fibromyalgia.
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How should constipation be evaluated in R.M.? Is she constipated?
Hint: See Constipation in PPP
What is the clinical presentation of constipation?
Hint: See Constipation in PPP
What are R.M.’s contributing causes of constipation?
Hint: See Table 22-1 in PPP
Which of R.M.’s medications are commonly associated with causing constipation?
Hint: See Table 22-1 in PPP
Are R.M.’s laxatives being used appropriately?
Hint: See Tables 22-2 in PPP
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How should R.M. be educated about methods of avoiding constipation?
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Hint: See Constipation in PPP
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According to the World Gastroenterology Organization, constipation is not a disease. It is a symptom. Different patients can have different perceptions of constipation. The clinical view of constipation may differ from the patients’ perception of constipation. (Worldgastroenterology.org) According to the American Gastroenterologists Association, constipation is a frequent diagnosis that is made in the ambulatory population and is a common cause of patient clinical referrals to gastroenterologists. There is a 15 % worldwide prevalence of chronic constipation. Symptoms can vary from person to person and can include incomplete evacuation, straining on defecation, a sense of anorectal blockage, or decreased stool frequency. Patient history analysis, physical examination, diagnostic testing, and individualized treatment are important factors in providing care for patients who are constipated.