REPLY 1: In your own words, define constipation and name the risk factors that might lead to developing constipation. List recommendations you would give to a patient who is suffering from constipation. You might use previous experience.
Constipation is an abnormal bowel pattern characterized by the inability and difficulty to pass hardened stool. Numerous risk factors influence the development of constipation. For example, a low-fiber diet, laxative abuse, poor physical activity, narcotic medications, stroke, pregnancy, and iron supplements (Dlugasch & Story, 2019). The recommendations I would give to a patient suffering from constipation vary depending on the underlying cause. Although some helpful strategies consist of the following: drinking more water and increasing the intake of vegetables, whole grains, and fruits. In addition to dietary changes, increasing one’s physical activity, avoiding processed sugars and red meat, limiting the use of laxatives, and limiting the administration of enemas are also key components to prevent constipation.
Based on the clinical manifestations of the R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms that are not present in the case study.
The symptoms R.H. is experiencing align with the diagnosis of constipation. Only having one bowel movement a week, straining for 10 minutes to pass stool, having a hard stool, and poor physical activity are all common signs and symptoms of constipation (Dlugasch & Story, 2019). However, the patient is not experiencing any discomfort or pain while defecating and these are also common signs and symptoms of constipation that the patient is not exhibiting during this case study (Wang et al., 2024).

REPLY 2:Prevalence of Diabetes Mellitus (D.M.) in Different Ethnic Groups Diabetes constitutes a significant worldwide public health concern. 8.3% of the U.S. population is affected by diabetes, while an estimated seven million individuals remain undiagnosed (Pham et al., 2019). Pham et al. (2019) reported that the incidence of diabetes is least prevalent among Alaska Indigenous (5.5%) and most prevalent among Native Americans (33%). According to the study, diabetes mortality is 2.3 times more prevalent among Native Americans than among members of other racial and ethnic groups. Furthermore, in comparison to different races and ethnicities, Native Americans have one of the highest prevalence rates of diabetic retinopathy, at 45.3%. Signs & Symptoms of Diabetes Mellitus Type 2 The clinical manifestations of C.B. are consistent with the symptoms and indications of type 2 diabetes mellitus. Her fasting blood sugar is 141, and her cholesterol is 225, both indicating elevated sugar levels. Additionally, she has been experiencing excessive thirst recently, a condition known as polydipsia, and she is awakening more frequently during the night to urinate, a condition known as polyuria, which denotes a high frequency of urination. Polydipsia and polyuria are conditions associated with diabetes mellitus type 2. Additionally, she has experienced a cumulative weight gain of 15 pounds within the past half-year. Potential causes of this unexplained weight gain could be due to insulin resistance and metabolic dysfunction. Additional symptoms of peripheral neuropathy, including weakness and paralysis in her left foot, are also evident (Bellary et al., 2021). These manifestations may be attributed to nerve damage caused by uncontrolled long-term diabetes.

REPLY 3: Why is the ability to make ethical decisions a crucial skill for advanced practice nurses? As was previously mentioned, there are a lot of ethical questions raised by clinical practice, and as APN we must be prepared to address these issues. Clinical expertise is the foundation for and grows out of ethical involvement. The difficulty in reaching a consensus among parties and the complexity of the ethical concerns in the health care industry during the past 30 years, some participants have turned to the legal system for resolution. APN’s need the knowledge and skills to avoid power struggles, and lead interdisciplinary communication, and facilitate agreement between team members in ethically difficult situation. (Sanders 2020). In my nursing practice, I faced an ethical dilemma with an elderly patient with dementia. The illness was at an advanced stage, and the client had repeatedly expressed their desire to have a natural progression of the condition rather than a life-prolonging treatment. The patient advocated that they wish to spend his remaining time at home with family and friends. However, this was against the wishes of the family members, who were adamant that the treatment should continue as they wished to see their dear member longer. Finding a balance between the patient’s autonomy and the family members’ wishes was difficult. Through my professional experience, I investigated the client’s health condition more deeply. I had extensive discussions about their wishes with the patient and family members. Using ethical principles, balancing autonomy and beneficence, I provided the family members with detailed implementations of every measure that could be undertaken. Respecting the patient’s autonomy was worth more than proceeding with the life-prolonging treatment (Sampson, & Harrison Dening, 2020). The family agreed on the importance of respecting the patient’s autonomy.
REPLY 4: In my healthcare experience, I have encountered situations that tested my ethical judgment and clinical expertise. A typical case was a patient who said that she shared using opioids given to her by friends as a supplement to the opioids she was already prescribed for pain. She continued looking, ashamed of what she was telling me. She was scared that I would report or stop her medication because she was ashamed of telling me so that I wouldn’t tell the doctor that she was abusing her medication and risk being discharged from his case load. Due to the sensitivity of the situation, therefore, my main focus was to make the patient feel understood, thus providing an environment for free discussion. I first acknowledged the courage it took for the patient to be able to reveal this information to me and told her that I was first concerned for her well-being. Building trust and rapport in such moments helps in the effective delivery of health care. Later, together with the patient, I sought to establish the real motives for her behavior in a shared decision-making process (Ganz, 2015). The causes of partiality that contributed to opioid abuse were poor pain control, fear of withdrawal syndrome, and social attractions. With her, we developed an individualized plan for her pain management that addressed the risk of misuse of opioids.
It was central to my approach to educating her. I educated her in detail about the consequences related to opioid misuse, the hazards of addiction, the risks of overdose, and legal consequences. This, in turn, will help the patient make decisions about health and foster a sense of self-maintenance attitude and thus, empower the patient. I enabled access to more support resources in seeing us through the treatment plan, which included helping the patient access counseling services, addiction specialists, and self-help groups that best addressed her needs (Motta-Ochoa et al., 2017). Working with such a team would ensure the patient receives the best overall care and thus more opportunities for the outcome to be positive.

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