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This paper is an attempt to come up with three differential analyses for a patient, who showed up with a 5-day constipation, passing gases, and abdominal pain during defecation attempts. Based on the collected information and assessment, especially bloated and distended abdomen, the emphasis will be made on such diagnoses as fecal impaction (K56.41), colonic inertia (K59), and irritable bowel syndrome with constipation (K58.1). Additional attention will be paid to developing treatment plans including medications, laboratory tests, diagnostics, referral, and educating the patient. Because labs, diagnostics, referral, and education are the same, one comprehensive care plan will be proposed. At the same time, meds will be prescribed for each diagnosis.
To begin with, it is essential to state that constipation is commonly caused by sedentary lifestyle and inadequate dieting. Because the patient sits at the desk for 15 hours a day, reports no exercise, and ignores the significance of healthy food giving preference to eating out, the causes of the problem are evident. Still, there are several potential differential analyses, which will be proposed below.
Fecal Impaction (K56.41)
This problem is usually signaled by such symptoms as constipation, abdominal pain, and rectal fullness. There are several risk factors for fecal impaction including malnutrition, sedentary lifestyle, dehydration, etc. (Fazio, Church, Delaney, & Kiran, 2017). This diagnosis is pointed to because of the fact that these symptoms are present in patient’s case and his lifestyle is one of the primary contributions to the potential risk of this health concern. In order to address this problem, fecal examination is required. Nevertheless, computer tomography can as well be recommended. As for meds, there are two possible ways to cope with fecal impaction – prescription of stool softeners or laxatives based on polyethylene glycol and endoscopic disimpaction. However, because the patient already takes softeners, more aggressive measure might be recommended once he sees a physician and the scope of the problem is assessed.
Colonic Inertia (K59)
Colonic inertia is usually signaled by lengthy constipation, discomfort, abdominal pain, and bloating (Fazio et al., 2017). Moreover, it is often caused by excessive intake of laxatives or stool softeners, which was reported by the patient, and unhealthy diet. In this case, it is vital to take a special test known as transit time measurement and incorporate specific dietary changes such as increased intake of fiber and water. In most severe cases, surgery is recommended. Still, the conclusion should be made after seeing a physician.
Irritable Bowel Syndrome with Constipation (K58.1)
This diagnosis was chosen because of its common symptoms: abdominal pain, which can get worse during an attempt to defecate, bloated abdomen, and constipation. This health concern is as well caused by inadequate diet, especially the lack of fiber. In order to diagnose it, a physical examination is required. In addition, CT scan of pelvis and upper endoscopy are advisable (Lacy, 2013). Laxatives (Dulcolax or Senocot) and antispasmodics (Bentyl or Levsin) are recommended. Still, final medical prescriptions should be made after physician’s examination.
Developing Care Plan
Because all three diagnoses are similar, one care plan can be developed. First of all, the patient requires laboratory tests. In similar cases, fecal occult blood test and complete blood count are recommended. Moreover, such procedures as X-ray and computer tomography are advisable. Still, one of the most significant aspects of care plan is educating the patient in order to avoid similar problems in future. First and foremost, the patient should be taught of the necessity of healthy food and start cooking at home instead of eating out and ordering whatever is available. More than that, it is suggested to increase daily water intake. Furthermore, because of sedentary lifestyle, it is critical to point to jogging or taking long walks, i.e. add some exercises to everyday routine. Finally, it is essential to highlight that all medications including vitamins should be taken only if prescribed by a doctor because constipation can be caused by a reaction to meds.
Fazio, V. W., Church, J. M., Delaney, C. R., & Kiran, R. P. (2017). Current therapy in colon and rectal surgery. Philadelphia, PA: Elsevier.
Lacy, B. E. (2013). Making sense of IBS: A physician answers your questions about irritable bowel syndrome. Baltimore, MD: Johns Hopkins University Press.