R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise. C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.


This assignment will analyze the case studies of two patients, R.H. and C.B., who present with different health concerns. R.H., a 74-year-old black woman, is experiencing symptoms of constipation and frequent heartburn. C.B., a 48-year-old significantly overweight woman from the Winnebago Indian tribe, is experiencing weakness and numbness in her left foot, along with increased thirst and frequent urination. The objective of this analysis is to identify potential diagnoses and develop treatment plans for both patients based on their presenting symptoms and medical history.

Case Study 1: R.H.

R.H. is a 74-year-old black woman presenting with complaints of bloating, constipation, and infrequent bowel movements. She reports a change in her normal bowel habits, with a decrease in frequency and difficulty initiating bowel movements. The stools have been described as extremely hard, and straining is required for evacuation. R.H. denies any pain during straining and has recently undergone a negative colonoscopy. She also reports frequent heartburn, occurring 3-4 times per week, particularly after lying down. R.H. has been using over-the-counter aluminum hydroxide tablets to relieve her heartburn symptoms, which have provided some improvement. Additionally, she has been using naproxen as needed for arthritic pain and has experienced stiffness in her hands and knees upon waking in the mornings. R.H. has reduced her exercise levels due to worsening arthritis symptoms.

Based on R.H.’s symptoms, a potential diagnosis of constipation with gastroesophageal reflux disease (GERD) can be considered. The change in her bowel habits, including infrequent and difficult bowel movements with hard stools, suggests constipation. The presence of frequent heartburn and relief with aluminum hydroxide tablets indicates the possibility of GERD. The stiffness in her hands and knees upon waking may be related to her arthritis.

To address R.H.’s constipation, dietary modifications can be recommended, including increasing fiber intake through fruits, vegetables, and whole grains, as well as increasing fluid intake. Additionally, regular exercise can help stimulate bowel movements. If lifestyle modifications are not effective, mild laxatives or stool softeners may be considered. For GERD, lifestyle changes such as elevating the head of the bed and avoiding triggering foods can help alleviate symptoms. Antacids may be used as needed for symptomatic relief. R.H.’s arthritis symptoms can be managed with non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and joint protection strategies.

Case Study 2: C.B.

C.B. is a 48-year-old significantly overweight woman from the Winnebago Indian tribe presenting with weakness and numbness in her left foot. These symptoms have been present for approximately three weeks and are accompanied by increased thirst and frequent urination. C.B. attributes these symptoms to the warm weather and increased fluid intake. She reports previous high blood sugar and cholesterol levels three years ago but did not pursue further medical evaluation or treatment. C.B. also mentions a recent weight gain of 15 pounds in the last six months.

Based on C.B.’s symptoms and previous medical history, a potential diagnosis of diabetes mellitus can be considered. The weakness and numbness in her left foot could indicate peripheral neuropathy, a common complication of diabetes. The increased thirst and frequent urination are classic symptoms of diabetes, suggesting hyperglycemia. C.B.’s previous high blood sugar and cholesterol levels further support this diagnosis. The significant weight gain in the last six months may be associated with insulin resistance and worsening glycemic control.

To address C.B.’s potential diabetes, further diagnostic testing is necessary, such as fasting blood sugar levels and HbA1c measurement. If confirmed, education and lifestyle modifications will be essential, including a healthy diet, regular exercise, and weight management. Medications, such as oral hypoglycemic agents or insulin, may be prescribed to achieve glycemic control. Additionally, management of associated risk factors, such as high cholesterol, may be necessary to reduce the risk of cardiovascular complications.


In conclusion, the case studies of R.H. and C.B. present different health concerns that require appropriate diagnosis and treatment. R.H.’s symptoms suggest constipation with GERD and arthritis, while C.B.’s symptoms indicate a potential diagnosis of diabetes mellitus. Developing individualized treatment plans based on these diagnoses, including lifestyle modifications and medication management, is crucial for improving the patients’ well-being and addressing their specific health concerns.