14.14 Clinical Judgment: Case Study

A 67-year-old client, pronouns she/her, came to the health clinic concerned about being constipated for the last 2 ½ weeks. She has been experiencing cramping and pain in her left lower quadrant (LLQ) for the past 4 days. She reported feeling like she has to have a bowel movement (BM), but nothing comes out, and she is worried she might have hemorrhoids. Today she began to feel nauseous. The client explained she was diagnosed with multiple sclerosis (MS) 5 years ago and that when she is stressed, her MS flares up and she gets constipated. Her daily life routine has been altered recently because she has been taking care of a friend who had heart surgery. Her vital signs are: blood pressure (BP) 138/88 mm Hg, pulse (P) 92 beats per minute, respirations (RR) 18 breaths per minute, oxygen saturation (O2 sats) 98% and oral temperature (T) 37.9 °C  100.2 °F.

The nurse learns the client experiences these symptoms a couple of times per year when her MS flares up. When not having a flare-up, the client normally has a bowel movement 5–6 times per week. The client reported that her diet and exercise has been interrupted due to helping a friend. She said that she usually eats a healthy diet, walks 30–60 minutes 5 times per week, and does yoga 3 times per week. During the last 2 weeks, she has not exercised and has  been ordering take-out. Other symptoms include straining when having a bowel movement, passing small hard stool, and a bit of bleeding during the last bowel movement. The client’s constipation usually resolves after a week, but she believes it has lasted longer due to the added stress in her life.