Case Presentation Ms. Amanda D

Case Presentation

Ms. Amanda Doyle is a 67-year-old white female with a history of type 1 diabetes and osteoarthritis in her left hip. Her diabetes is well controlled with diet and insulin. Although she takes ibuprofen to treat the arthritic pain, her mobility has declined and now uses a walker. Because of a past bad experience with anesthesia, she has been resistant to having hip replacement surgery and instead opted to increase the dosage of ibuprofen to 600 mg four times a day and just learn to live with the pain. For the past 3 months, Ms. Doyle has experienced intermient abdominal pain, cramping, and bloating with diarrhea. She also has had a reduced appetite and has frequently felt tired.

On several occasions she has experienced fecal incontinence because she was unable to get to the bathroom in time and was unable to “hold it.” On two occasions, she experienced fecal incontinence in a public seing and was completely embarrassed by the situation. She is now afraid to leave the house because she fears it will happen again. Ms. Doyle’s daughter took her to her primary care provider who ordered several diagnostic tests. An occult blood test showed blood in her stool. A stool culture was done to rule out parasitic infections; this was negative. Because it had been 9 years since her last colonoscopy, a colonoscopy was ordered to rule out pathology within the colon such as ulcerations, inflammation, or tumors. The colonoscopy revealed inflammation to the lining her colon. Her physician made the diagnosis of inflammatory bowel disease.

Case Analysis

1. In what way does the case exemplify the concept of elimination?

2. What risk factors for altered elimination (fecal incontinence) and inflammatory bowel disease does Ms. Bowel have?

3. How are the diagnostic tests described in the case consistent with what was described for assessment of elimination?