A 12-year-old, white, female

Source: Self, reliable source

Subjective:

Chief complaint: “I feel bloated.”    

HPI:  Patient states she has felt bloating in her stomach for the past 3-4 days. She states her last bowel movement was roughly 5 days ago. She generally has a bowel movement daily. She states she was at summer camp all last week and didn’t like using the shared public bathrooms. She denies any nausea or vomiting. She denies any hematochezia.  She has been taking Metamucil wafers several times a day for the past two days and states she has passed some small hard stools.  She walks with her family every night and her activity level has not changed significantly.  She denies any depression and states she is happy in life.

Allergies: NKA

Current Medications: 

Metamucil wafers (4 grams of fiber per wafer) with meals

Pertinent History: None

Health Maintenance/Immunizations: Immunizations and pertinent screening up-to-date

Family History: 

            Paternal grandfather – prostate cancer

            Maternal grandmother – hypertension

Social History: Patient lives with father, mother and younger brother. Denies any tobacco, alcohol or drug use.

ROS: Incorporated into HPI

Objective:

VS – BP: 120/78 mmHg, HR: 86, RR: 16, Temp 97.6, oxygenation 99%, weight: 120 lbs, height: 64 inches.

The patient is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age. 

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop. No peripheral edema or jugular vein distention

Respiratory: Clear to auscultation, normal breath sounds

Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly       

Assessment:

Diagnosis: Constipation

Please answer the following:

 

1. Is polyethylene glycol 3350 (Miralax) an appropriate option for this patient? Why or why not? (2 points)

 

2. Is bisacodyl (Dulcolax) an appropriate option for this patient? Why or why not? (2 points)

 

3. Is magnesium hydroxide an appropriate option for this patient? Why or why not? (2 points)

 

4. Is lactulose an appropriate option for this patient? Why or why not? (2 points)

 

(remaining 2 points for spelling and grammar)