Primary Diagnosis
Chronic Obstructive Pulmonary Disease (COPD) (ICD 10 – J44.9) is the primary diagnosis for L. J. A partial restriction of airflow in the airways occurs in this disease with alveolar damage. It can happen because of an inflammatory response to toxicity. In addition, it frequently evolves due to smoking. According to statistics, it is one of the conditions causing death (Amstrong, 2012). More than 6% of the American population dies because of it. The highest prevalence is among Caucasian population. The symptoms of this disease include coughing with sputum and shortness of breath. Often enough patients have whistling in the chest. The patient has signs of COPD. The person coughs with characteristic sputum. The history of smoking is present. Apart from that, the tests revealed +prolonged expiratory phase. The flattening of the diaphragm has been observed. Lab tests evidence moderate airway obstruction.
Secondary Diagnosis
Tobacco Dependence (ICD 10 – F17.2) is the secondary diagnosis. This condition is one of the main reasons for morbidity and mortality. It can lead to the development of Chronic Obstructive Pulmonary Disease and certain form of cancer (for instance, lung cancer). It has a tendency to affect airflow and the entire respiratory tract (Amstrong, 2012). Individuals suffering from tobacco dependence have a lower capacity to exercise and, in general, have a poorer health status. L. J. has a long history of smoking. The patient smokes approximately 65 packs yearly, which has resulted in other negative manifestations as well. For example, coughing intensifies when L. J. intends to be physically active.
Additional/Tertiary Differential Diagnoses
Anxiety disorder (ICD 10 – F41.9) is the first differential diagnosis. Patients suffering from COPD tend to develop this condition rather often. The evidence suggests that up to 50% of senior patients experience it (Kennedy-Malone, Fletcher, & Plank, 2014). Anxiety disorder has a potential to intensify the symptoms of the main disease; therefore, it is essential to evaluate L.J.’s cognitive well-being. Many individuals suffer from this disorder because of their fear to work out. It can strongly affect pulmonary rehabilitation, and such patients should receive pharmacological interventions to take control of their health state (Wahls, 2012).
Hypertension (ICD 10 – I10) is the next diagnosis. It is a disease associated with recurrent or persistent high blood pressure. Both systolic and diastolic indicators are important for this matter. When it comes to the patient, smoking can be one of the factors that can cause hypertension (Benich & Carek, 2011). In addition, patient’s age and weight pose additional threats to the development of ischemic heart disease. The person receives Lisinopril to manage blood pressure; nevertheless, patients with COPD are rather likely to have arterial stiffness.
Hypercholesterolemia (ICD 10- E78.0) is the last diagnosis. At present, the patient takes Simvastatin every day, which evidences the presence of this condition. L.J. requires additional assistance regarding hyperlipidemia management; therefore, they should be informed about the need for behavior modification (King, Kingery, & Casey, 2012). L. J. should exercise enough, keep a balanced diet, and get enough rest. Since the patient’s body mass index is more than 27, they will relieve the symptoms of the current disease by leading a healthier lifestyle. Moreover, other COPD-associated conditions will become less intense.
Plan
The plan of treatment should include both pharmacological and non-pharmacological interventions. L. J. should quit smoking and lead a healthier lifestyle. To manage COPD, long-acting anticholinergic therapy can be advised. However, beta2 agonist can be prescribed as well. Apart from that, inhaled maintenance drugs can also help in alleviating the consequences of this condition (Lee, Kim, & Tagmazyan, 2013). L. J. can be prescribed Aclidinium (400mcg) to relieve wheezing and other respiratory issues (one dose of oral inhalation 2 times per day). Importantly, the drug can cause AV block and heart failure (Lee et al., 2013).
References
Amstrong, C. (2012). ACP updates guidelines on diagnosis and management of stable COPD. American Family Physician, 85(2), 204-205.
Benich, T.J., & Carek, P. J. (2011). Evaluation of the patient with chronic cough. American Family Physician, 84(8), 887-892.
Kennedy-Malone, L., Fletcher, K., & Plank, L. (2014). Advanced practice nursing in the care of older adults. Philadelphia, PA: F. A. Davis Company.
King, M., Kingery, J., & Casey, B. (2012). Diagnosis and evaluation of heart failure. American Family Physician, 85(12), 1161-1168.
Lee, H., Kim, J., & Tagmazyan, K. (2013). Treatment of stable chronic obstructive pulmonary disease: The GOLD guidelines. American Family Physician, 88(10), 655-663.
Wahls, S. A. (2012). Causes and evaluation of chronic dyspnea. American Family Physician, 86(2), 173-180.