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Primary Presumptive Diagnosis Essay

Congestive Heart Failure (CHF) (ICD 10 Code: I50.9)

This recurrent progressive illness is diagnosed when the heart’s pumping function is weakened (Hollenberg & Heitner, 2012). CHF has the following signs and symptoms: chest pain, dependent edema, orthopnea as an outcome of pulmonary edema, shortness of breath, palpitations, wheezing cough, and paroxysmal nocturnal dyspnea (Hollenberg & Heitner, 2012). The reasons why CHF may develop in elderly patients are coronary artery disease, atrial fibrillation, renovascular disease, hypertension, cardiomyopathy, valvular heart disease, and myocardial infarction.

In addition, diabetes mellitus and such a non-cardiac disorder as anemia may also lead to symptomatic congestive heart failure (Iacoviello & Antoncecchi, 2013). The predominance of CHF is higher among the elderly, especially females who suffer from obesity and/or have a history of hypertension or atrial fibrillation (Iacoviello & Antoncecchi, 2013).

Osteoarthritis(ICD 10 M15.9)

This chronic illness of joints predominantly influences cartilage. Osteoarthritis is the major reason for disability among aging people (“What is osteoarthritis?” 2014). The conditions that lead to patients’ high exposure to osteoarthritis are elderly age, belonging to the female gender, having genetic deficiencies in joint cartilage, obesity, injuries of joints, and excessive stress on joints associated with the profession or physical activity (“What is osteoarthritis?” 2014). Osteoarthritis is the prevailing rheumatic illness. It can also be related to cardiovascular diseases due to physical passivity and chronic inflammation. The disease is most closely associated with congestive heart failure (Sood & Sood, 2015).

Acute Renal Failure (ARF) (ICD 10 – N18.9)

Acute renal (kidney) failure is a rapid or sudden deterioration in the patient’s renal filtration capacity. Under the conditions of acute kidney failure, a decrease in the glomerular filtration rate is noticed over a period of several days or weeks (Holmes et al., 2016). ARF may be caused by three types of effects: pre-renal, intrinsic renal, and post-renal. The first group of causes includes impaired cardiac pump efficiency, severe hypovolemia, and vascular disease that restricts the flow of blood in kidneys (Holmes et al., 2016). Intrinsic effects are presented with the hepato-renal syndrome, renal parenchymal disease, and acute tubular necrosis. The third group of causes – post-renal – includes such conditions as bilateral stone disease, radiation fibrosis, and outflow obstruction by pelvic malignancies.

The critical determinants for developing acute kidney failure are obesity, diabetes, liver disease, hypertension, atherosclerosis, and chronic heart failure. The symptoms of the disease are increased jugulovenous distention, reduced exercise capacity, recent peripheral edema, dyspnea upon exertion, hematuria, and fatigue (Holmes et al., 2016).

Ms. B. J. has the following vital signs: hypertension 150/86, R 22, and BMI 29.8. The patient’s symptoms are bilateral ankle and leg edema lasting for a week, lightheadedness when climbing the stairs that disappear when she sits down and rests, dyspnea, pulmonary edema, and reduced activity. Such a combination of signs and symptoms is compatible with acute kidney failure diagnosis.

Chronic Obstructive Pulmonary Disease (COPD) (ICD code 10 – J44.9)

COPD is a progressive recurrent disease whose characteristic feature is the restricted flow of air to the lungs (Kim & Criner, 2013). Due to the hypersensitivity of the airways, COPD pertains both to the small airways and lung parenchyma (Kim & Criner, 2013). The signs and symptoms of the disease are a chronic cough, wheezing, fatigue, and fainting or breathlessness that intensifies during activities and reduces during rest (Kim & Criner, 2013).


Hollenberg, S., & Heitner, S. (2012). Congestive heart failure. In S. Hollenberg & S. Heitner (Eds.), Cardiology in family practice (pp. 91-111). New York, NY: Humana Press.

Holmes, J., Rainer, T., Geen, J., Roberts, G., May, K., Wilson, N., …Welsh AKI Steering Group. (2016). Acute kidney injury in the era of the AKI e-alert. Clinical Journal of the American Society of Nephrology, 11(12), 2123-2131. Web.

Iacoviello, M., & Antoncecchi, V. (2013). Heart failure in elderly: Progress in clinical evaluation and therapeutic approach. Journal of Geriatric Cardiology, 10(2), 165-177. Web.

Kim, V., & Criner, G. J. (2013). Chronic bronchitis and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(3), 228-237. Web.

Sood, A., & Sood, A. (2015). Prevalence of knee osteoarthritis in elderly persons in a district of Central Uttar Pradesh: A cross sectional study. International Journal of Health Sciences and Research, 5(9): 89-93. Web.

What is osteoarthritis? Fast facts: An easy-to-read series of publications for the public. (2014). Web.

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