Chronic Illness- 68-Year-Old Male

Chronic Illness- 68-Year-Old Male

Differentials and Final Diagnoses

The differentials include prostatic pathology, ischemic heart disease, and chronic obstructive pulmonary disease (COPD). A thorough history is required to narrow down to differential diagnoses. History of weight loss, family history of prostate cancer, especially with first-degree relatives, history of dysuria, blood in urine, and weak urine flow will point toward prostate cancer (Barsouk et al., 2020). The increased urination also prompts ruling out diabetes using a history of increased food and water intake and performing tests outlined below. A history of difficulty breathing, swelling of feet, and chest pain is used to rule out ischemic heart disease caused by hypertension. With the information provided, my final diagnosis would be COPD and benign prostatic hyperplasia in a patient with a history of chronic hypertension.

The Plan of Care and Medications

The care plan includes a range of pharmacological and non-pharmacological interventions. Non-pharmacological interventions are lifestyle modifications geared toward the management of hypertension. They include stopping tobacco use, maintaining weight within the required range, reducing salt intake, reducing caffeine, limiting alcohol use, alleviating stress, and performing cardiac exercises (Dhungana et al., 2022). Monitoring blood pressure would form a basis for further adjustment of medication. If the blood pressure is poorly controlled, the second medication, among first-line antihypertensives, will be added.

COPD can be treated with bronchodilators such as albuterol and formoterol. Antibiotics, like azithromycin 500mg OD for 5-7 days, should also be introduced to reduce the risk of worsening of COPD caused by influenza, pneumonia, or chronic bronchitis—steroids are used only in case of an exacerbation. Additionally, a pulmonary rehabilitation program encompassing exercise training, nutritional advice, and counseling will improve the quality of life and the ability to participate in day-to-day activities. Lastly, home remedies include controlling breathing, regular exercises, a balanced diet, clearing airways, and avoiding smoke.

Benign prostatic hyperplasia would require both lifestyle modifications and pharmacological management. Lifestyle modifications include eating more fiber, drinking less water in the evening, double voiding, and bladder training. Pharmacological management includes the use of alpha-blockers such as tamsulosin 0.4mg OD. The dosage should be increased to 0.8mg OD if the symptoms do not reduce in four weeks. If the patient cannot tolerate these drugs, anticholinergics or alpha-5-reductase can be used.

Tests

Several tests can be done for the patient to ensure an accurate diagnosis or severity. First, a complete blood count would be done as a routine test. Secondly, urinalysis is done to rule out urinary tract infections as a cause of increased frequency. Thirdly, the renal function tests check the baseline renal capacity. Investigations for COPD include lung function tests, chest X-rays, CT scans, and arterial blood gas analyses. Changes in a chest x-ray suggestive of COPD include hyperinflation, flattening of hemi diaphragm, reduction of lung markings, hilar enlargement, increased anteroposterior diameter, and increased lucency of the lung fields.

Since the patient has had arterial hypertension for five years, it is important to perform some follow-up tests. First is the lipid profile to screen for dyslipidemia. Secondly, a visual exam is important to assess for hypertensive retinopathy. Moreover, benign prostatic hyperplasia is diagnosed using transrectal ultrasound, which shows the level of echogenicity of the zones and enlargement. Additionally, prostate-specific antigen is a screening test for possible prostate cancer, with age as a risk factor.

References

Barsouk, A., Padala, S. A., Vakiti, A., Mohammed, A., Saginala, K., Chandra, K. C., & Barsouk, A. (2020). Epidemiology, staging, and management of prostate cancer. Medical sciences, 8(3), 28.

Dabscheck, E., George, J., Hermann, K., McDonald, C. F., McDonald, V. M., McNamara, R., & Yang, I. A. (2022). COPD‐X Australian guidelines for diagnosing and managing chronic obstructive pulmonary disease: 2022 update. Medical Journal of Australia, 217(8), 415-423.

Dhungana, R. R., Pedisic, Z., & de Courten, M. (2022). Implementation of non-pharmacological interventions for treating hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC Primary Care, 23(1), 298.

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A 68-year-old male presents to your clinic today. He complains of a cough for the last two (2) months that will not go away. He also complains of frequent urination for the last four (4) months. Past medical history only includes hypertension diagnosed five years ago, treated with hydrochlorothiazide. He does not know his family history since he was adopted. He has smoked ½ pack of cigarettes daily for the last 40 years.

Chronic Illness- 68-Year-Old Male

1. What are your differentials and final diagnoses?
2. What will be your plan of care for your patient?
3. Include any diagnostic tests and medications.
al least 2 high-level scholarly references in APA from within the last 5 years