Advanced Geriatric Assessment with ICD-9 Codes - Essay Example

Pityriasis rosea, ICD-9 Code: 696.3: This common skin condition starts as a small rash on the skin, and is later characterised with red scaly patches and plaques when not properly managed.

Squamous cell carcinoma, ICD-9 Code: 232.9: This is one of the common skin cancers that present with the development of thin squamous cells of the skin. It usually does not respond to most topical drugs, and if not managed quickly it disseminates all over the body.

Psoriatic arthritis, ICD-9 Code: 696.1: The patient complains of pain in the knee and hands, and since he has psoriasis, it can be a predisposing factor to development psoriatic arthritis (Duarte, Faillace, & Freire de Carvalho, 2012).

The questions that will be relevant to develop the differential diagnosis shall be:

How the lesion started; This is because pityriasis rosea starts with a single large herald patch then followed by multiple oval lesions over the body.

Whether the skin lesion responds to treatment since Squamous cell carcinoma does not respond to topical dermatological drugs.

The tool that shall be used is to assess the severity and rate of psoriasis will be psoriasis area and severity index tool. This is because the tool is widely accepted,  and acts as the current gold standard for assessing extensiveness of psoriasis. Moreover, it measures the thickness and redness of the lesion.

DISCUSSION 2

1. Primary diagnosis: Bronchitis; The patient has a history of chronic smoking and on examination, there was wheeze as well as bilateral crackles. Long term smoking is the major cause of bronchitis because of persistent bronchial tree irritation by the smoke.

 Differential diagnosis: chronic obstructive pulmonary disease, ICD-9 Code: 496: This is because the patient is a chronic smoker and presents with wheeze as well as bilateral lung crackles (Tuder & Petrache, 2012).

2. Primary diagnosis: Nail psoriasis; The patient had yellowish discolouration and transverse ridging of the fingernails, as well as having chronic plaque psoriasis.

Differential diagnosis: Tinea unguium, ICD-9 Code: 703.8: This is a chronic fungal infection that affects the nails and usually presents with yellow discolouration of the nails.

3. Primary diagnosis: congestive cardiac failure; The patient has a history of hypertension and now present with dyspnoea as well as pitting oedema. These are some classical signs of heart failure, oedema occurs due to pooling of blood in the veins (Liu et al., 2014).

Differential diagnosis: pulmonary oedema, ICD-9 Code: 514: The patient presented with dyspnoea, lung crepitations as well as pitting oedema. This can suggest the accumulation of fluid in the lung field thus impeding the breathing of the individual.

Treatment plan

Diagnosis and treatment

Chronic plaque psoriasis

Treatment: 

Topical salicylic acid/beclomethasone valerate 0.1% apply topically on the skin once weekly for 6 months.  The drug acts by inhibiting cytokines and Langerhans cell migration, thus inhibiting uncontrollable skin cell growth as well as removing the plaques.

Psoriatic arthritis

Treatment:

Celecoxib 100mg BD for 2 weeks, administered orally and acts by inhibiting cyclooxygenase enzyme thus stopping prostaglandin biosynthesis at inflammatory points. In that respect, it prevents inflammation at the joints.

Nail psoriasis

Treatment:

Topical fluorouracil that acts by inhibiting thymidylate synthase enzyme thus preventing the nail from hardening and changing in colour.

CCF

Treatment:

Spironolactone 100mg OD Orally, that acts as a potassium-sparing diuretics by competitively binding to Aldosterone-potassium receptors and an increasing amount of sodium water excretion while potassium is retained. It leads to diuresis as well as retaining potassium that is needed for proper body function.

Captopril Orally 6.25mg TID for one month. It acts by inhibiting the stimulation of RAAS thus prevents water retention in the body as well as lowering blood pressure.

Bronchitis

Treatment:

Amoxicillin/clavulanic acid orally 625 mg QID for 7 days, that acts as a bactericidal, which inhibits the synthesis of bacterial microorganism. It prevents bacterial action in the bronchial tree and prevents an inflammatory action that leads to secretions.

Patient education

Avoid exacerbating factors of psoriasis for example smoking

Use the drugs as prescribed

Observe body hygiene through bathing twice in a day

Eat a balanced diet to boost his immunity

Referral of the patient

The patient is going to be referred to a dermatologist for further management. Additionally, a cardiologist shall be called to review the patient.

Treatment plan

Follow up

The nurse shall do weekly follow up of patient at his home, this will enhance the utilization of the treatment administered thus improving outcome.