Geriatric Diagnosis The author of this report has been asked to assess the medical condition and prognosis for John Smith. John is a sixty-eight years old and has a pretty good array of medical problems. He has had psoriasis for more than a generation and the ointments he has been using to treat it have become ineffective. Beyond that, the psoriasis is spreading to parts of his body that have not been trouble areas before. His son Patrick asserts that he believes that the psoriasis is to the point that it is contagious. While John is facing some challenges, there are things that can be done and this includes properly education both John and Patrick.

Straight off the top, the assertion by Patrick that the psoriasis is "contagious" is patently and absolutely false. Psoriasis is never contagious and there is not a chance that anyone around John will "catch" it. Further, the psoriasis is almost certainly being aggravated due to stress due to his new living situation. Indeed, him and his wife moving in with John's daughter Mary, son-in-law Patrick and their four children has surely put him on edge because there are many more people in and around him and kids tend to be loud and excitable. Further, if there is any fighting or discord in the house including between the kids, the parents (Patrick and Mary) or a combination of the two, then that is surely making things worse. If there is a part of the house that can be isolated (e.g. a mother-in-law suite, etc.) as a "quiet" area for John and his wife, that would surely help him be less stressed and his psoriasis would probably lessen as a result. Patrick curtailing the kids being loud and/or obnoxious would probably also help greatly. If the kids are excited and loud, they can go outside or go to the park or something like that. Given the above, the flare-up of the psoriasis is deemed to be stress-related per the primary diagnosis and the new living situation is surely the trigger unless there is another detail or happenstance that is not being mentioned here (WebMD, 2015).

Before getting into the "meat" of the other things going on, there are a few housekeeping items that should be mentioned. First, it should be figured out if Smith has had the Pneumovax because he is certainly in the age group of people that should be having it. Pretty much anyone in their 60's should have it because getting pneumonia at his age could be lethal and this is even truer when taking into account that his lung has crackles in bases bilateral and wheezing with dyspnea with exertion. If John has not had a pneumonia vaccine, he should certainly have one. The same goes for the tetanus shot. If he has not had one in the last five to ten years, he should absolutely have one now. A flu vaccine for the current strain is also a must (WebMD, 2015).

Now there will be a focus on the other things going on. There are three things in particular that stand out in the secondary diagnosis and the overall vital signs that need to be addressed as soon as possible. First, the blood pressure is a huge red flag. The diastolic number is actually not that bad, actually. A reading of 84 is in the pre-hypertension range. However, eighty and below would be normal so the 84 figure is not a huge cause for alarm. However, the systolic number is entirely too high. A reading of 154 is nearly state II hypertension. Whether it be stress from the new living situation or due to other lifestyle issues, that number needs to come down via medication and/or lifestyle adjustments including better eating, a quieter home environment and so forth. His pulse rate is 102. That is a smidge high as it is on the high end of the range of "normal" values. However, it could be much worse (WebMD, 2015).

As for the secondary diagnoses, there are two in particular that are entirely fixable and they need to be fixed or John will die sooner rather than later. The fact that John has apparently been smoking for fifty to sixty years is a very bad thing. The amount of damage he has done to his body is probably monumental and his lung symptoms are probably due to the smoking. Beyond that, he drinks one to two glasses of whiskey a day. The whiskey is probably not a huge problem for him if that is truly what he drinks, although it would be better if he did wine or beer as those drinks have lower alcohol content. However,...

There is a good chance they already are. The S3/S4 indicators are a sign of high blood pressure and/or heart disease and the smoking would aggravate both of those issues. There is a good chance that bad days are ahead for John as the dyspnea is a bad sign. It would commonly be associated with asthma, heart failure, COPD and other diseases that would probably ultimately be lethal. There is a chance John is not facing one of those disorders or diseases but it is a very bad sign. Much the same thing can be said of the bilateral crackles and it is much of the same diseases that are indicated. These disorders, as with the dyspnea, would include problems with the heart or the lungs (WebMD, 2015).
John also has apparent issues with arthritis and such. That should be treated as well but it is far from being the major issue as his symptoms that point to heart and/or lung issues are more important and the psoriasis would seem to be the bigger problem as compared to the arthritis, at least for now. The use of the atenolol would indicate that he is being treated for the high blood pressure as it is a beta-blocker and it treats high blood pressure. His taking of simvastatin (aka Zocor) is also an indicator that there is a concern about heart blockages as the drug is a statin. This drug being taken, coupled with the symptoms above, make it pretty clear that prior professionals are very worried about his arteries and his heart and this is rightly so (WebMD, 2015).

Given the above parameters and issues, here is a quick summary of what needs to happen. No matter how it happens, the smoking needs to stop and stop quickly. John can use nicotine patches and the like or he should at least try e-cigarettes due to the fact that the amount of chemicals and harmful substances is so much less, if not zero. Second, a second approach to couple with the beta-blocker might be called for given how high his blood pressure his. Other options include renin inhibitors and thiazide diuretics. However, the author of this report is fairly sure fixing the home environment would help the blood pressure a lot. As noted before, the diastolic number is pretty good but the systolic is nearing dangerous levels. Next, the drug list that John is taking would indicate that he is not being treated for arthritis. Given the amount of pain and exertion that would be involved as a result, this is probably something else that is stressing him. Thus, getting him on a medication that would help that would be a wise thing to do. All in all, the smoking and the calmness (or lack thereof) of the home environment are probably the two major things that should be addressed first. Even so, there is an extremely high likelihood that John will be entering a palliative care situation rather than actually fixing what is wrong with him. His symptoms tell a grim story and he is extremely lucky to be almost seeing his 70's given his lifestyle choices (WebMD, 2015).

Conclusion

John is getting hit by a proverbial double whammy when it comes to his health. Part of the problem is his excessively bad lifestyle choices over the years, his whiskey and smoking habits being the worst of the proverbial litter. However, his most recent challenges are surely a project of his new environment and perhaps his untreated arthritis as well, to a lesser degree. To be sure, it would be best to hit all of those at the same time and perhaps he could live another five to ten years. However, the overall likelihood that John will quit smoking is probably extremely slim and he is showing some very bad signs when it comes to heart and/or lung disorders. Even so, his pain and stress can be minimized and that should be the overall goal.