The observed client is a 62-year-old white heterosexual male with 41 years of smoking history and no regular drug abuse experience. The client reports the absence of allergies and severe chronic health conditions. The client is self-employed, performing miscellaneous manual work that requires physical strength. The chief complaints concern medium severity pain in the low back area that radiates to the left leg, and constant dry coughing with difficulty breathing and occasional wheezing. Therefore, these areas are observed with increased precision during the head-to-toe assessment.
Age and Patient-Specific Risk Reduction and Screening
The client is 62 years old and is exposed to several age-related health risks that require screening and prevention practices. As Haber (2016) claims, people over 50 often suffer from such chronic conditions as “hypertension, arthritis, heart disease, cancer, and diabetes” (p. 33). These diseases are the most pervasive reasons for death among Americans. Hypertension and other issues of the cardiovascular system require regular screening of blood pressure and heart rate. In the case of this client, BP and heart rate are within the age-appropriate range, but regular check-ups are required to detect issues at the early stage. According to Haber (2016), cancer diseases with the highest mortality, such as prostate, lung, and colorectal cancer, are age-related.
Therefore, the client must undergo screening colonoscopy, PSA screening, and lung examination regularly. The latter is of utmost importance as the patient has a long history of smoking and thus belongs to a risk group. Additionally, skin observations should be conducted to detect malignant formations at the early stage. As older adults often suffer impairment due to the loss of hearing and visual abilities, regular physician visits should include an assessment of these capacities. As people over 60 are vulnerable to infection complications, influenza immunization is highly recommended for the client.
Differential Diagnoses regarding the Issues in the Systems
During the head-to-toe assessment, the issues were detected in the respiratory system and the spinal area. Given such symptoms as a dry cough for several years and difficulty breathing, the differential diagnosis for lung issues must focus on asthma, lung cancer, chronic bronchitis, allergic rhinitis, gastroesophageal reflux disease, and COPD. Due to a long history of smoking, COPD (chronic obstructive pulmonary disease) can be defined as a provisional diagnosis. According to De-Torres et al. (2015), “patients with COPD are at high risk for the development of lung cancer and LC is an important cause of death in these patients” (p. 285). That is why screening for lung cancer is an essential diagnostic procedure for this client.
As far as low back pain is concerned, it can signify several health conditions. That is why the differential diagnosis of this issue includes back strain, lumbar degenerative dis disease, osteoporosis, osteoarthritis, lumbar disc herniation, and malignancy. According to Amin et al. (2017), radial pain and unequal distribution of muscle strength and mobility due to nerve damage are the signs of disc herniation. Thus, lumbar disc herniation is the provisional diagnosis for this patient. Nevertheless, further examination, including MRI, is necessary to prove this diagnosis.
Care Plan for the Issues
First and foremost, the care plan for the issues must begin from a more careful examination that aims to exclude or confirm the diagnoses and identify the severity of the conditions. In the case of COPD as a provisional diagnosis, spirometry should be conducted to detect the issues in breathing. Moreover, an X-ray of the chest area will provide additional information regarding the condition of the lungs. To relieve the patient from dry cough, bronchodilators can be used as the primary medication to improve breathing. Moreover, lifestyle change is necessary to improve the current condition and avoid complications. As Tanner et al. (2016) claim, “seven years of smoking abstinence reduced lung cancer-specific mortality” (p. 534). Therefore, there is evidence that smoking cessation is efficient even in older age after a long smoking experience.
To evaluate the severity of the low back condition, an MRI diagnostic should be applied. As most lumbar disc herniations do not pose a significant threat to the patient’s health, it is most likely that surgical treatment will not be necessary. Treatment for the patient with this condition should be based on both medication and non-medication approaches. Such methods as massage, acupuncture and specially designed exercising can relieve painful sensations significantly. However, the use of pain management and anti-inflammatory medication is possible when needed.
Health Promotion Practices for the Client
From the individual perspective, nutrition management, exercising, regular screening, and health literacy development are significant predictors of health outcomes. According to Haber (2016), every individual over 50 should have a minimum of one 30-minute physical activity daily. As the discussed patient is not retired and performs physically demanding work regularly, he does not lack overall activity. Nevertheless, his low back condition requires specific exercise and a switch to less damaging activities. Nutrition and weight management helps to reduce risks of renal disease, diabetes, and cardiovascular diseases. As this patient does not show signs of obesity or malnutrition, the risks of these complications are lower if he maintains this lifestyle. The most pressing issue for the client under discussion is heavy smoking. Therefore, smoking cessation is an essential health promotion initiative that should be taken immediately. Additionally, the patient must be educated about the risks of smoking and other lifestyle activities that impact his life quality. General health literacy especially is beneficial for older adults who face multiple health conditions and need to know how to manage their health.
Amin, R. M., Andrade, N. S. & Neuman, B. J. (2017). Lumbar disc herniation. Current Reviews in Musculoskeletal Medicine, 10, 507-516.
De-Torres, J. P., Wilson, D. O., Sanchez-Salcedo, P., Weissfeld, J. L., Berto, J., Campo, A., Alcaide, A. B., Garc´ıa-Granero, M., Celli, B. R. & Zulueta, J. J. (2015). Lung cancer in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 191(3), 285-291.
Haber, D. (2016). Health promotion and aging. Springer Publishing Company.
Tanner, N. T., Kanodra, N. M., Gebregziabher, M., Payne, E., Halbert, C. H., Warren, G. W., Egede, L. E. & Silvestri, G. A. (2016). The association between smoking abstinence and mortality in the National Lung Screening Trial. American Journal of Respiratory and Critical Care Medicine, 193(5), 534-541.