Differential Diagnosis and Treatment Education

Question: Discuss about the different term for Differential Diagnosis And Treatment Education? Answer: Differential Diagnosis of Hypertension The systolic blood pressure (SBP) is considered as a major factor for the detection of hypertension (Quinn et al. 2010). The Ambulatory Blood Pressure Monitoring is the differential test done to detect accurate hypertension. The below described in ABPM process for diagnosis: - Screening and identification of Blood Pressure It involves routine screening process of blood pressure evaluation. The evaluated blood pressure is categorized as per sections below: - HTN stages Systolic (BP mmHg) Diastolic (BP mmHg) Pre-HTN 120-139 80-89 HTN stage 1 140-159 90-99 HTN stage 2 160 100 Table 1: The stages of hypertension (Source: Quinn et al. 2010, p. 245) The diagnosis technique involved determining the blood pressure of patient with ambulatory blood pressure measurement technique (ABPM). The ABPM is a small, movable, automatic machine that is connected with patients blood pressure cuff in the hospital room. This is considered as the most accurate measurement of blood pressure and generally used as a differential diagnosis of hypertension (Patton, Frank Clark, 2013). The ABPM device is used to record blood pressure of the patient with instrument oscillometry. In this process, the blood pressure was measured in regular interval of 20 to 30 minute for coming 24 to 48hours. The recordings of blood pressure are reported for 24hours divided into two section day readings (awake BP) and night readings (sleep BP). Differential diagnosis of Type -2 Diabetes Mellitus The Patient identifies with symptoms of Diabetes Mellitus Type- 2 will undergo the differential diagnosis tests that involves the following three tests Diagnosis Test: - Test Indication of DM2 Haemoglobin A1C test 6.5% Fasting plasma glucose level (FPG) 126mg/dL 2h plasma glucose level 200mg/dL Random Plasma glucose level 200mg/dL Table 2: Test for diagnosis of diabetes mellitus type-2 (Source: American Diabetes Association, 2010, p. 67) Haemoglobin A1C test This diagnosis determines the attached glucose molecules to haemoglobin cells of the blood. This indicates the volume of blood glucose level that is been carried by haemoglobin molecules from last 3 months and not been converted to glycogen in the body (Inzucchi, 2012). Method of diagnosis: - The blood glucose level is tested in three durations that are before meal, after meal and bedtime test The blood sample of the patient is collected each time by the traditional method of pricking the fingertip and the Blood Glucose Meter collects blood sample for getting the reading of test. The test results are recorded and studied by specialist Stages Haemoglobin A1C levels for DM2 Normal 5.7% Prediabetes 6.5% Diabetes 5.7 to 6.4% Table 3: Stages of haemoglobin level for DM2 (Source: Inzucchi, 2012, p.545) Fasting plasma glucose level (FPG) The FPG test is used to determine blood glucose level in the stage of fasting where the body does not receive glucose for 8 hours. In this testing if the value of blood glucose level comes high, indicates only that glucose which is not converted to glycogen in the body and remains in the blood. But, in this analysis determinations the glucose molecules attached to plasma cells of blood (Chattopadhyay et al. 2013). Steps of diagnosis: - The patient is instructed to remain in fasting stage since night untill 8-10 hours; only allowed for water consumption. In morning (8:00 am) after completion of 10 hours, the blood test was conducted by collecting blood sample from arm of body and sent for laboratory analysis Stages FPG glucose level Normal 110 mg/dL Impaired fasting glucose 111 to 125 mg/dL Diabetic 126 mg/dL Table 4: Stages of FPG test for DM2 (Source: Inzucchi, 2012, p.546) 2-Hour Plasma glucose level The patient is allowed to have a meal after FPG and again by following similar methodology, the blood sample was collected after 2 hours of the meal (11:00 am) to determine the plasma glucose level. Random Plasma glucose level This last test is performed randomly in any period of time within the day to determine the normal blood glucose level. The value of random plasma glucose test can vary with time and meal consumed by the patient. But, if the random plasma glucose level is determined high combined with FPG and haemoglobin A1C test, it confirms diabetes mellitus type -2 in the patient (Chattopadhyay et al. 2013). For collecting the blood sample, similar method described in FPG was followed but the time of sampling is 3:00 pm. Differential diagnosis of Ischemic heart disease The following analysis was performed to confirm Ischemic heart disease in the patient. Echo Stress test or Cardiac Echo The coronary heart blockages indicate no symptoms at resting position. But, at the period of exercise or stress when the heart pumps and requires more blood for oxygenation, the coronary heart blockages allow a slow blood flow towards heart creating the starvation stage in the body. This starvation leads to development of symptoms in ischemic heart disease. In this starvation condition, the normal movement of septum gets minimized in heart indicating disease (McMurray et al. 2012). Diagnosis method Any of the previous heart related medication was stopped 2-3 days prior to this test The patient is instructed to not have any meal or drink three hours prior to echo stress test The patient is bought to echo laboratory at resting stage, where the normal functioning of all the walls of the heart is determined by echocardiogram (EKG or ECG). A colourless gel is applied on the chest and the echo transducer is placed above the chest. This transducer allows getting imaging of heart from various sections as required in the test. Patient was allowed to hold breath and release for clear picture new, the patient is instructed to undergo exercise phase till starvation and the stress echo readings are collected from starvation phase by similar manner using echocardiogram All the recording were collected and analysed by specialist in ECG laboratory (Qaseem et al. 2012) Spiroergometry This test involves the process to diagnose the high respiratory rate leading to breathing issues in the patient suffering from ischemic heart disease. The spirometry involves the process of recording ECG in the stage of maximum oxygen uptake by the body (McPhee Papadakis, 2010). Diagnosis method The patient is allowed to exercise on the bicycle ergometer to reach the stage of starvation. The breathing mask of instrument collects the air patient in inhaling and exhaling. This respiratory air is used to determine the oxygen uptake, AT, RCP, release carbon-di-oxide and maximum oxygen uptake of the body (Nabel Braunwald, 2012). Plan Medication Medication Rationale Hyzaar SIG For treatment of hypertension and lowering the risk of stroke metFORMIN The oral medicine to control blood sugar level specifically type-2 diabetes mellitus. amLODIPine These are calcium channel blockers that increase blood flow in the body and provide relaxation to blood vessels. Lantus A chemically constructed form of insulin used to lower the blood glucose level Aspir 81 Aspirin medication is given to reduce pain, fever and inflammation in body Labetalol Beta blockers for the treatment of hypertension Atorvastatin This medicine is inhibitors of HMG CoA that reduces cholesterol level and triglycerides level in blood Cipro Antibiotic for treatment of infection in body Table 5: Prescribed medications with their rationale (Source: Patton, Frank Clark, 2013, p. 3456) Education Urine tract infection in men: care instructions The following instructions are required to be followed for control over urinary tract infection Clearly understand the cause of infection Adopt personal hygiene practices as much as possible Wash hands before and after urination and meals Intake plenty of water, minimum 3-4glasses each day to clear occurring infection Intake food containing vitamin-D that are broccoli, oranges and other citrus fruits Use cotton undergarments Practice safe intercourse with precautions like condom Cut off caffeine and alcohol consumption Call professionals in situations like decreased urine flow, urination difficulty and no empty bladder feeling after urination (Hooton, 2012). Non-medication treatments The non-medication treatments are not the part of standard medication protocol but are verbally instructed by physicians for management and care of health conditions. Non-medication treatment for DMT2 Eat plant food that controls DMT2 that are okra, peas, sage, fenugreek seeds, buckwheat and brewers yeast Intake rich fibrous diet Diabetes is always linked with weight gain; therefore, adopt weight loss processes like exercises or yoga Get regular blood sugar analysis and eye test once in 3 months (Gagnier et al. 2013) Non-medication treatment for hypertension Have a DASH diet to reduce hypertension that is prescribed by doctors. DASH diet involves eating of fruits, vegetables, whole grains, fish, poultry and low-fat dairy products (Birdee et al. 2010) limit the intake of fat-rich diet Rich intake of magnesium, calcium and potassium Maintain regular 30 to 60 minutes of exercise schedule to have lower blood pressure Ancient yoga, qigong and tai chi relaxation methods are also helpful as non-medication for hypertension (Yildirim et al. 2010) Non-medication treatment for Ischemic heart disease Have plant base diet and avoid intake of animal diet Develop cardiovascular activities in daily schedule Try to practice pleasure providing activities like playing, music, reading or any activity as per interest (Yildirim et al. 2010) References Books McPhee, S. J., Papadakis, M. A.(2010).Current Medical Diagnosis Treatment 2012. New York:: McGraw-Hill Medical. Patton, R. J., Frank, P. M., Clark, R. N. (2013).Issues of fault diagnosis for dynamic systems. Springer Science Business Media. 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D., Auricchio, A., Bhm, M., Dickstein, K. Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.European journal of heart failure,14(8), 803-869. Nabel, E. G., Braunwald, E. (2012). A tale of coronary artery disease and myocardial infarction.New England Journal of Medicine,366(1), 54-63. Qaseem, A., Fihn, S. D., Williams, S., Dallas, P., Owens, D. K., Shekelle, P. (2012). Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American college of physicians/american college of cardiology foundation/american heart association/american association for thoracic surgery/preventive cardiovascular nurses association/society of thoracic surgeons.Annals of internal medicine,157(10), 729-734. Quinn, R. R., Hemmelgarn, B. R., Padwal, R. S., Myers, M. G., Cloutier, L., Bolli, P., Hackam, D. G. (2010). The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part Iblood pressure measurement, diagnosis and assessment of risk.Canadian Journal of Cardiology,26(5), 241-248. Yildirim, Y., Parlar, S., Eyigor, S., Sertoz, O. O., Eyigor, C., Fadiloglu, C., Uyar, M. (2010). An analysis of nursing and medical students attitudes towards and knowledge of complementary and alternative medicine (CAM). Journal of clinical nursing,19(7à ¢Ã¢â€š ¬Ã‚ 8), 1157-1166.