Mr. Jorge Ramirez 4

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The University of Nairobi *

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Nursing

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Nov 24, 2024

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1 78-year-old with fever lethargy, and anorexia Student’s Name University Affiliation Course Professor’s Name Date

2 i. The List of Appropriate Differential Diagnoses and Reason The case of the 78-year-old can be linked to various differential diagnoses based on the objective and subjective information given with the chief complaint of fever lethargy, and anorexia. The first differential diagnosis for the patient is Hypotension which is an illness that is majorly identified with low blood pressure and can cause dizziness and fainting from an insufficient supply of oxygenated blood to the brain (Van Campen et al., 2020). Mr. Jorge Ramirez has the risk of possible hypotension confirmed by the blood pressure getting to 80/40 mm/Hg with the septic shock making it the primary diagnosis that is suspected for the patient. The confirmation will need the assessment of the blood pressure regularly to determine the consistent low blood pressure as the indication of the illness. The second possibility is Leukemia as another differential diagnosis that will need to be ruled out during the patient analyses. Leukemia is an illness identified with infection and interference with the hematopoiesis as cancer term of the blood cells with the identification of fatigue and frequent infections as the major symptoms (Blackburn et al., 2019). Mr. Jorge Ramirez's worry is supported by fatigue and hematopoiesis from the test. The third differential diagnosis that will need to be addressed is the possibility of anemia which is a condition that is linked with insufficient red blood cells hampering the circulation of blood to the tissue and organs with the major sign of exhaustion, skin pallor, light-headedness and dizziness with lack of enough healthy blood cells (Kasiviswanathan et al., 2020). Fever and tiredness could be used to support the possible anemia condition as the illness resulting from insufficient blood circulation. ii. The Final Diagnosis, And the Assessment Findings Serve to Support This, Discussion of The Normal Versus Abnormal Findings.

3 The determination of the primary diagnosis will be based on the patient history with the need to identify the illness as the main focus during patient care. The patient final diagnosis that will need to be confirmed via diagnostic measures is Hypotension. The illness is primarily identified with blood pressure falling below the optimal pressure with the determination of the low blood pressure needs for various patient differing. The optimal determination of low blood pressure is when the blood pressure of a patient is consistently below 90/60 mm/Hg (White, Griffiths, 2019). The patient abnormal finding that could be used to support the primary differential diagnoses is blood pressure recorded at /40 mm/Hg with the septic shock. The normal findings that could be used to rule out the low blood pressure would be lack of septic shock and well-maintained cardiac output, normal blood pressure, and energetic patient with no symptoms of fatigue and lack of energy. The patient had major signs that could be used as abnormal findings for Hypotension with the reported low blood pressure, exhaustion, fever lethargy, and anorexia which could be from the insufficient flow of blood to the brain and other major organs as reported during the assessment of the patient. iii. The Description of the Pathophysiology That May Lead Up to The Final Diagnoses. The pathophysiology that defined low blood pressure can be caused by the various condition that affects the pumping of blood and circulation of blood. The condition of low blood pressure can be caused by cardiovascular conditions such as heart attacks, heart valve disease, and bradycardia, it can also be caused by endocrine conditions that affect parathyroid or adrenal glands making the blood pressure drop among other conditions that might limit the blood circulation within the blood veins to the systems. The pathophysiology from the various causes can be determined by the reduced blood volume with the inability of the heart to pump the

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4 needed volume of blood under the right pressure and hence systemic blood pressure dropping below the optimal pressure values. The reduced volume of blood will be attributed to reduced cardiac output that is caused by low sinus rate with the manifestation of reduced energy level, dizziness, troubled concentration, and fatigue (Clark, & Buhr, 2022). The illness shown by Mr. Jorge had the blood pressure at 80/40 mm/Hg with the resulting septic shock as contents of low blood pressure. iv. The pharmacology treatment is recommended and why? The treatment that is recommended for the treatment of low blood pressure will need a list of life-key modifications that can be used to increase the volume of blood and blood pressure. The pharmacology treatment is recommended for the patient with orthostatic hypotension and other long-term low blood pressure. The use of fludrocortisone or midodrine can be prescribed for a patient with low blood pressure boosting the volume of blood and enhancing the blood pressure with the use of midodrine is preferred for an older patient with low blood pressure (Godbole, & Aggarwal, 2018). Mr. Jorge Ramirez at the age of 78 years will need the prescription of midodrine to raise his blood pressure by reducing the possibility of blood vessels expanding.

5 References Blackburn, L. M., Bender, S., & Brown, S. (2019, December). Acute leukemia: diagnosis and treatment. In Seminars in Oncology Nursing (Vol. 35, No. 6, p. 150950). WB Saunders. https://doi.org/10.1016/j.soncn.2019.150950 Clark, E. A., & Buhr, G. T. (2022). Hypotension. Pathy's Principles and Practice of Geriatric Medicine, 1, 419-426. https://doi.org/10.1002/9781119484288.ch32 Godbole, G. P., & Aggarwal, B. (2018). Review of management strategies for orthostatic hypotension in older people. Journal of Pharmacy Practice and Research, 48(5), 484-492. https://doi.org/10.1002/jppr.1484 Kasiviswanathan, S., Bai Vijayan, T., Simone, L., & Dimauro, G. (2020). Semantic segmentation of conjunctiva region for non-invasive anemia detection applications. Electronics, 9(8), 1309. https://doi.org/10.3390/electronics9081309 Van Campen, C. L. M., Verheugt, F. W., Rowe, P. C., & Visser, F. C. (2020). Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography. Clinical Neurophysiology Practice, 5, 50-58. https://doi.org/10.1016/j.cnp.2020.01.003 White, S. M., & Griffiths, R. (2019). Problems defining ‘hypotension’in hip fracture anaesthesia. British Journal of Anaesthesia, 123(6), e528-e529.https://doi.org/10.1016/j.bja.2019.09.002

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