The patient of interest is an elderly female with hypertension, diabetes, and cancer of the cervix. This patient also has hypertensive heart disease. The patient has been on treatment for hypertension over the last ten years and developed hypertensive heart disease within the same period. She also has cancer of the cervix that was diagnosed recently. The disease process is important because there are many patients with similar conditions around the world. Hypertension and diabetes are leading causes of morbidity in developed and developing nations. The third condition is cervical cancer is a leading cause of death among women. The prognosis is also poor when the condition is not diagnosed early. The three conditions are also expensive to treat. The other challenge, especially with diabetes and hypertension, is the diagnosis of patients with these conditions because they are usually asymptomatic.
History of Presenting Illness
The diagnosis of hypertension was made ten years ago when the patient went to the hospital with complaints of a recurrent headache. She had also experienced photophobia and lightheadedness before the diagnosis was made. Three years later, the diagnosis of diabetes was made after the patient reported increased urination, thirst, and water intake. A routine blood sugar check showed that she was diabetic. The patient was started on treatment immediately after the conditions were diagnosed. The patient was told that she had cervical cancer in its second stage of progression. Her blood pressure and sugar control are adequate, and her progress is satisfactory. She reports a foul smell and discharges from the vulva. The screening revealed cervical cancer. She was also diagnosed to have hypertensive heart disease after she developed edema.
Past medical history (PMH)
The patient had not been on any medication for any condition before the diagnosis of hypertension was made. She is not allergic to any medication or food. The current admission is her third after being admitted three years ago. She was admitted due to a febrile illness. She has not had any surgery.
The patient is a graduate in education and has worked with the federal government. She is a retired teacher currently running a family business in her local area. She is also a school board member and a community strategist. She is a Catholic Christian and reports a stable family with good social support. She is a smoker and takes wine during the weekend and during family gatherings.
There is a strong history of hypertension and diabetes in the family. The father and mother are diabetic and hypertensive. However, none of these relatives have hypertensive heart disease. A distant cousin died of breast cancer, but there is no other history of cancer in the family.
The vital signs were within the normal range with the temperature at 36.60 Celsius, blood pressure at 138/87, and respiratory rate at 20 breaths per minute. In the general examination, the patient had edema of the lower limbs but no pallor, jaundice, cyanosis, inflamed lymph nodes, or dehydration. In the Head neck and ENT exam, this patient had normal anatomy and physiology. In the chest examination, the cardiovascular system revealed a murmur with an irregular heartbeat. The respiratory examination was normal with no crepitus or rhonchi. The pulse rate was rapid at 106 beats a minute. The back and the peripheral vascular exam were also reported as normal.
The abdominal exam revealed a normal gastrointestinal system with no distention or organomegaly. The extremities were also normal with adequate power, tone, and reflexes. The neurological examination was also normal for age. The genitourinary system was thoroughly examined based on the clinical diagnosis of cervical cancer. The results include per-vaginal discharge and foul smell. A speculum exam was also performed that revealed some inflammation around the cervical opening. The skin and musculoskeletal systems were normal for age with only some age-dependent changes.
The tests carried out for this patient include routine and diagnostic tests. A complete blood count was reported as normal with all the parameters being within the normal range. Another test that was carried out as a baseline is the urea, electrolyte, and creatinine that showed a relatively high creatinine for age. Some of the other tests carried out include a urinalysis and a pap smear. Urinalysis showed signs of urinary tract infection while the Pap smear histology showed a stage II cancer of the cervix. A CT scan was also carried out to assess the progress of cervical cancer.
The diagnoses for this patient include diabetes and hypertension, hypertensive heart disease, and cancer of the cervix. Hypertension was diagnosed based on elevated blood pressure while diabetes was diagnosed based on consistently elevated blood sugars. The cervical cancer diagnosis was made based on the histology report. Hypertension and diabetes are some of the most common conditions affecting the elderly in developed nations (Bernstein 54). These conditions have several modifiable and non-modifiable causes (Sibbritt 1693). One of the leading causes of these conditions is obesity which is currently a big problem in the United States and North America (Noel 485). The diagnosis of hypertension and diabetes entails consistent monitoring of blood pressure and blood sugar levels respectively.
The management of hypertensive heart disease and cervical cancer requires the involvement of a specialist. A physician should be involved in the management of these patients with a close follow-up of the patients. A gynecologist and an oncologist should also be involved in the management of patients with cervical cancer (Miller 774). The patient should improve if the recommended guidelines are followed and monitoring is done adequately (Khan 192). Cryotherapy was performed for this patient with surgery being planned to excise the tumor mass on the cervix.
Course and Prognosis
The course of the patient’s disease can be described as satisfactory. This patient had adequate control of blood sugars and pressure. In addition, the anti-hypertensive and oral hypoglycemic products were adequate to ensure a favorable outcome. Cervical cancer has a good prognosis since it was diagnosed at an early stage. This patient has a better chance of survival if she completes the treatment and continues with her medication. An annual review of the response to the medication should be made to ensure that the patient is responding well. In addition, the patient will survive with hypertensive heart disease provided that she is on medication.
The progression of hypertension to hypertensive heart disease is a topic that has been discussed in the literature. However, there is no common agreement on the time it takes between the diagnosis of hypertension and the development of hypertensive heart disease. Patients with this condition should receive anti-hypertensive drugs and medication that controls the heart rate and rhythm. There is also a need to establish the effects that diabetes has on the development of hypertensive heart disease.
In summary, the patient is an elderly lady with a ten-year history of hypertension and a seven-year history of diabetes. She is also known to have hypertensive heart disease and cancer of the cervix. Currently, the patient is on treatment for these conditions and is stable. The recommendations include that the patient receives adequate social support and continue with her medication. In addition, she needs close follow-up and further screening to establish the course of cervical cancer.
Bernstein, Rebecca S. “Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis.” American Journal of Public Health 105.2 (2015): e46-e60.
Khan, Momna. “Visual Inspection of Cervix with Acetic Acid: A Good Alternative to Pap Smear for Cervical Cancer Screening In Resource-Limited Setting.” JPMA. The Journal of the Pakistan Medical Association 65.2 (2015): 192-195.
Miller, Ross A. “Squamous Cell Carcinoma of the Cervix: A Cytology-Histology-Human Papillomavirus Correlation in Clinical Practice.” Archives of Pathology & Laboratory Medicine 139.6 (2015): 776-781.
Noel, Ashley A. “America’s Growing Problem: How The Patient Protection And Affordable Care Act Failed To Go Far Enough In Address Ing The Obesity Epidemic.” Connecticut Insurance Law Journal 21. (2015): 485.
Sibbritt, David. “Use of Complementary and Alternative Medicine in Women with Heart Disease, Hypertension and Diabetes (From the Australian Longitudinal Study on Women’s Health).” The American Journal of Cardiology 115.12 (2015): 1691-1695.