Lisa is 67 years old and lives at home with her husband. She has hypertensive heart disease with CHF, generalized arthritis, and bunions on both feet. Seven years ago, she was diagnosed with polyateritis nodosa. Over the last seven or so months, her husband notes that she's becoming belligerent almost to the point of being combative when she gets upset. He is finding it more difficult to provide care and has reluctantly decided to place her in a specialized assisted living center. She was examined today for a physical exam. Her hypertensive heart disease and CHF are stable. She complains about aching in just about all her joints and has asked for some medication to alleviate the pain. Her bunions are quite pronounced, but she is not a good surgical risk, so she has learned to adapt by purchasing special shoes or by wearing slippers that do not aggravate the bunions. An exam of her mental status showed she is developing dementia from the polyarteritis nodosa. When challenged about something she said, she became very, very angry and verbally abusive. She actually raised her hand as if to strike out, and then changed her mind. Placement in the specialized facility is warranted, as they will be better able to manage the personality changes she is exhibiting.
Dx: Dementia due to polyarteritis nodosa
What are the first-listed diagnosis and secondary diagnosis for this scenario?
Formation of an atherosclerotic plaque within a coronary artery; may lead to coronary artery disease
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