Some bugs also may occur together as primary entities or as secondary conditions to one another. Proper patient and disease management requires a comprehensive assessment of both objective and subjective clinical manifestation to come up with the correct diagnosis. Identification of patients disease is not only limited to primary diagnosis. Differential diagnosis has to be made since several diseases present with similar clinical symptoms. Differential diagnosis helps in preventing misdiagnosis and improper treatment. It, therefore, requires a proper assessment to identify the primary disease and make differential diagnoses for patients presenting with multiple signs and symptoms involving more than one system.

Hypertension is one of the common cardiovascular diseases that affect many people in America. Statistics indicate that in every three adults, one is having hypertension that is either diagnosed or not. Hypertension is usually asymptomatic in its mild and moderate stages but can result in severe health complications with it reaches its advanced stages Cooper-Dehoff, R., & Johnson, J.A. (2016). It is also good to note that hypertension can be managed successfully with the use of medication and lifestyle modification.

From the readings of the case study presented involving Joshua, it is clear that a psychiatric evaluation is needed. Developmental history is usually essential in any psychiatric assessment of patients across all the ages. Therefore, for Joshua’s case study, getting the developmental history from his parents is necessary. Included in the developmental history of Joshua is the prenatal stage, which usually influences the infancy and childhood stages of life to a significant extent. In addition to the developmental history, there is a need to include the family psychiatric history in the assessment data for this child.