Primary medical diagnosis Assessment 2022

Running Head: DR 0
Diabetic retinopathy
MARCH 27, 2020
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DR 1
Table of Contents
Introduction..........................................................................................................................................2
Primary medical diagnosis.................................................................................................................2
Medication management................................................................................................................3
Nursing diagnosis...........................................................................................................................4
Interprofessional plan and nurses................................................................................................5
Role of nurse...................................................................................................................................6
Conclusion...........................................................................................................................................6
References..........................................................................................................................................8

DR 2
Introduction
Diabetic retinopathy is described as the complication of diabetes that impacts a patient's
eyes. It is commonly caused by damage to different blood vessels of the tissues (light-
sensitive) at the backside of the eyes (retina). This particular problem can occur in anyone
with type 2 or type diabetes. the longer the patient has diabetes and the less regulate his or
her sugar, then more likely they are to have this complication (Tang and Kern, 2011).
Symptoms associated with diabetic retinopathy include spots of dark strings in the vision,
blurred, vision, impaired color vision, dark or empty areas in the vision, and vision loss
(Hammes et al., 2011).
Patient identification
Mr. Hank Jackson is a 64-year-old independent male. he is a self-described bachelor and
lives alone in his single-story house, however he has a daughter who lives interstate. He
was truck driver and due to his health issues
Situation
He has recently been identified with diabetic retinopathy and lawfully blind in hid left sided
eye. He is prescribed with metformin and metoprolol twice a day. He also has suboptimal
blood pressure and diabetes control. he is overweight and a flushed facial appearance, and
facing problem in reading.
Background
He has a history of type 2 diabetes mellitus and hypertension. He is referred from a general
practitioner and preferred to receive interprofessional community plan of Care.
Assessment
His vital sign assessment identified that he has blood pressure of 159mmHg/96mmHg and
HbA1C of 8 per cent. these assessments indicated that his blood pressure is high.
Request
He is suggested to adhere to the medication and work collaborate with nurses for faster
recovery.
This paper will discuss the primary medical diagnoses for him, the medication management,
nursing diagnosis, and the role of nurses and inter-professional plan of care.

DR 3
Primary medical diagnosis
The doctor uses drops into the eyes of the patient. These specific drops dilate the pupils and
permit the physician to view inside the eye more deeply. Photographs of the interior side of
the eyes are taken (Wu et al., 2013). During the eyes test, the physician can identify the
presence of abnormalities in Hank’s blood vessel, optic nerves, cataracts, alterations in the
eye pressure or the overall vision, new blood vessel, retinal detachment, and scar tissues.
Patients with diabetes frequently develop ophthalmic problems, for example, corneal
irregularities, glaucoma, iris neovascularization, cataracts, and neuropathies. The utmost
common and theoretically most blinding of these difficulties, though, is diabetic retinopathy
(He et al., 2013). patient has also developed obesity and not perform exercises regularly,
which is often deteriorates health condition in diabetes, and may also be the source of Mr.
Hank’s health.
The probability of developing diabetic retinopathy is linked to the period of the illness. In
case of Mr. Hank, the chronic illness is type 2 diabetes which might also be the reason of his
deteriorating condition. Type 2 diabetes has a deceptive onset and can go ignored for years.
As an outcome, patients might already have DR at the time of analysis (Cohen and Gardner,
2016). Diabetic retinopathy due to the damage to the tiny blood vessels and the neurons of
the patient’s retina which causes visual issues as experienced by Mr. Hank. The earliest
alteration resulting in diabetic retinopathy comprise tightening of the retinal arteries linked
with abridged retinal blood flow; impairment of the neurons of the internal retina, followed in
advanced stages by alterations in the function of the external retina, linked with subtle
variations in the visual role; impairment of the blood-retinal blockade, which defends the
retina from several materials in the blood (counting toxins and immune cells), resulting in the
leaking of blood ingredients into the patient’s retinal neuropile. Later, the lower membrane of
the patient’s retinal blood vessels thickens, capillaries debased and loses cells, mainly
pericytes and vascular type of smooth muscle cells. This leads to loss of blood movement
and advanced ischemia, and microscopic type of aneurysms which seem as balloon-like
shapes projecting out of the capillary walls, which novice inflammatory cells; and progressive
dysfunction and deterioration of the neurons and different glial cells of the retina (Wu et al.,
2013). These pathophysiological processes caused blindness in Mr. Hank’s left eyes as he
reported to have issue in reading with his left eye.
Medication management
Mr. Hank Jackson has bene prescribed with Metformin 500 mg and Metoprolol 50mg.
Metformin 500 mg
Mechanism of action

DR 4
Metformin is recognized as biguanide with the anti-hyper-glycaemic effects, dropping both
the basal and postprandial plasma glucose. Metformin might act through 3 mechanisms:
Decrease of hepatic production of glucose by hindering gluconeogenesis and
glycogenolysis, in muscle, through up-surging insulin sensitivity, refining peripheral uptake of
glucose and its utilization, and postponement of glucose absorption in the intestine.
Metformin inspires intracellular glycogen synthesis through acting on the glycogen synthase
(Diabetes Prevention Program Research Group, 2015).
Indication
Metformin is designated as an adjunct to the diet and workout to upsurge glycemic
regulation in adults’ patients ten years of age and elder identified with type 2 diabetes
mellitus (Aroda et al.,2017).
Side effects
Nausea, vomiting, weakness, stomach upset, diarrhea, or a metallic taste in the patient’s
mouth might occur (Diabetes Prevention Program Research Group, 2015).
Precautions
Before taking this medicine, one must discuss with the doctor or pharmacist if they are allergic
to this drug; or if they have any other allergies (Aroda et al.,2017).
Metoprolol 50mg
Mechanism of action
Metoprolol is the beta one-selective adrenergic type of receptor blocker. Metoprolol also
hinders beta two adrenoreceptors, primarily situated in the bronchial and vascular
musculature. the beta-blocking action of this drug, as revealed through a decrease in heart
rate and the cardiac output at rest and while doing exercise, a decrease of systolic BP upon
workout, stoppage of isoproterenol- persuaded tachycardia, and decrease of reflex-
orthostatic tachycardia (Heffernan et al., 2011).
Indication
Metoprolol drugs are specified for the treatment of hypertension. They might be used
unaided or in mixture with other different antihypertensive agents (Price et al., 2013).
Side effects

DR 5
Commonly informed side effects of this drug comprise cardiac failure, bradycardia, blurry
vision, faintness, irregular heartbeat, sweating, unusual tiredness, and hypotension
(Heffernan et al., 2011).
Precaution
If the patient has any allergies with this drug, he must discuss it with the doctor. He must
also discuss any medical history (Price et al., 2013).
Nursing diagnosis
(A)
Regular examination of the patient's eyes is essential for patients with diabetic retinopathy.
In the case of older individuals, it becomes difficult as they get irritated due to repetitive
examinations (Jiménez-Báez et al., 2015). Mr. Jackson is also has a history of diabetes type
and hypertensions, thus he needs to check his blood sugar level. Therefore, performing a
nursing diagnosis in his case might be difficult. Most of the older patients need family
support when diagnosed with chronic disease (Salz and Witkin, 2015). In the case of Mr.
Jackson, there is no family support, which can also hinder the medical process. As the
patient is obese, spend most of his time living alone in house with unfavourable conditions
and cannot see clearly with his left eye, there is probability of fall which might affect his
health condition negatively.
(B) nurses may also experience a problem related to medication management. As the
patient discussed that he often forgets to take his medicine, and do not perform regular
blood glucose level check at his home. this indicates that Mr. Jackson is no more adhered to
his treatment plan and do not think the treatment and diagnosis tests are working for him. It
has been reported that These issues arise as a result of long-term health issues and lack
support. he also reported that what would have knowledge of the number do for him.
checking blood glucose levels is essential to control the alterations and manage the
symptoms of the disease (Scanlon et al., 2014). But in the case of Mr. Jackson, this would
be difficult there is a possibility that Mr. Jackson would not support nurses in the regular
blood glucose check-ups. As the patient needs health care services at his home and
manages daily activity on his own, this increases the chances of patient falls. an older
patient with chronic health issues often develops aggressive behaviors due to continuous
check-ups and drug administration (Salz and Witkin, 2015). This may hinder nurses to
provide effective care and proper management of medication in the case of Mr. Jackson.

DR 6
The patient is prescribed with metformin which provided to control the blood sugar level in
diabetes. Patient with nonadherence to the treatment of diabetes often experience
worsening pf their health condition. In diabetic retinopathy controlling blood sugar level is
essential. as Mr. Hank is not adhered to the drugs accurately, there is a possibility
that his right eye might also be affected in future.
Interprofessional plan and nurses
The Aged Care Assessment Team (ACAT) can support Mr. Hank and his carers to
determine what type of provision will best encounter their requirements when they are
stressed in their present living situation. The health care team, frequently including a doctor,
nurse, community worker and occupational therapist (Hellquist et al., 2012). Using an
interprofessional approach in case of Mr. Jackson can have may benefits such as improving
patient care and outcome, reduce medical errors, start the treatment faster in case of any
emergency, decrease inefficiencies and health care costs, and improve team relationships
and work in a collaborative manner. For Mr. Jackson, the team will involve diabetes
specialists, eye specialists, physiotherapists, social workers, community nurses, and
nutritionists. A diabetic specialist physician would help the nurses to guide nursing care in
order to control his blood sugar level. An eye specialist will support the care of eyes and
vision issues is that it cannot affect the eye of the patient. Either the ophthalmologist (a
clinician who can treat eye difficulties both pathologically and surgically) or the optometrist
(someone who is skilled to manage primary care of patient’s eye, for example, how healthy
the eye emphases or helping identify more severe difficulties; optometrists are not actually
medical doctors) must check patient’s eyes minimum once a year. Diabetes problems can
disturb the blood containers in the eyes, which can result in losing eyesight (Kapustin, 2012).
As the patient agrees to perform the daily exercise as he has enough time because of his
retirement, a physiotherapist can assist Mr. Jackson with different exercises that can be
beneficial to control his blood sugar levels and overall health. Social workers can also play a
key role in Mr. Hank’s case. A social worker can take care of the legal and ethical issues
that may arise during the treatment process. He or she can advocate the patient about
different financial support provided by the government and non-government organizations.
There are different health care services being freely provided by government bodies to older
individuals. A social worker can inform Mr. Jackson about such services. Management of
diabetes retinopathy needs nutritionist support to regulate blood glucose levels. It has been
reported that with the proper and controlled diet one can control their diabetes more
effectively (Thomas et al., 2015). A nutritionist may assist Mr. Hank in mage his daily diet. A

DR 7
registered dietitian or nutritionist is competent in the arena of nutrition. Food is an important
part of the diabetes treatment, so a dietician will help the patient figure out his food needs
based on his weight, lifestyle, medicine, and other well-being goals (Hellquist et al., 2012).
Role of nurse
A nurse can play a key role in facilitating the interdisciplinary approach of care to Mr.
Jackson. There are two different nursing diagnostic problem, one was the difficulty with the
regular eye check-up and the patient's nonadherence to the medication. These issues might
be arising as the patient is not able to cope with the stress and depression that occurs with a
chronic health issue. a registered nurse can educate Mr. Jackson about adhering to the
treatment and check his blood sugar level (Spurr et al., 2018). She can provide enough
information about the importance of regular blood glucose levels and performing exercises.
A nurse can also provide emotional support. as the patient is living alone for many years,
there is a possibility that he develops stress, thus providing psychological support can help
him to recover rapidly. Nurses equipped with the different skills necessary to develop a
therapeutic relationship with the client. The therapeutic relationship is the association
between the patient and the nurse. It helps the patient to feel empowered in the treatment
process. it helps the nurse to receive complete support from the patient. It has seen reported
that patients feel more satisfied when they feel that they are being cared for (Blows,2015).
Nurses can use some skills such as active listening, empathy, cultural knowledge to develop
a therapeutic relationship with Mr. Jackson.
Conclusion
Diabetic retinopathy is defined as the complication of diabetes that affects the eyes of an
individual. This can affect individuals with type 1 or type 2 diabetes. Mr. Jackson is a 64-
year-old male diagnosed with DR and has a history of diabetes and hypertension. the
primary medical diagnosis for him may include the use of drops to dilate the pupil for
observation, or assessing symptoms of DR. the diabetic retinopathy is the result of damage
to the small blood vessels and associated neurons in the retina pert. The patient has seen
prescribed with Metformin and Metoprolol. Metformin is prescribed for diabetes and
Metoprolol is provided for hypertension. Both drugs have a different mechanism of action
and may cause nausea, upset stomach, blurry vision, and sweating. There are two different
problems may arise during nursing diagnosis: one is difficulty irregular check-ups and lack of
belief in the treatment prices. Including an interprofessional plan or ACAT can help the
patient to recover rapidly. The healthcare team will involve, a community nurse, nutritionist,
physiotherapist, a diabetes specialist, and social workers. A nurse can help in implementing

DR 8
an interdisciplinary approach to care. She can provide emotional support to the patient, and
develop a therapeutic relationship with the patient. She can also educate the patient about
medication management and self-care.

DR 9
References
Aroda, V.R., Knowler, W.C., Crandall, J.P., Perreault, L., Edelstein, S.L., Jeffries, S.L.,
Molitch, M.E., Pi-Sunyer, X., Darwin, C., Heckman-Stoddard, B.M. and Temprosa, M., 2017.
Metformin for diabetes prevention: Insights gained from the diabetes prevention
program/diabetes prevention program outcomes study. Diabetologia, 60(9), pp.1601-1611.
Blows, P., Peto, T. and Mbulawa, K., 2015. Empowering patients with diabetic
retinopathy. Community eye health, 28(92), p.s14.
Cohen, S.R. and Gardner, T.W., 2016. Diabetic retinopathy and diabetic macular edema.
In Retinal Pharmacotherapeutics (Vol. 55, pp. 137-146). Karger Publishers.
Diabetes Prevention Program Research Group. 2015. Long-term effects of lifestyle
intervention or metformin on diabetes development and microvascular complications over
15-year follow-up: the Diabetes Prevention Program Outcomes Study. The Lancet Diabetes
& endocrinology, 3(11), 866-875.
Hammes, H.P., Feng, Y., Pfister, F. and Brownlee, M., 2011. Diabetic retinopathy: targeting
vasoregression. Diabetes, 60(1), pp.9-16.
He, F., Xia, X., Wu, X.F., Yu, X.Q. and Huang, F.X., 2013. Diabetic retinopathy in predicting
diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis.
Heffernan, K.S., Suryadevara, R., Patvardhan, E.A., Mooney, P., Karas, R.H. and Kuvin,
J.T., 2011. Effect of atenolol vs metoprolol succinate on vascular function in patients with
hypertension. Clinical cardiology, 34(1), pp.39-44.
Hellquist, K., Bradley, R., Grambart, S., Kapustin, J. and Loch, J., 2012. Collaborative
practice benefits patients: an examination of interprofessional approaches to diabetes
care. Health and Interprofessional Practice, 1(2), p.3.
Jiménez-Báez, M.V., Márquez-González, H., Bárcenas-Contreras, R., Morales-Montoya, C.
and Espinosa-García, L.F., 2015. Early diagnosis of diabetic retinopathy in primary
care. Colombia Médica, 46(1), pp.14-18.
Kapustin, J., 2012. Collaborative Practice Benefits Patients: An Examination of
Interprofessional Approaches to Diabetes Care.
Price, A., Raheja, P., Wang, Z., Arbique, D., Adams-Huet, B., Mitchell, J.H., Victor, R.G.,
Thomas, G.D. and Vongpatanasin, W., 2013. Differential effects of nebivolol versus
metoprolol on functional sympatholysis in hypertensive humans. Hypertension, 61(6),
pp.1263-1269.

DR 10
Salz, D.A. and Witkin, A.J., 2015. Imaging in diabetic retinopathy. Middle East African
journal of ophthalmology, 22(2), p.145.
Scanlon, P.H., Aldington, S.J. and Stratton, I.M., 2014. Delay in diabetic retinopathy
screening increases the rate of detection of referable diabetic retinopathy. Diabetic
Medicine, 31(4), pp.439-442.
Spurr, S., Bullin, C., Bally, J., Trinder, K. and Khan, S., 2018. Nurse-led diabetic retinopathy
screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal
peoples. International journal of circumpolar health, 77(1), p.1422670.
Tang, J. and Kern, T.S., 2011. Inflammation in diabetic retinopathy. Progress in retinal and
eye research, 30(5), pp.343-358.
Thomas, R.L., Dunstan, F.D., Luzio, S.D., Chowdhury, S.R., North, R.V., Hale, S.L., Gibbins,
R.L. and Owens, D.R., 2015. Prevalence of diabetic retinopathy within a national diabetic
retinopathy screening service. British Journal of Ophthalmology, 99(1), pp.64-68.
Wu, L., Fernandez-Loaiza, P., Sauma, J., Hernandez-Bogantes, E. and Masis, M., 2013.
Classification of diabetic retinopathy and diabetic macular edema. World journal of
diabetes, 4(6), p.290.