HealthCare - Primary Medical Diagnoses

Healthcare
Student’s details

HealthCare 1
Table of Contents
Introduction................................................................................................................................................2
Primary medical diagnoses.....................................................................................................................2
Early diabetic retinopathy....................................................................................................................3
Advance diabetic retinopathy..................................................................................................................3
Medication management Advanced diabetic retinopathy..........................................................................4
Metformin 500mg...................................................................................................................................4
Metoprolol 50mg...................................................................................................................................4
Nursing diagnoses....................................................................................................................................5
Nursing problem related to medical diagnosis..................................................................................5
Nursing problem related to medication management......................................................................5
Nursing Role and Inter-professional Plan of Care................................................................................6
Conclusion...................................................................................................................................................7
Bibliography................................................................................................................................................9

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Introduction
The given case works upon the study report a 64-year-old newly retired truck driver namely Mr.
Hank Jackson diagnosed with diabetic retinopathy which results in blind in his left eye. He has
history of 2 diabetes mellitus and hypertension’s medical history. He is taking medicine to
control both of the diseases. He is living alone for many years. According to his General
Practitioner (GP), despite of medications, he developed suboptimal blood pressure and diabetes
control. Jackson’s blood pressure and Glycated Haemoglobin is out of standard range and
besides these he had an overweighed body. However, he does not feel significant issues in his
health until he takes medicine properly.
This study aims to identify medical issues suffering by older people with specific focus on the
case study. Pathophysiology concerning Diabetic Retinopathy has been discussed in this given
study and discusses how it is associated with a case scenario. This discussion also covers
medication management such as the mechanism of action, indication, side-effects and
precautions regarding case scenario by reviewing the literature. An analysis of nursing issues in
medical diagnoses and medication management has been covered in this discussion. This
discussion also comprises the roles of nurses in healthcare and community care services and
along with the Inter-professional Plan of Care.
Primary medical diagnoses
In the above-discussed case scenario, Mr. Hank Jackson has been diagnosed with Diabetic
Retinopathy and hypertension. Diabetic retinopathy disorder is a physical condition of a person
that leads to eye complication due to diabetes impacts. It is a type of eye diseases that occur
due to diabetes is known as Diabetic retinopathy (Duh et al., 2017). It should be noted that high
level of sugar in the blood causes damage to blood vessels which results in retina

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complications. Also, high level of blood sugar in blood vessels causes dwelling and leaking of
blood vessels and this swelling and leaking subsequently stops blood supply into the retina
(Wang & Lo, 2018). Sometimes due to high blood sugar, abnormal new blood vessels grow
deformities in the retina and these deformities result in a blur and blind vision of the person.
Chances of Diabetic retinopathy increase over time and less control in blood sugar or on
diabetes. The major system of Diabetic retinopathy includes spots or dark strings floating in the
vision (floaters), Fluctuating and blur vision, dark areas in vision and extreme level vision losses
(Tarr et al., 2013). The Diabetic retinopathy has two stages or two types that affects the patients
differently.
Early diabetic retinopathy
This is the most common form of diabetic retinopathy which is known as non-proliferative
diabetic retinopathy (NPDR). In this type of diseases, development of blood vessels does not
grow and stop to develop. In the NPDR diseases, the wall of blood vessels of retina loosens the
strength and small microaneurysms protrude from the walls of the blood vessels that leads to
reducing the blood vessels. This sometimes create leakage of blood and fluid into the retina
occur (Tan et al., 2019). Besides this, larger blood vessels start to dilate which results in
irregular in diameter along with mild to severe irregularities and creates blockages in blood
vassals. Further, it creates swelling in nerve fibers retina, also in some cases, central part of the
retina which is known as macula starts swell which is a medical required condition (Shah &
Gardner, 2017).
Advance diabetic retinopathy
In the advance diabetic retinopathy progress to proliferative, this is a more severe type of
diabetic retinopathy. In this type of retinopathy, blacked blood vassals reflect retina as a jelly-like
substance and results in glaucoma in the eye. In the case of Mr. Hank Jackson blockage into
blood vassals of the retina of Mr. Hank Jackson led blindness in his eye (Singh et al., 2008).

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Medication management Advanced diabetic retinopathy
To control the blood sugar level and blood pressure of Mr hank Jackson, he has been
prescribed Metformin 500mg twice daily and Metoprolol 50mg. Metformin helps to control blood
sugar and Metoprolol helps to control blood pressure (WEBMD, 2020).
Metformin 500mg
Metformin is useful to treat patients with type II diabetes because of uncontrolled high blood
sugar damage to causes of kidney diseases, blindness, nerve problems, sexual functions
disabilities, and loss of limbs. Uncontrolled blood sugar also increases the chances of heart
attack or stroke (HHP, 2018). Hence, Metformin helps to body for proper response to insulin
and its natural production. Metformin also reduces the sugar amount produced by the liver and
absorbs by the stomach in the intestines. This medication needs to be followed by the proper
diet and exercise. Mr. Hank Jackson take these medicines twice a day according to prescription
of general practitioner for the best results. These tablets are available in oral form. Generally,
Metformin should not be taken if a person has kidney disease and metabolic acidosis. During
the time of x-rays or CT scan, the patient should temporarily stop the consumption of Metformin.
Using the Metformin sometimes gives some side effects such as breathing difficulty, muscle
pain, stomach pain, feeling cold, dizziness and feeling tired or weak. Low blood sugar, nausea,
and diarrhea are some other significant side effects of the medicine (Marín-Peñalver et al.,
2016).
Metoprolol 50mg
Metoprolol this drug help to control high blood pressure. Lowering blood pressure decrease the
risk of stroke and heart disease. Apart from controlling high blood pressure, the medication also
uses to treat angina and to improve survival after the chronic heart arrest. Metoprolol belongs to
a class of beta-blockers which blocks the action of some chemicals in the human body such as
epinephrine which works to improve blood vessels. Drowsiness, tiredness, diarrhea, dizziness

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and slower heartbeat are common side effects of Metoprolol. It is advisable that to reduce the
risk of dizziness and lightheadedness gets up slowing while rising from sitting and lying (Dézsi &
Szentes, 2017).
Nursing diagnoses
Nursing diagnoses are clinical judgment related to human responses on health issues and
condition or vulnerability for humans. Nursing diagnosis occurs during the nursing assessment
and that makes enables nurses to develop the care plan.
Nursing problem related to medical diagnosis
In the case of Mr. Hank Jackson, he is having diabetic retinopathy and hypertensive issues.
Thus, the most aggrieve potential nursing problem for the Mr. Hank is the risk for increasing
cardiac health risk. For a long time having high level of blood glucose due to diabetes could
damage to blood vessels that carry blood for the heart. Over time the blood vessel’s damages
due to having a high level of glucose, which leads to blocking the destruction in blood vessels
and this damage in blood vessels may end up with serious cardiovascular disease (WEB MD,
2020). Besides this, it increases the risk of high blood pressure, because, high level of blood
glucose reduces to nitric oxide in blood vassals and a shortfall nitric oxide increases the risk of
high blood pressure and the increased level of blood pressure also affects heart health. As high
blood pressure narrows down to blood vessels and blocks to blood supply which eventually
leads to heart attacks. Apart from this, the fatty body and inactive lifestyle of Mr. Hank Jackson
also increase the risk of cardiovascular health (Tian & Meng, 2019).
Nursing problem related to medication management
To control blood pressure and level of blood sugar Mr. Hank Jackson has been prescribed
Metformin 500mg twice daily and Metoprolol 50mg twice a day by his GP. Despite taking both
these medicines to control blood sugar and to control blood pressure, he is having high blood of

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blood pressure and a high level of blood sugar than to standard healthy levels. In medication
management, nursing diagnoses may find it challenging to manage depression. As he is living
alone for a longer time, therefore, we want to work on cancelling of his driving license because
his blindness would not allow him to work. Using the Metoprolol for a longer time may result in
depression. Reducing the risk of depression is a challenge for medication management for
nursing (Håkans, 2012).
Nursing Role and Inter-professional Plan of Care
Nurses play a crucial role in the healthcare system and community care system in the country.
In the country, a large number of people having multiple chronic conditions are requiring primary
care services and the involvement of the nurse also increasing with the increasing demand for
primary care service (Trisyani & Windsor, 2019). People especially old aged people having
complex healthcare issues demands for the demand of multi-disciplinary care and professionals
from various disciplines collaborate to provide healthcare to these people (Institute of Medicine
(US) , 2011).
Mr. Hank Jackson identified cardiac risk due to his increasing medical condition of diabetic
retinopathy and high blood pressure. Hence Mr. Hank Jackson needs a nurse who has
proficiency in diabetic’s control, would be able to manage cardiac health and blood pressure as
well. Besides these, he also needs a nurse to monitor a helper to improve his living conditions.
Thus, Mr. Hank Jackson requires an inter-professional team care plan because he needs a care
plan to consider his need for a medical condition, emotional and environmental. He is a retired
person thus he needs an economical support in care plan also.
Patient care planning encompasses a wide range of concepts, studies, and interventions. As
per the client’s needs, firstly, he need a nurse who can provide him suitable care and manage
his medications as well. He is taking two medications twice a day to control his medical

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condition. With the effect of Metformin, he also may develop dementia, thus a need for a nurse
who can take of his medication management and ensure that he is taking the medication
regularly, because when he skips the medication, he increases the chances of high blood and
high blood sugar.
With the medical support, he also needs emotional support, as the effect of Metoprolol patient
increase the risk of depression. Besides this, living alone with blindness also creates depression
with increasing secondary risk such as injury with sharpening objects, fallen from high objects
like stairs or chair or wet floor and these other kinds of risk. Hence, the nurse's care should also
provides him support to prevent him to get into depressive state due to the side effects of
Metoprolol and loneliness. The other medical diagnosed identified an increased risk of cardiac
health (Tanner, 2006). With the side effects of medicine, inactive lifestyle due to blindness,
obesity and controlled blood sugar and blood pressure leading the risk on cardiac health. Thus,
nursing care with proficiency in cardiac health is also an essential and required care for the old
ages people in the country. With the nurse's care support towards old people with such medical
condition also require community care services so as to increase socialization, to provide them
with cleaning care and hygiene care services and to help them into day to day activities
(Nancarrow et al., 2013).
So, the nurse plays various roles in providing healthcare services along with the overall well-
being of people. Nurses also play a role of primary medical diagnostic for existing and potential
health issues. Nurses play the role of an interconnected link between specialist professionals,
general practitioners, community care services and patients (Reinke, 2016). Hence, as per the
discussion it has been identified that nurses play several roles towards well-being of people. For
the quality care and patient centric services, nurses play inter-professional role in the care plan
specifically in mental healthcare in the country (Love, 2008). Inter-professional role of nurses
are interconnected and coordinating between nurses, pharmacists, physicians, psychiatrics
specialist and, social workers which are important for patients centric services. Thus, inter-

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professional roles of nurses create collaboration between various healthcare practices which
gives a team-based perspective to mental healthcare system of the country (Salmond &
Echevarria, 2017). According to a report of the World health organization, inter-professional
services, team working and multi disciplines care services in the mental healthcare services,
give a spirit of teamwork teach to respect to each other’s profession. This team working delivers
more effective care services that result in improvement in health outcome because multiple
disciplines delivers more effective services (Kieft et al., 2014).
Conclusion
Old aged people care is a most concerning topic across the world, specifically in the country
having a higher rating of graying population. This discussion compasses the medical condition
of a 64 old person who is having high blood sugar and high blood pressure history and suffering
from diabetic retinopathy. Although he is taking medicine proscribed by the general practitioner,
yet he needs an interdisciplinary care plan. He has been identified some nursing risk and
medication management risk due to adverse impacts of his medical conditions and side effects
of medical treatment. High blood glucose and high blood pressure are increasing the risk of
cardiac risk health, whereas his medication side effects also increases the risk of his mental
health and subsequently increasing the chances of depression.
Thus, to manage his health and give the patient a quality life, it is required to provide him a
multidisciplinary care plan including the care of cardiac nurse professionals, diabetic nurse
profession, metal nurse professional along with community care to improve socialization and
cleaning facility in his house.

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Bibliography
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Håkans, B.V., 2012. Nurses’ perception of nursing diagnosis. NI 2012 : 11th International Congress on
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