Nursing Diagnosis and Medication Management for Diabetic Retinopathy and Hypertension

This document provides information about the nursing diagnosis and medication management for a patient with diabetic retinopathy and hypertension. It discusses the primary medical diagnosis, medication management, nursing diagnosis, and inter-professional plan of care. It also highlights the role of registered nurses and key members of the inter-professional healthcare team.

NURSING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Primary medical diagnosis..........................................................................................................3
Medication management.............................................................................................................4
Nursing diagnosis........................................................................................................................6
Inter-professional Plan of Care...................................................................................................7
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10

INTRODUCTION
ISBAR is basically the clinical framework which is mainly created for improving safety
as well as ensuring the effective treatment to patients. It is a tool for safe transfer of the patient
information within clinical handover.
Identify
Mr Jackson is 64 year old truck driver who has retired and has been diagnosed with the
diabetic Retinopathy. Mr Jackson mainly lives alone in house and is self-described bachelor. He
has daughter who lives interstate.
Situation
Mr Jackson has been diagnosed with diabetic Retinopathy and hypertension. Mr Jackson
have blurred vision due to diabetic Retinopathy. Besides this, Mr Jackson is also suffering from
overweight due to excess of blood sugar.
Background
Mr Jackson had a medical history where he was diagnosed with type 2 mellitus five years
back and hypertension 7 years back. Due to negligence of Mr Jackson, this type 2 mellitus took
the form of diabetic Retinopathy and resulted in impaired vision.
Assessment
For treating the two major medical conditions which were hypertension and diabetic
Retinopathy, doctors recommended two medications which are Metformin and Metoprolol in the
amount 50 mg. The last blood pressure which was being recorded was around
159mmHg/96mmHg. Besides medication, the dietary requirements of Mr Jackson was given
utmost importance.
Recommendation
For preventing the emergence of similar situation or diseases in the future, Mr Jackson
should focus on eating healthy diet having less sale for overcoming risk of hypertension. Besides
this, Mr Jackson should also daily check his diabetes and weekly consult his doctor for reducing
the risk of death and other issues.
MAIN BODY
Primary medical diagnosis
Although Mr. Jackson is basically suffering from multitude of diseases like diabetes,
hypertension, overweight, impaired vision but the primary medical condition which has been

diagnosed is Diabetic Retinopathy. Initially, five years ago Mr Jackson was diagnosed with type
2 diabetes mellitus which has now taken the form of diabetic Retinopathy. This is the primary
disorder which has become the cause of other diseases and problems like hypertension, impaired
vision etc (Bragadóttir, Kalisch and Tryggvadóttir, 2017).
Diabetic Retinopathy is basically the medical condition as well as disorder which is
complication of diabetes and thus mainly affects eyes. This generally causes a damage to blood
vessels of light-sensitive tissue which is present at back of retina. This condition can even lead to
blindness if not treated at time. People who suffer from diabetes generally develops this eye
disease. When the sugar levels in blood increases then the blood vessels within retina swells and
starts to leak and thus stopping the flow of blood through the vessels. This is one of the major
cause of impaired vision within Mr Jackson. This condition mainly develops within patients who
has either type 1 diabetes of type 2 diabetes. When this diabetes persists for long period of time
then this leads to high blood sugar and thus develops into diabetic Retinopathy. Now in this case,
Mr Jackson was diagnosed with type 2 diabetes mellitus five years ago which Mr Jackson took
lightly and did not take effective treatment. This diabetes mellitus started to increase within Mr
Jackson over the time and blood sugar level slowly raised in Jackson within these five years.
This blood sugar level began to affect the blood vessels within retina and thus took the form of
diabetic Retinopathy leading to impaired vision in Mr. Jackson. Besides this, overweight also led
to increased level of blood sugar within Jackson and thus affected the eyes badly (Sharma and
Dhar, 2016).
Medication management
The medications which has been prescribed to Mr Jackson by the senior doctors are
Metformin and Metoprolol.
Metformin
Mechanism of action
Metformin is antihyperglycemic agent which lowers basal as well as postprandial plasma
glucose. This medication reduces production of hepatic glucose, decreases intestinal absorption
of glucose and enhance insulin sensitivity through raising peripheral uptake of glucose as well as
its utilization (Spry, 2016).

Indication
Metformin is generally used for treatment of the patients having non-insulin-dependent diabetes
mellitus which is type 2 diabetes. Metformin can be combined with the different antidiabetic
agents. It is mainly used for lowering down the blood sugar within patients (Ellis, 2018).
Side-effects
The major side effects of Metformin are
 Blurred vision
 Confusion
 Anxiety
 abdominal pain
 Stomach discomfort
 fever
 Muscle pain
Precautions
 The patient should take Metformin with a meal in order to reduce risk of the stomach
upset. Besides this, patients should take it once along with the evening meal
 The dosage of Metformin should be splitted throughout day in order to improve the
gastric side effects like nausea, indigestion etc.
Metoprolol
Mechanism of action
Metoprolol is generally beta 1-selective adrenergic receptor blocker. This tablet basically
have beta-blocking activity and thus inhibits beta 2 adrenoreceptors which are mainly located
within bronchial as well as vascular musculature. This is the selective beta-1 blocker which is
derivative if succinate as well as tartrate and thus reduces the risk of various heart related
diseases (Fischer, 2016).
Indication
Metoprolol is basically used along with or without the other medications for treating a
high blood pressure. This basically reduces the risk of hypertension by reducing blood pressure
for preventing strokes and heart attacks. This medication is mainly used for treating chest pain as
well as improving the survival of patient from heart attack (Reed and Shearer, 2017).
Side-effects

The various side-effects of this tablet are
 Tiredness
 constipation
 breathing problems
 diarrhea
 bradycardia
 hypertension
 slow heart rate
 extreme fatigue
Precautions
 This tablet should be taken after the evening meal in order to avoid the various side
effects.
 The dosage of Metoprolol should be taken as advised by doctors as each and every
patient has different needs of the tablet
 The patient should not drink alcohol during the course of Metoprolol for avoiding
constipation and breathing problems.
Nursing diagnosis
Nursing problem in medical diagnosis
One of the major problem which nurse might face while treating Mr Jackson is the lack
of communication. As Mr Jackson is suffering from multitude of the problems like Diabetes,
overweight, impaired vision and hypertension thus nurse might face problem in effectively
interacting with patient regarding his medical history, diseases and disorder etc (Kelly and
Symonds, 2017). The nurse might face the problem in deciding that which medication to provide
to patient due to lack of proper communication with Mr Jackson. Thus lack of communication
might pose a great impact on the health of Mr Jackson as well as on the work of nurse. This
problem may arise due to lack of proper communication of nurse with Mr Jackson during
primary diagnosis. When nurse will not properly interact with the patient then nurse will not be
able to know that what kind of problem the patients suffering from and what are their medical
history.
Nursing problem in medication management

One of the major problem which nurse might face related to medication is lack of proper
knowledge as which medication or treatment to provide. As doctor of Mr Jackson has prescribed
for Metformin as well as Metoprolol thus nurse might face problem in knowing that what other
treatment needs to be given to the patient besides the medications recommended by doctor.
Besides this, nurse might face the issue of effectiveness of treatment strategies as nurse might
find it difficult to analyze that which treatment or other medication will help in speedy recovery
of Mr Jackson (Thomas and Revell, 2016).
The major reason behind the emergence of this problem is lack of proper knowledge and
communication with patient and senior doctor. When nurse will not have enough knowledge
about the various treatment strategies as well as medications like its dosage level then this
problem might occur. Besides this, when nurse will not appropriately interact with senior doctors
and Mr Jackson regarding which medication have been taken and how frequently then this
problem may takes place (Hardin and Kaplow, 2019).
Inter-professional Plan of Care
Mr Jackson is mainly suffering from hypertension and diabetic Retinopathy.
Diabetic Retinopathy
This disease is mainly diagnosed with the dilated eye exam. In order to treat diabetic
Retinopathy in Mr Jackson, Photocoagulation will be one of the effective treatment. This is focal
laser treatment which eventually helps to stop leakage of the blood as well as fluid within eye. In
this procedure, leaks from the abnormal and distorted blood vessels are generally treated with the
laser burns (Presti, 2016).
Hypertension
Hypertension is mainly diagnosed by measuring the blood pressure. The last blood
pressure which was recorded in Mr Jackson was around 159mmHg/96mmHg. The most
effective treatment which will be given to Mr Jackson for treating hypertension is proving a
healthy diet to patient. As Mr Jackson wants to remain within his house thus nurse will provide
healthy diet to patient having less salt (Bragadóttir, Kalisch and Tryggvadóttir, 2017).
Aim
The main aim of this suing this inter-professional approach as well as providing the plan
of care is to provide effective treatment to Mr Jackson at home and ensure the speedy recovery.
Importance

The major importance using this inter-professional approach is that it Mr Jackson will
receive an effective treatment and specific attention from the entire health care team. As the
health care team will consist of different care providers thus this will help to provide professional
treatment and medications to the patient. Besides this, another importance of using inter-
professional approach is that it will help to provide the better outcomes to Mr Jackson by
reducing the medication error as well as advising the various strategies to patient on the health.
Under the care of professional healthcare team, medication errors will highly reduce and this will
help in speedy recovery of Mr Jackson (Sharma and Dhar, 2016).
Role of registered nurse
The registered nurse who has been appointed by the healthcare organizations to provide
special emphasis on patient has a great role to play and is the major link between patient and its
disease. In the case of Mr Jackson, the registered nurse will mainly play a great role by provide
array of services to the patient. This nurse will take care of the various requirements of Mr
Jackson like dietary requirements, medication dosage etc and will serve as integral entity for
proving effective treatment to Mr Jackson (Spry, 2016).
Another role which this registered nurse will play is educating Mr Jackson about his
medical conditions and providing information on various preventive measures which can be
taken to avoid recurrence of similar disorder like hypertension, diabetes (Ellis, 2018).
Key members of inter-professional healthcare team
Key members in inter-professional healthcare team are physician, doctor and nurses.
Doctors
The major role which doctors will play in case of Mr Jackson is diagnosing the levels of
diabetes in patient on daily basis and recommending the proper medication for treatment.
Besides this, doctors will also play an important role in changing medications weekly whenever
they realize that existing medication is not resulting in recovery (Fischer, 2016).
Nurses
There will be 2 nurse among which one will be registered nurse for whole time and
another will serve as helping hand for that nurse. The major role of nurse will be ensuring the
proper treatment of Mr Jackson. Nurse will basically ensure that patient is given proper
medication in correct dose. Besides this, nurse will take care of various dietary requirements of
Mr Jackson

Physician
The main role of physician will be to regularly check the blood pressure of Mr Jackson in
order to prevent hypertension and hypotension. Physician will help to provide better guidance
and advise to nurse as what medication has to be given to Mr Jackson, at what frequency and in
how much amount. Besides this, Physician will also help to recommend various physical
exercises for reducing overweight (Reed and Shearer, 2017).
CONCLUSION
It has been summarized that Mr Jackson is mainly suffering from two major diseases
which are hypertension and diabetic Retinopathy. Diabetic Retinopathy is one of the major cause
of hypertension and impaired vision due to which Mr Jackson has now become blind from the
left eye. In order treat these two disorder in Mr Jackson, doctors have recommended tow
medications which are Metformin and Metoprolol. These two medications basically helps in
reducing the blood sugar as well as blood pressure within the patient. In order to provide
effective treatment to Mr Jackson, an inter-professional plan will be given to Mr Jackson which
will help in efficient diagnosing and will help top provide proper care to patient.

REFERENCES
Books & Journals
Bragadóttir, H., Kalisch, B.J. and Tryggvadóttir, G.B., 2017. Correlates and predictors of missed
nursing care in hospitals. Journal of clinical nursing.26(11-12). pp.1524-1534.
Ellis, P., 2018. Leadership, management and team working in nursing. Learning Matters.
Fischer, S.A., 2016. Transformational leadership in nursing: a concept analysis. Journal of
advanced nursing.72(11). pp.2644-2653.
Hardin, S.R. and Kaplow, R., 2019. Cardiac surgery essentials for critical care nursing. Jones &
Bartlett Learning.
Kelly, A. and Symonds, A., 2017. The social construction of community nursing. Macmillan
International Higher Education.
Presti, C.R., 2016. The flipped learning approach in nursing education: A literature review.
Journal of Nursing Education.55(5). pp.252-257.
Reed, P.G. and Shearer, N.B.C., 2017. Nursing knowledge and theory innovation: advancing the
science of practice. Springer Publishing Company.
Sharma, J. and Dhar, R.L., 2016. Factors influencing job performance of nursing staff. Personnel
Review.
Spry, C., 2016. Essentials of perioperative nursing. Jones & Bartlett Publishers.
Thomas, L.J. and Revell, S.H., 2016. Resilience in nursing students: An integrative review.
Nurse education today.36. pp.457-462.