Nursing - Diabetic retinopathy

Nursing
Student’s name:
Institutional:

Diabetic retinopathy
Introduction
Mr Hank Jackson is a 64-year-old man who recently retired as a truck driver. The
reason for his retirement is impaired vision due to diabetic retinopathy as he reports he
has never been sick before. He has a past medical history of type 2 diabetes mellitus
diagnosed five years ago, and hypertension diagnosed seven years ago. He is currently
on medication for the two conditions he is taking metformin and metoprolol. However,
he does not measure his blood sugar at home as he reports that there is no need since
the doctor already knows that his blood sugars are high.
He lives alone in a single-storey home and enjoys cooking and making home brews. He
also likes reading but has been having problems due to impaired vision, and he has one
daughter who lives in interstates. He reports that he does not want to be moved from his
home, therefore, making it necessary for an inter-professional community plan of care.
The purpose of this report is to identify Mr Jackson's problems and be able to manage
them inter-professionally. The structure of the report will outline the introduction,
medical management of Mr Hank's condition, nursing management of his condition, the
role of a nurse in the inter-professional plan of care and finally the conclusion.
Primary medical diagnosis
Mr Hank’s primary diagnosis is diabetic retinopathy. Diabetic retinopathy is an eye
condition that is caused by damage of the blood vessels supplying the retina (a light-
sensitive tissue) of the eye (Solomon et al. 2017). This condition starts with mild vision
impairment and eventually leads to blindness either of one eye or both eyes. The main

contributing factors are diabetes, preferably uncontrolled blood sugar or hyperglycemia,
blood pressure and hyperlipidemia. The actual mechanism on how it causes
microvascular damage remains unclear, but multiple interconnecting biochemical
pathways have been proposed (Madams, Cuadrosand Kim 2016).
One of the pathways is the polyol pathway. In diabetes, this pathway metabolizes
excess glucose into sorbitol by use of an enzyme aldose reductase (AR) present in the
retina using nicotinamide adenine dinucleotide phosphate (NADPH) as the cofactor.
Since sorbitol is impermeable, it leads to the accumulation of sorbitol and fructose as it
is being converted slowly within the cell. This buildup of sorbitol is thought to have
multiple damaging effects in retinal cells, including osmotic effect. Another physiologic
change in diabetic neuropathy is increased thickness of the retinal capillary basement
membrane and leukocyte adhesion to endothelial cells (Li, Chen, Mei and Zhao 2019).
The use of NADPH in the pathway results in reduced NADPH available for use by
glutathione reductase, which is crucial for the generation of reduced glutathione. This
leads to reduced protection against oxidative stress and an increase in the production of
reactive oxygen within the cell. Reactive oxygen is known to cause cellular damage by
damaging lipids, DNA, RNA and proteins in the cell (Calderon et al. 2017). Glutathione
is an antioxidant in animals and plants. It prevents damage of important cellular
components caused by reactive oxygen species such as free radicals (Vina 2017). Mr
Hank’s has a past medical history of type 2 diabetes mellitus and hypertension, which
has been a problem controlling them (HbA1C 8%, Bb159/96 mmHg).
Medical management

Mr Hank is currently taking Metformin 500 mg twice a day and Metoprolol 50 mg twice a
day. Metformin is an antidiabetic drug of the biguanide class. It has multiple sites of
action and lowers blood sugar level by acting either directly or indirectly on the liver to
lower glucose production. It also acts on the gut to increase utilization of glucose and
increases GLP-1. It also lowers blood glucose levels by increasing muscle sensitivity to
insulin and can also alter the microbiome (Rena, Hardie and Pearson 2017).
Metformin is used to manage type 2 diabetes mellitus, especially in adults. The main
side effects include lactic acidosis, nausea and vomiting. Other side effects include
diarrhea, flatulence, asthenia, and reduces vitamin b12 serum concentrate. Blood sugar
level should be measure before giving metformin if hypoglycemic withhold the
medication (Seelig et al. 2017).
Metoprolol is a selective beta-1 adrenergic receptor blocker. It is cardioselective at
normal dosage. However, at high plasma concentration, it can inhibit beta-2 receptors
located at the arteries of skeletal muscles and bronchial muscles. Beta-1 receptors are
located in the heart. Their main function is to increase cardiac muscle contractility and
increase heart rate (Morris and Dunham 2018).
Metoprolol is used to manage hypertension, angina pectoris and prevention of
myocardial infarction and to lower mortality rate in patient with recurring MI. It can also
be used in managing stable symptomatic heart failure of class II and III. It can also be
used in combination with ACE inhibitors and diuretics. Its main side effects include
dizziness, depression, dry mouth and nausea. It can also cause tiredness, dry mouth,
vomiting, gas and bloating and stomach pain. Long-term use of metoprolol can damage