Case Report on Mr. Hank Jackson: Diabetic Retinopathy and Hypertension

This case report presents a detailed analysis of Mr. Hank Jackson, a 64-year-old retired truck driver with a diagnosis of diabetic retinopathy and hypertension. The report begins with an introduction to Mr. Jackson's medical history, including his type 2 diabetes diagnosis and current medication regimen. The primary medical diagnosis of diabetic retinopathy is explored, detailing its causes, stages, and potential complications. The report then delves into medication management, outlining various treatment options such as photocoagulation, vitrectomy, and the use of vascular endothelial growth factor inhibitors. A nursing diagnosis is provided, highlighting the risk of unstable blood sugars, imbalanced nutrition, and imbalanced blood volumes, with a focus on the challenges posed by Mr. Jackson's lifestyle. The nursing role and inter-professional plan of care are then discussed, emphasizing the importance of a collaborative approach involving the patient, family (if applicable), and healthcare professionals. The care plan includes assessments for hyperglycaemia, retinopathy progression, and patient education. The report draws upon relevant academic literature to support an evidence-based plan of care and provides insights into the nursing interventions and strategies needed to effectively manage Mr. Jackson's condition and improve his health outcomes.

CASE REPORT 1
Mr HANK JACKSON CASE REPORT
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CASE REPORT 2
Introduction
Mr Hank Jackson, a 64-year-old, is a self-prescribed bachelor and a retired truck driver living in
his home in Australia. Jackson lives in a single storey building alone. Mr Jackson is also entirely
blind in one eye and says apart from that he has never been sick. Mr Jackson was diagnosed with
diabetic retinopathy and hypertension seven years ago. He was diagnosed with type 2 diabetes.
After this diagnosis, Jackson’s doctor prescribed metformin 500mg and Metoprolol twice per
day. The referral letter indicated that Mr Jackson has suboptimal blood pressure which may have
come up due to poor management of hypertension. This shows that Mr Jackson had not been
paying attention to his medication. Despite the medication, Mr Jackson's blood pressure was
recorded at 159mmHg/96mmHg, and his glycated haemoglobin has never been less than 8%
(Gargeya, and Leng, 2017). This was an indication that the two diseases were poorly managed.
Despite this problem, Mr Jackson feel that he is alright in terms of health and says that he only
feels fuzzy in the head when he forgets to take the medications. The major problem with Mr
Jackson is that he doesn't take a reading of his blood sugars, he feels that it would be of no help
to do the readings daily as the doctor knows that his blood sugars are already high.
Primary medical diagnosis
Diabetic retinopathy is a complication that affects people by affecting their ability to see. It
damages the blood vessels of the eye's light-sensitive tissues. This condition causes Mr Jackson's
blurred eyesight. He says that he gets some mild vision problems when he is reading. Diabetic
retinopathy affects both type 1 and types 2 diabetes, especially if the blood sugars are not in
constant observation and control (Duh, Sun, and Stitt, 2017). Concerning Jackson's case, he says

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that he thinks it's of no use to take a measure of his blood sugars, this may be leading to his
condition.
Diabetic retinopathy mostly occurs to patients who have had diabetes for a long time like Mr
Jackson. However, it has been sighted in people who have just contracted the disease due to
some other medical history. Early diabetes retinopathy is called non-proliferative diabetic
retinopathy. In this stage, the blood vessels are not growing. These vessels become blocked and
may cause some severe eye disorder.
In advanced diabetic retinopathy, new abnormal blood vessels start growing and causing some
jelly-like substance to clog the centre of the eye. Scar tissues arise as a result of the new blood
vessels and may damage the retina by detaching it from the back of the eye (Solomon et al.
2017). At this stage, the patient is at risk of suffering glaucoma by causing damage to the nerves
that carry images from the eye to the brain.
Mr Jackson is in the very first stages of diabetic retinopathy and needs medical attention before
it's too late. If Jack’s condition is not controlled, it may keep getting worse due to his poor
control over his blood sugars and hypertension. To ascertain that the reason why Mr. Jackson has
blurred vision; he needs to take a comprehensive eye exam from an expert. During the exam, the
eye doctor will take note of any abnormal blood vessels in the eye. If there are new blood vessels
which are growing unusually, it means that Jack's condition is a little advanced. Bleeding and
some jelly-like substance in the eye, abnormal optic nerve and a detached retina are also signs of
advanced retinopathy.
After taking a look at these signs, the doctor will test the eye by using some simple ways like
reading a statement or word on different fonts. The eye pressure of Jack will also be taken to
determine whether the condition has developed into glaucoma (Stitt et al. 2016).

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Medication management
After all these tests, Mr Jackson will be taken through fluorescein angiography where the doctor
injects some dye in the patient's eye and watches for the veins that are blocked and those that are
leaking. In this process, the doctor will take images and then study them to pinpoint those vessels
that are affected. Besides, the doctor may also carry out an Optical Coherence Tomography
(OCT) exam. In this exam, images showing the thickness of the retina are taken. These images
help to know the fluid levels in the tissue and to detect any leakages. The OTC exams are later
on used to monitor treatment of the eye.
The type of treatment for this condition depends on the type of diabetes that the patient is
suffering and the stage of retinopathy. For patients with early-stage retinopathy, the procedure is
not done right away. Instead, regular check-ups are advised so that the doctor can determine
when the patient needs treatment (Pratt et al. 2016). This may be the case with Mr Jackson, apart
from seeing an eye specialist, he will also work with his diabetes doctor to manage the condition
even better this will help slow the rate at which the retinopathy develops.
For patients with advanced retinopathy, the best treatment is to have eye surgery. However, there
are several alternatives for this process before the retinopathy develops into macular Edama
where the patient must go through eye surgery. One of them is photocoagulation which is a laser
treatment that slows down the leakage of fluids in the eye. This treatment is carried out by a
doctor in just one session (Ahangar et al. 2016). Focal laser treatment may also be carried out
after surgery to prevent the macular Edama from becoming worse.
The other type of treatment is pan-retinal photocoagulation. This type of therapy also uses laser
just like photocoagulation. Its primary difference with photocoagulation is that it uses scattered
laser to kill abnormal blood vessels in the eye. After the procedure, the patient goes through

CASE REPORT 5
some blurred vision in the first few days and possible night blindness. Vitrectomy is another
procedure for correcting retinopathy (Doenges, Moorhouse, and Murr, 2016). In this procedure,
an incision is made in the patient's eye, the blood in the eyes to monitored and removal of all
other scar tissues.
Lastly, the doctor may prescribe medicines that are to be injected in Jack's eye; these medicines
are known as vascular endothelial growth factor inhibitors. As their names suggest, the drugs
help in inhibiting the growth of vessels in the eye and thus reducing the risk of abnormal vessels
growing. Some stand-alone treatments like anti–VEGF therapy, which helps slow the
development of diabetic retinopathy (Ellis, 2020). If Jack’s condition is found mature enough for
surgery, he will be going through some therapies that will help in recovery.
Nursing diagnosis
A nursing diagnosis is a clinical judgement that a nurse makes in response to health problems,
either actual or potential health problems on patients, family and the community at large
(Hardiker et al. 2017). The most significant of them being the risk of Jack having unstable blood
sugars. As we saw in the case study, Jack's lifestyle may be a considerable hindrance to his
health status. In the nursing diagnoses for diabetes, is fluid balance and nutrition for the patient,
this will turn out to be trouble for the nurse who will be involved with Mr Jack’s case. This type
of diagnosis is called hypoglycaemia nursing diagnosis.
The risk of imbalanced nutrition will also be high for Jack’s case, as he has no caretaker. For a
patient like Jack, who is struggling with weight issues, the nurse has got faced with a massive
task of making sure that the patient follows the diet to the letter. Failure to do so, Jack will be
increasing the chances for his retinopathy to advance. This risk is most common in patients who
have type 1 diabetes or insulin-dependent patients.

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The other risk is that of imbalanced blood volumes. This happens as a result of increased blood
sugars where the body tries to get rid of them through excessive urination, sweating and having a
lot of thirsts to keep the sugars diluted (Carroll, 2019). This, in turn, brings about an imbalance
in the body electrolytes.
Lastly, diabetic patients may develop a condition whereby they have some impaired skin
integrity and may not realise when they are injured. Neuropathy is a condition that inhibits the
skin or reduces the amount of pain felt on the surface. This increases their risk of developing an
ulcer or a wound. Patients with neuropathy take long to heal their injuries due to lack of an
essential white blood cell that fights bacteria in the wounds. For this reason, nurses are urged to
take a keen look at health management of diabetes as it might be challenging to manage this
disorder.
Nursing role and inter-profession plan of care
A care plan is a strategic development that is created by nurses based on data that has been
collected on an individual patient (Bezze et al. 2020). In our case scenario, the nurse taking care
of Mr. Jack is required to create a goal for the care of Jack. The most significant plan being that
of the patient gaining his good health back the plan is one that will be recording all the progress
that is made by the patient. Mr Jackson's nurse will first be faced with an obligation to make sure
that all the disciplines involved with the patient participate in follow up activities of their patient.
The eye doctor who will be included in Mr Jack’s retinopathy will be required to do some follow
up on the patient to know their progress; this also applies to his specialist who is dealing with his
diabetes. This care plan will be specific for each patient as they share different sickness, and
various health disciplines are involved (Lemone & Burke's). Jack is a reasonably older person,
and thus the care that he will be given will depend on his wishes. For example, Jack says that he

CASE REPORT 7
likes living alone in his all adult life house and thus despite his condition, a caregiver shouldn't
be forced on him. It might be a little hard this way, but the decision of the patient and the family
are to be respected. This ensures that the patient and his caregiver have something to contribute
to the achievement of goals set. The ultimate care plan incorporates the perception of need by the
patient, family and the caregiver if there is one (Rees, 2019).
The plan requires the caregiving team to assess the patient every day and to recognise the type of
care they need in their road to recovery. For the Jacksons care plan, all the assessments and
recommendations are provided by each discipline and then a program is rolled out on how to
achieve the desired result (James et al. 2020). This includes the nursing diagnosis and their
intervention in the treatment of the diagnosis. Jacks nurse following the diagnosis above will be
required to assess for any signs of hyperglycaemia. If the amount of insulin in the patient's
system is inadequate, there will be an osmotic effect that will result in thirst and increased
urination. The patient may also complain of fatigue and some impaired vision.
The nurse will also assess the levels of blood glucose after meals and during bedtime. Jack's case
requires a regular look at the progress of the retinopathy by looking out for any signs of
advancements. In the nursing plan, Jack's knowledge on the conditions that he is faced with
should be of high priority to ensure that he knows the big list of dos and don'ts that he is faced
with (Dunning, 2016). This will enable the nurse to educate the patient all about the condition
and how to control it.
The nurse should also observe for any injuries in the feet so that they can be given further
attention to prevent them from developing into wounds. This is part of the involvement of the
nurse with the patient that ensure the patient takes care of his health and follows instructions
accordingly (Johnson et al. 2018).

CASE REPORT 8
Conclusion
Mr Hank Jackson a diabetic patient is found with some eye disorder that is causing blurred vision
when he is reading. Due to this condition, Mr Hank has to go see an expert in eyes so that he can
be treated. Although there are a number of treatment options, the patient is forced to wait until
the condition has advanced enough for treatment. The best treatment being eye surgery followed
by some therapies using laser rays. The alternatives to this treatment is medication which is not
preferred by doctors as it has not yet been fully proven to work for patients with diabetic
retinopathy. After the eye therapy, Mr hank will be required to be observant of his blood sugars
to prevent the condition from developing again. The nurse who is responsible for Mr Hank will
also be required to diagnose any risk that the patient is in and treat it accordingly. Apart from
that, they will also be required to create an inter-professional plan of care that will see Mr Hank
through to recovery and his blood sugars stable.

CASE REPORT 9
References
Ahangar, A.A., Saadat, P., Alijanpour, S., Gale, M. and Hosseinalipour, S., 2018. Post Ischemic
Stroke Complication: How Much Nursing Diagnosis Are Confirms by Neurologist. J Pat
Care, 4(140), p.2.
Bezze, S., Ausili, D., Erba, I., Redini, S., Re, S. and Di Mauro, S., 2020. Development of a
subset of ICNP Nursing Diagnoses for the promotion of self-care in people with diabetes
mellitus: a multi-center observational study. Annali di igiene: medicina preventiva e di
comunita, 32(1), pp.38-49.
Carroll, K., 2019. Bringing Nursing Care to Patients Living With Diabetes Mellitus. Nursing
science quarterly, 32(3), pp.187-188.
Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2016. Nursing diagnosis manual: Planning,
individualising, and documenting client care. FA Davis.
Duh, E.J., Sun, J.K. and Stitt, A.W., 2017. Diabetic retinopathy: current understanding,
mechanisms, and treatment strategies. JCI insight, 2(14).
Dunning, T., 2016. Assessing older people with diabetes in Australia. Diabetes Prim Care
Aust, 1(4), pp.1-6.
Ellis, P., 2020. Nursing diagnosis. Patient Assessment and Care Planning in Nursing, p.75.
Gargeya, R. and Leng, T., 2017. Automated identification of diabetic retinopathy using deep
learning. Ophthalmology, 124(7), pp.962-969.
Hardiker, N.R., Coenen, A. and Jansen, K., 2017. Nursing classification and care planning.
In Psychiatric and Mental Health Nursing (pp. 103-112). Routledge.

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James, Steven Brian Ernest. "Current and future services to support young adults with type 1
diabetes in Australia." PhD diss., 2017.
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