Case Report: Aged Care Assessment of Mrs. Jane Summers - Nursing

This case report presents a comprehensive analysis of Mrs. Jane Summers, a 64-year-old retired woman with diabetic retinopathy and blindness in her left eye, assessed by a community nurse. Utilizing the ISBAR framework, the report introduces Mrs. Summers' case, outlining the purpose and structure of the assessment. It delves into her primary medical diagnosis, detailing the pathophysiology of diabetic retinopathy and the implications of hyperglycemia. The report explores Mrs. Summers' medication management, including metformin and metoprolol, explaining their mechanisms of action. It then identifies nursing diagnoses related to her condition, such as potential risks associated with medication and sensory perception disturbances. The report also outlines the nursing role and inter-professional plan of care, emphasizing the importance of patient education, balanced diets, and injury prevention. The inter-professional team model of care, including doctors, nurses, and pharmacists, is discussed, highlighting their collaborative efforts in providing comprehensive care. The report concludes by emphasizing the need for a thorough diagnosis, appropriate medication management, and a well-coordinated care plan to improve Mrs. Summers' health and well-being.

CASE REPORT

Table of Contents
INTRODUCTION...........................................................................................................................3
Primary medical diagnosis..........................................................................................................3
Medication management.............................................................................................................4
Nursing diagnosis........................................................................................................................1
Nursing Role and Inter-professional Plan of Care......................................................................2
CONCLUSION................................................................................................................................3
REFERENCES................................................................................................................................4

INTRODUCTION
Aged care assessment team refers to the medical group in which different nursing allied
health professionals can access psychological, vital, social, cultural, and physical about helping
them in a better condition regarding the health and care to their patients with an appropriate level
of support. Person-centered care is the one in which there is a need to provide health care to the
patient and analyze and support them all the time. In this report, there is an introduction about
the plan and optimal person-centred nursing care and interpretation of clinical information. There
is also discussion about pathophysiology evidence-based clinical practice. ISBAR refers to the
standardized approach which is related to communication that can be used in any situation. This
ISBAR stands for introduction, Situation, Background, Assessment, along with a
recommendation. This can help to get better treatment during the nursing practice to the patient.
Here the patient is Mrs. Jane Summers, who is 64 years old and has retired from her office work.
She is diabetic retinopathy and blind with her left eye. She lived alone and described herself as
an independent woman. She is the one who has two children from her old marriage one is a boy,
and another is the daughter, and they live nearby. This report aims to understand the medicals
scenario and recommend the best medicine management that can have a better impact on her
health (Wang, 2018).
Primary medical diagnosis
There is some discussion about the primary diabetic retinopathy in which there are there
diagnosed using the comprehensive dilated eye exam. In this, some drop of medicine is placed in
the eye where an eye should be widened with pupils, providing the doctor's better view into
inside looks. This drop can let the vision blur for several hours and can get normal after several
hours automatically. There is a need to afraid of this condition which is caused for the diagnosis
for better treatment and for knowing the situation better. This primary diagnosis doctor may look
for abnormal blood vessels, growth of new blood vessels, scar tissue, retinal detachment,
abnormalities in optic nerve, swelling, blood, or fatty deposits in the retina. There could also be a
view for the vision, look for the evidence of cataracts' chances, and measure eye pressure for
glaucoma test (Altmann, 2018).
There is some information about the pathophysiology, which is there for diabetic
retinopathy. This one is recognized by microvascular disease. Here, Hyperglycemia plays an

essential role in the pathogenesis of damage of retinal microvascular. There is the implication of
metabolic pathways resulting in hyperglycmia-induced vascular injury, including the polyol
pathway, protein kinase, advanced glycation end products accumulation, and hexosamine
pathway. There are retinal blood vessels and blood flow changes in the earliest response of
retinal blood vessels. Pericyte loss can also be cause for early events of DR. in addition to
Pericyte loss, apoptosis of endothelial cells, and there is a thickening of basement membrane
there which able to detect the pathogenesis of DR. that is collectively contributed with
impairment of BRB.
Moreover, there is a loss of endothelial cells, which results in capillary occlusion along
with ischemia. Retinal Hypoxia can lead to up regulation of VEGF that is through activation of
hypoxia-includible factor 1. There is also some evidence that phospholipase A2's elevation under
the diabetic condition can trigger the up regulation of VEGF. This is the critical factor that
involves a progression of PDR and DME that is believed to increase vascular permeability.
There is enhanced expression of VEGF detached in the retina and can leads to vitreous patients.
Medication management
For the Mrs. Jane summer used to take some the medicine which is related with diabetes
mellitus which is diagnose five year ago. The hypertension which is diagnose for the seven year
ago. As per this, the doctor prescribed the drug metformin 500 mag and metoprolol which is
taken 50 mg twice the daily. This drug is used to take under the condition of Mrs. Jane summer
and this help to show to reduce the complication. In addition to this, the metformin is a drug used
for the diabetic patient. As per this, Summer face issue with the diabetes and this drug help to
provide the proper relaxation from the disease.
Mechanism of action: In this, metformin decrease blood glucose level by declaring the hepatic
glucose production. Moreover, it help to increase the peripheral glucose which is usually provide
an order to uptake and utilise the glucose. This is well established that the metformin which help
to inhibit the complex 1 activity. The above process which help to lead in decrease of blood
glucose which help to manage the type two diabetes and this help to create the positive effect in
the glycemic control.
After the ingestion of drug, the organic transporter-1 is responsible for the uptake of the
metformin which is comes under the conditions of hepatocytes which is called as liver cell. As
per this, some of the drug is positively charged. It allow the plasma membrane as well as the

mitochondrial inner membrane. Metformin inhibit the mitochondrial complex 1, which help to
prevent the production of the mitochondrial ATP which is used to enhance the cytoplasmic ADP
and ATP. Overall, they used to enhance the anaerobic glucose metabolism in the cell.
As per this, metoprolol is sold under the drug name lopressor, this is selective beta
blocker medication. This is used under the high blood pressure, chest pain and this help to know
the poor blood flow to the heart.
Mechanism of action: The metoprolol which is act as the beta 1 selective which is called as the
adrenergic receptor blocker. This is well indicated that the effect is no longer and however, with
the higher risk of plasma concentration. Metoprolol is used to inhibit the beta 2 adrenoreceptor
which is situated in the position of bronchial and vascular musculature.
Nursing diagnosis
As per this, the patient, Mrs. Jane summer, used to take nursing diagnosis to eradicate the
patient's issue. In context with this, the patient faces various problems which are related to this.
In this, the patient identifies the different loops and segments targeted to create the fraction,
which helps Mrs. summer (Cavan and et al., 2017). Some of the nursing problems which is
related to the patient are:
Moreover, this is used to provide to take the little food and do excessive physical activity,
which is also exacerbated, helping to do the complication. There are some factors such as they
used to maintain the glucose level over this. Some of the alteration, which is level to manage of
the consequence, enables the function of the central nervous system. In this, some of the risk
factors associated with this are that they create the chemical alteration specific in the glucose,
insulin, or electrolyte, which is powered in this and makes the factor electrolyte imbalance
(Platania and et al., 2018).
One of the problems related to medication management is that some drug therapy is
undertaken, which is probably helpful in this context. Intravitreal triamcinolone comes under the
intravenous position, which may be caused by diabetic macular edema. An intravitreal anti-
vascular enothelial growth factor is an act in anti-VEGF, which helps reduce diabetic macular
edema. Some of the drugs taken in the combination are NVD and NVE. Some medicines, such as
Bevacizuman, which is called Avastin, and Ranibizumab called the Lucentis, which is accessibly
helpful in the working of antibody and antibody fragment, also called anti-VEGF, respectively.
There are various factor which is accessible and create the issue of intravitreal injection (Zhang

and et al., 2019). In context with this, Aflibercept (Eylea) is also used to provide Mrs summer
with diabetic macular edema. As per this, in this case, the as overviewing the context of
pathophysiology. This is well-identified that during diabetic retinopathy. The patient must
maintain their blood glucose. In this context, the saturation of the blood glucose is essential for
this. To keep the blood glucose, it is crucial to control the factor associated with hypertension
and others. In this, the risk of disturbed sensory perception is defined as the patient taking the
insulin or oral hypoglycaemic agent at risk, which is used to create hypoglycemia.
Nursing Role and Inter-professional Plan of Care
In this, the inter-professional team model of care usually shows the different health
professionals associated with the physicians, nurses, diabetes educator, and pharmacist. As per
this, they are used to create the fraction of and do their work in collaborative form to reduce
diabetes care. This all used to provide the services and also they are not do any unusual activity.
As per this, the healthcare team is usually acting in various team members' scope, and this all is.
Some healthcare team members look to include doctors, physicians assistants, nurses,
pharmacists, dentists and technologists, and technicians (Spencer and et al., 2020). As per this,
various factors are used to manage this by providing the course. In this, they must be taking care
of their proper motivation and another factor associated with this. This is all well associated with
the element. As per the above discussion, this is well identified that the nursing situation. Some
of the nursing intervention which is used to determine is and mentioned above.
Provide proper knowledge: As per the nursing diagnosis, Mrs. Jane summer must know
their self-management. This is used to provide self-care and provide the proper knowledge and
skill, which is helpful for a longer duration. In context with this, they are used to provide a care
plan which is accessible for this. The care plan is used to provide self-management, which helps
eradicate the function and is abnormal. The abnormality is used to create various positions, and
all factors are well designed and used to create a peculiar part in the body. These all are
eradicated by using self-management and or by educating the patient for their number of
correlation. Nurses used to provide the proper medication and accurate time for their care. The
nurses give their patients quality care, such as Mrs. Jane summer (Porwal and et al., 2018).
Avoid the risk of injury and provide a balanced diet: In this case, they must avoid risky
work to manage the damage. As per this, any harm, in this case, take a more extended time to
heal. In context with this, they used to take a balanced diet and make a proper diet chart

regularly. This all helps develop the appropriate diet to make an energetic path used to allow and
provide better support. These all are used in such an account; all are used to create the drug
regimen based on a proper diet plan (Ting and et al., 2017).
CONCLUSION
From the above discussion, it can be concluded that there is a need to diagnose and have
the primary medication. There is a need to know diabetic retinopathy, which can provide a better
diagnosis and the related pathophysiology. There is also medication management for diabetic
retinopathy concerning giving the patient better treatment and better health. There are some
nursing problems which is connected to medication management. There is also discussion about
the nursing role and the inter-professional plan of care for the patient. There is also the creation
of an inter-professional plan for the client. There is also discussion about a registered nurse
concerning a plan for interdisciplinary care for a client.

REFERENCES
Books and Journals
Cavan and et al., 2017. The diabetic retinopathy barometer study: global perspectives on access
to diabetic retinopathy screening and treatment experiences. Diabetes research and
clinical practice, 129, pp.16-24.
Platania and et al., 2018. Computational systems biology approach to identify novel
pharmacological targets for diabetic retinopathy. Biochemical pharmacology, 158,
pp.13-26.
Porwal and et al., 2018. Indian diabetic retinopathy image dataset (IDRiD): a database for
diabetic retinopathy screening research. Data, 3(3), p.25.
Spencer and et al., 2020. Pericytes, inflammation, and diabetic retinopathy.
Inflammopharmacology, 28(3), pp.697-709.
Ting and et al., 2017. Optical coherence tomographic angiography in type 2 diabetes and diabetic
retinopathy. JAMA ophthalmology, 135(4), pp.306-312.
Zhang and et al., 2019. Automated identification and grading system of diabetic retinopathy
using deep neural networks. Knowledge-Based Systems, 175, pp.12-25.
Wang, 2018. Diabetic retinopathy: pathophysiology and treatments. International journal of
molecular sciences, 19(6), p.1816.
Altmann, 2018. The role of microglia in diabetic retinopathy: inflammation, microvasculature
defects, and neurodegeneration. International journal of molecular sciences, 19(1),
p.110.
Online:
Diabetic Retinopathy: Pathophysiology and Treatments, (2018). [Online] Available through
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032159/>