-Health Of Older Adults

Clinical Scenario

Mr Hank Jackson is a 64-year-old newly retired truck driver, who has recently been diagnosed with diabetic retinopathy and is legally blind in his left eye. Mr Jackson has a medical history which includes type 2 diabetes mellitus (diagnosed five years ago) and hypertension (diagnosed 7 years ago). Mr Jackson’s doctor has prescribed Metformin 500mg twice daily and Metoprolol 50mg twice daily. Mr Jackson lives alone, in his own home. He is a self-described bachelor, but he has a daughter who lives interstate, from a relationship he had in his 20s.

The referral from the General Practitioner (GP) indicates that he has suboptimal blood pressure and diabetes control, despite medication management and recommended dietary control. The last blood pressure recorded was 159mmHg/96mmHg and his glycated haemoglobin (HbA1C) has never been less than 8%.

Mr Jackson lives in a single-storey home, with a sunken living room and an outdoor veranda leading to a large, overgrown garden. Each room of the home appears cluttered, with ‘keepsakes’ from overseas travels and old newspapers stacked in piles in each room of the home.

On general appearance, Mr Jackson appears overweight and has a flushed facial appearance. He wears glasses for reading and says that he loves to read but has been having trouble recently and describes his vision as ‘patchy and blurred’. On questioning, he does admit to feeling ‘fuzzy in the head’ if he forgets to take his tablets, but otherwise feels that he is in good general health. He states that he has “never been sick a day in my life” and only retired because he lost his drivers’ license due to his impaired vision. Mr Jackson does not routinely test his blood glucose levels at home and expresses doubt that this would help him, saying: “what would knowing the numbers do for me? The doctor already knows the sugars are high”. Mr Jackson has been trying to lose weight for the past 6 months, without success; but feels that he has more time for exercise now that he is retired

Mr Jackson wants to remain in his own home, that he has lived in all his adult life, and takes pride in his cooking and making his own home-brew. He will require an interprofessional community plan of care.

Task

1.Based upon the clinical scenario provided above, construct a case report which is a detailed report of the client’s clinical presentation, nursing diagnosis and inter-professional plan of care. The case report will draw upon your knowledge of pathophysiology, pharmacology and relevant academic literature to support an evidence-based plan of care.

2.Using the ISBAR clinical handover framework, introduce the client and provide a brief overview of their case. Provide an outline of the purpose and structure of the report.

3.Identify the primary medical diagnosis for the client (i.e. Diabetic Retinopathy). Provide a brief description of the pathophysiology of Diabetic Retinopathy, with clear links to the case scenario. Support this discussion using current literature (last 10 years).

4.Identify the current medications prescribed for the client. Provide a brief description of the medications (i.e. mechanism of action, indication, side-effects and precautions). Support this discussion using current literature (last 10 years).

5.Using your knowledge of pathophysiology, document one (1) nursing problem that may arise as a result of the client’s primary medical diagnosis. This problem may be an actual or potential nursing problem. Provide a brief description for why this problem may arise for this client. Support this discussion using current literature (last 10 years)

6.Using your knowledge of pharmacology, document one (1) nursing problem that may arise as a result of the client’s current medications. This problem may be an actual or potential nursing problem. Provide a brief description for why this problem may arise for this client. Support this discussion using current literature (last 10 years).

7.Discuss the aim for and importance of using an interprofessional approach. Discuss the role of the Registered nurse to facilitate the interdisciplinary plan of care for this client. Identify the key members of the interprofessional health care team, and the role that they would play, specific to the two identified nursing diagnoses. Support this discussion using current literature (last 10 years)