Primary medical diagnosis
a) Nursing problem related to medical diagnosis
b) nursing problem related to medication treatment
Nursing role and interprofessional plan of care
The ISBAR handover framework relates to getting acquainted with the healthcare scenario of a person for interacting with a patient before the care user can be provided with adequate care as per the special care needs. In other words, it identifies what the role of the nurse is to bring a recovery in the condition of the patient. The first component is to understand the critical problems that the patient is facing. In this case, it has been shown the Jackson is facing Diabetes mellitus which is a health threat in itself.The next is to observe the patterns faced by Jackson and understanding the role of the nurse to take care of dealing with Jackson. First, she has to check all the records which signify the health status of Jackson.
After that, she has to update it regularly and keep it in the proper documented form so that she can pass it on to her senior doctor. ISBAR clinical Framework works in successive stages. The fourth stage is to check the clinical history of Jackson to find out if he can have any other medication or treatment rather than the existing one. The case study highlighted that Jackson has been suffering from Diabetes and high blood pressure and therefore the nurse should plan and carry out effective treatment of medication and discharge planning. The last would be to assess the overall health scenario and check whether there has been any improvement or any intensity of health risk like that of heart attack for Jackson(Dujic et al., 2016).
Careful study on the case history of Jackson has shown that he had suffered from Diabetes mellitus 25 years ago and high blood pressure 7 years ago from the present day. The purpose of this report is to bring betterment in Jackson’s condition through aged care intervention and support. His condition is far from being stable and because of this, he has lost the power of his vision of his left eye. Immediate measures to be taken towards diabetic retinopathy so that his condition does not degrade. He has to maintain a stable diet. All such risks have to be carefully dealt with immediately. In this case, there are abnormal blood pressure and glucose level variations. The registered nurse must involve at least two other members from within the HSC for improved care delivery to Jackson
Patho-physiology and diabetic retinopathy of Jackson indicate that he cannot see with his left eye due to prolonged diabetes which has impaired his vision ability. The polyol will be checked to acquire more information on the type of diabetics ie (type 1 or 2) and associated problems like that of a sudden cardiac arrest, or blindness. Finally, it has been shown that Mr. Hank Jackson has an extremely high blood pressure i.e. 159 mm/Hg in contrast to the normal blood pressure which is 120/80mm/Hg. Further, his glycated hemoglobin content or HBA1C is 8% while in normal male individuals it should be below 5.7%. Even in the case of individuals who are suffering from pre-diabetic conditions, the rate is between 5.7 % to 6.7%(Kuan et al., 2017) . All these reasons indicate that he needs urgent medication. While judging from either situation, it can be analyzed that Jackson is going through a serious stage that cannot be ignored
Identifying the medication procedure that Jackson is currently following, it can be understood by the nurse that he is under medication of 500mg metformin of daily dosage, meant to be taken twice every day and 50mg metoprolol to be taken twice every day. He has to take his meals on time urgently and has to maintain a steady level of blood pressure and glucose. He is aged 64 years of age with blindness on his left eye. Therefore urgent clinical intervention is required in terms of aged care intervention measures by the nurse to her patient i.e. Jackson.
On the other hand, prolonged use of metformin or metoprolol has taken simultaneously can cause bring negative implications upon a patient. In most cases when patients have this inconstant amount, they fall drowsy or dizzy and often complain about headaches and nervousness. At the same time, patients also face nausea or abnormal hunger, confusion or weakness and many other associated problems that have to be avoided. This is probably the main reason why he lost his job, i.e. due to certain impairment of his vision. During the last context, he lost his driving license. Under such a situation, the nurse has to be proactive and to understand what medicine can be used to replace content intake of metformin and metoprolol for Jackson so that his health status can be recovered.
Literature-based reviews from Google Scholar have shown that metoprolol decreases the amount of Plasma exposure that is otherwise to be there within healthy men. When metformin and metoprolol are used simultaneously, the two medicines tend to react and combine, which results in negative implications upon the patient like variation in blood pressure level, variation in lactic acid and uric acid levels. In lieu of this, the nurse should strictly check and also advise Jackson that he should try to take care of himself by alternate activities. First of all, he should not consume alcohol which can bring him closer to cardiac arrest (McDowell and Boyd 2018). As a mechanism of action, Jackson should take his meals on time, and then take metformin and metaprolol, so that his body can absorb the medicines well.
a) Nursing problem related to medical diagnosis
Because of all abnormality conditions checked within Jackson, he is most likely to face increased viscosity as a result of cardiovascular disease related risks. In addition to this, the cardiovascular system will show much likeliness of abnormality. At present, his blood pressure level is 159/96 mmHg, has to be controlled immediately. In a normal healthy male, the glycated hemoglobin content is around 5.7%, while the hemoglobin content measured for Jackson was as high as 8%. In his case, it is abnormal and the glucose level can also should be checked. Due to all these conditions, he may face a stroke, or even face blindness on his right eye anytime. Therefore, he has to bring a check on his eating habits (he eats anything he finds on the road while driving his truck), change his lifestyle habit( be careful in diet and sleep), as suggested to him by his nurse (Ishizawa et al., 2016). At this point if his blood pressure is not brought under control, he can get completely blind in future.
b) nursing problem related to medication treatment
Pharmacology reports suggest that the intake of metoprolol and metformin for Jackson at the same time has to be checked. There are possible chances that it could lead to cardiac arrest in him, and it is even serious as he stays alone most of the time. Some of the threats are variation in lactic acid and juric acid levels leading to lactic acidosis. Usually, metoprolol tartrate and metformin belong to the essential groups of 472 drugs, as indicated in clinical reports, which act as serious Beta-blockers. Once they enter into the human body, they can abruptly bring negative implications starting from high blood pressure or angina to sudden cardiac arrest within the patient at any time. So the nurse has to be careful about Jackson (Mut-Vitcu et al., 2016).
The role of a registered nurse is to perform certain nursing diagnoses, through an inter-professional approach which can help to bring a recovery in the condition of the patient (like Jackson in this case). The nurse has to first of all, bring down the level of glucose and blood pressure to normal. He needs nursing intervention whereby the nurse needs to check about his meals that he has regularly so that he can maintain normality within his body. He should not continue to be overweight. At present, he seems to be bulky, with a flushed appearance on his face. Overall this can be done by making notes of his health status and seeking the support of some other caregiver within the HSC/community care service for the aged. She can refer the case to another junior nurse or doctor who may try to understand the condition of Jackson and supporting him by providing necessary intervention all the time (Chatterjee et al., 2017).
For example, to control the blood pressure of Jackson, the nurse should take another junior nurse who should be able to keep track of the glucose level of Jackson daily. Here, the collaborative care approach would work well.
She can even take the help of the nurse who will be able to record the rhythmic heartbeat and blood pressure rate of Jackson daily, without missing any information or abnormal changes. Here too, the collaborative care approach would work well. after this, the information will be passed on to the registered nurse and the cardiologist.
So, interprofessional collaboration is a part of nursing that talk about working collaboratively by seeking the help of other care providers by understanding the situation of a patient collectively, and getting facilitated in the decision-making process as well as in providing adequate support to any patient immediately, within any clinical scenario. Here it will help Jackson.
Therefore, the role of the junior nurse, in this case, would be to record the level of glucose and the role of the cardiologist would be to track across the changes in rhythmic patterns of the heartbeat rate of Jackson all of which is not possible to be handled by the registered nurse alone (Katende and Becker 2016).
Apart from that, the registered nurse will also have to keep a check about the patterns in the Pharmacology reports as well as the pathophysiology reports of Jackson. If there is any abnormality found, then she has to seek clinical advice or intervention from her senior doctor who can monitor Joseph, help him to take medicines on time, as he is already partially blind. Also, she has to understand that Jackson needs support and care in terms of emotional/psychological attachment also, and not just clinical intervention, just like any other patient.
Therefore, by maintaining the duty of care, she should be able to develop good emotional bonding with Jackson implying a positive nurse-patient relationship, which will help him to feel comfortable within the HSC, and in turn, cooperate with her during all medical/medication processes and recover faster. Community care aims to provide urgent care to patients who are facing risks from serious health problems. Again, a registered nurse administers all medication and clinical processes to verify if they are appropriate or needs to be monitored and modified.
The case study has also added that Jackson leads a solitary life, away from his family members, because of which he will even feel isolated and depressed to stay within this HSC setting when his treatment is going on. At this point, the nurse must care for him like a mother so that Jackson can stay comfortable, as well as emotionally stable throughout his stay within the HSC setting. She has to talk more and understand what Jackson wants to say or help him by any means possible. For example, if Jackson wants to go out and feel the fresh air during the afternoons, then there should arrangement of the second nurse, who can accompany Jackson to walk within the HSC premises. In case he is thirsty, the nurse should provide water and in case he forgets to have his medicines on time, she or her two members, should help him by giving him medicines on time. This kind of clinical intervention can help him to recover faster. All these suggest that she has to assist the patient nin daily activities or has to make referrals so that allhis needs are met (Wolk and Cao 2017).
This piece of document has discussed how aged nursing care can be made effective for elderly people who suffer from serious health complications, like the present case study discussing Mr. Hank Jackson. He is aged 64 years, and he has been leading careless life as a truck driver, far away from his family for quite some time now.
He has been diagnosed with high blood pressure variations in his glucose level as well as blindness on his left eye. In this situation, he has to be prevented so that there is no degradation of health that takes place further. The registered nurse has to undergo primary medical diagnosis to understand how he can cope with the problems. For example, she has understood that prolonged intake of metoprolol and metformin can affect the body, rather than doing good. It is the duty of the registered nurse, to develop a professional care plan.
She can refer it to somenurse who can record his health status and pass on to cardiologist and senior doctor for collective care delivery to Jackson. The nurse will help to check blood pressure and heartbeat rate of Jackson, check and keep a note of glucose level in his body daily and send the report to the cardiologist, the registered nurse and senior doctor. All this will help them to understand whether there is any improvement in his clinical physiology. Additionally, the nurse should understand the psychology of Jackson and make some effort so that he can perform daily activities, and comfortable within the HSC setting (Ma et al., 2016).
Chatterjee, S., Khunti, K. and Davies, M.J., 2017. Type 2 diabetes. The Lancet, 389(10085), pp.2239-2251.
Dujic, T., Causevic, A., Bego, T., Malenica, M., Velija‐Asimi, Z., Pearson, E.R. and Semiz, S., 2016. Organic cation transporter 1 variants and gastrointestinal side effects of metformin in patients with Type 2 diabetes. Diabetic Medicine, 33(4), pp.511-514.
Ishizawa, K., Babazono, T., Horiba, Y., Nakajima, J., Takasaki, K., Miura, J., Sakura, H. and Uchigata, Y., 2016. The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). Journal of Diabetes and its Complications, 30(4), pp.597-602.
Kooienga, S. and Wilkinson, J., 2017, January. RN prescribing: an expanded role for nursing. In Nursing forum (Vol. 52, No. 1, pp. 3-11).
Katende, G. and Becker, K., 2016. Nurse-led care interventions for high blood pressure control: Implications for non-communicable disease programs in Uganda. International Journal of Africa Nursing Sciences, 4, pp.28-41.
Kuan, Y.C., Huang, K.W., Lin, C.L., Hu, C.J. and Kao, C.H., 2017. Effects of metformin exposure on neurodegenerative diseases in elderly patients with type 2 diabetes mellitus. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 79, pp.77-83.
McDowell, J. and Boyd, E., 2018. Community diabetes nurse specialists: Service evaluation to describe their professional role. British journal of community nursing, 23(9), pp.426-434.
Ma, Y.R., Rao, Z., Shi, A.X., Wang, Y.F., Huang, J., Han, M., Wang, X.D., Jin, Y.W., Zhang, G.Q., Zhou, Y. and Zhang, F., 2016. Simultaneous Determination of Metformin, Metoprolol and its Metabolites in Rat Plasma by LC–MS-MS: Application to Pharmacokinetic Interaction Study. Journal of chromatographic science, 54(1), pp.1-9.
Mut-Vitcu, G., Timar, B., Timar, R., Oancea, C. and Citu, I.C., 2016. Depression influences the quality of diabetes-related self-management activities in elderly patients with type 2 diabetes: a cross-sectional study. Clinical interventions in aging, 11, p.471.
Wolk, B. and Cao, K., 2017. Medications matter: a case of metformin-associated lactic acidosis. In B56. CRITICAL CARE CASE REPORTS: ICU TOXICOLOGY (pp. A3774-A3774). American Thoracic Society.
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