An ISBAR is a tool that helps to organize a conversation into important elements for information transfer from one source to the other. This tool is effective in clinical and non-clinical situations. The introduction includes the patient, Mrs. Nancy Winter, who is a 68-year-old retired office worker, and who has been diagnosed with a cataract that is on her left eye. The situation includes the patient has cataract in her left eye. The history includes a medical history of hypertension, which was diagnosed nearly 7 years ago, hearing loss, and type 2 diabetes. Assessment includes blindness and lack of knowledge regarding the administration of medication. And the recommendations include the involvement of an interpersonal approach, which includes psychiatrists, pharmacists, social workers, dieticians, nurses, physicians, etc. Support and assistance can help in improving their overall health.
The paper includes the primary medical diagnosis, medication management, nursing problems, and the care plan that involves a multidisciplinary approach (Gali, Sella and Afshari 2019). The paper focuses on the case study of Mrs. Nancy Winter and the involvement of a multidisciplinary approach in improving their overall health.
The primary medical diagnosis for the patient is cataracts in her left eye which is mainly due to the patient’s age. Senile cataract is an age-related cataract whose pathogenesis is multifactorial and involves a complex interaction among the physiological processes that are modulated by genetic, systemic, nutritional, and environmental factors (Kiziltoprak et al. 2019; Gali, Sella and Afshari 2019). A cataract occurs when the proteins present in the eye generate a clump that hits the lens and prevents it from sending a clear picture to the retina. With age, the lens of the eyes ages, and this increases thickness and weight while a decrease in power is witnessed. With the addition of a new cortisol layer in a concentric pattern, the central nucleus gets hardened and is compressed in a process termed nuclear sclerosis. The mechanism that leads to the loss of lens transparency includes age-related changes in the lens epithelium, mainly a reduction in cell density of the lens epithelium and differentiation of lens fiber cells (Kiziltoprak et al. 2019).
The cataractous lens experiences a reduction in apoptotic death, causing a decrease in cell density. However, a collection of small-scale epithelial losses results in modification in homeostasis and lens fiber formation, causing loss of lens transparency (Becker et al. 2018). Moreover, as the lens ages, a decrease in the rate at which water-soluble, as well as water-soluble low-molecular-weight metabolites, can enter the lens nucleus through the cortex and the epithelium occurs with a reduction in the rate of nutrient transport, water transport, and transport of antioxidants (Becker et al. 2018). All these contribute to the development of cataracts. In the case study, the patient was 68 years old, which is a major factor in the development of cataracts. With aging, the fibers and proteins in the lens start to break down, resulting in hazy or cloudy vision. Furthermore, the patient has diabetes and high blood pressure, which are the major risk factors for the development of cataract (Kiziltoprak et al. 2019).
Mrs. Winters has been prescribed Metformin 500mg twice daily and Metoprolol 25mg twice daily by her General Practitioner.
Metformin comes as an extended-release tablet, as a liquid, or as a normal tablet that can be taken by mouth. The mechanism includes the alteration of the cell’s energy metabolism. The glucose-lowering effect of metformin is exerted by opposing the glucagon action and inhibiting hepatic gluconeogenesis (Moin et al. 2018). The side effects associated with this drug are physical weakness (asthenia), bloating, constipation, diarrhea, gas (flatulence), low blood sugar (hypoglycemia), weakness, muscle pain (myalgia), upper respiratory tract infection, lactic acidosis (rare), abdominal pain, chest discomfort, chills, nausea, vomiting, dizziness, heartburn, etc. The precautions include the administration of medicine with meals to reduce bowel side effects. Avoid crushing, chewing, or breaking it. It must be taken with a glass of water. Blood, as well as urine tests, need to be done to identify unwanted effects (Moin et al. 2018).
Metoprolol is available as a tablet or extended-release tablet that needs to be taken orally. This drug can also be given as an infusion in the vein for a short time before switching to the oral route. Metoprolol is a beta-blocker that affects the heart and circulation. This drug is useful for treating hypertension and angina and it reduces cardiac output via negative chronotropic and inotropic effects. Side-effects associated with this drug include heartburn, runny nose, nausea, tiredness, lightheadedness, depression, dry mouth, vomiting, stomach pain, bloating, rash, constipation, etc. Adverse side-effects include wheezing, fainting, irregular heartbeat, difficulty in breathing, swelling of legs and feet, weight gain, etc. (Grassi 2018). Because this drug can exacerbate the symptoms of heart failure, it is critical to exercise caution when administering it to patients who have a history of heart failure. In Case of persistent discomfort or chest pain, extreme fatigue, dilated veins, etc. it is important to consult a doctor. It is important to avoid alcohol consumption while taking extended-release tablets (Schwartz et al. 2021).
One nursing problem is blindness. Cataracts are painless clouding on the internal eye lens, however, as they block the light from passing through the lens, resulting in blurred vision and, over time, the patient might suffer from complete blindness (Nizami, Gulani and Redmond 2021). Being unable to see clearly can impact the ability of the patient to perform their everyday activities. However, in the case study, the patient, Mrs. Nancy Winter, is a single woman who lives alone in a two-story terrace house. The patient described her vision as “patchy and blurred,” which could lead to a fall. However, as the patient lives alone, her home requires maintenance. Everything is scattered in the patient’s home and things are not maintained properly, increasing her risk of falling. Along with blurred vision, the patient is quite old, and managing everything on her own makes it difficult in such a condition, and being overweight further increases her risk of falling.
The patient might suffer from medication overdoes. As in the case study, it was highlighted that she often forgets to take her tablets with her morning tea, so she takes all of them together with glass of wine later. This is a potential problem because taking all the medications together can lead to medication overdose. A Metoprolol overdose can result in hypotension, myocardial depression, and the potential for cardiovascular collapse (Moin et al. 2018). Whereas metformin overdose can lead to lactic acidosis where the lactic acids buildup in the bloodstream, which further leads to irregular heart rhythm, coma, or shock, leading to deterioration in the quality of life of the patient (Grassi 2018).
In healthcare settings, interprofessional approaches are required to establish an integrated approach that promotes and maintains the health of the patient while improving healthcare delivery and its efficiency. In this case, the patient is old and she lives alone in a three-story building. The patient suffers from cataracts and, as a result, finds it difficult to perform everyday tasks. Involving an interprofessional approach can help in addressing all the needs of the patient and contribute to their overall mental as well as physical health (Nizami, Gulani and Redmond 2021).
The first nursing problem is blurred visions that increase the risk of falling, which can be reduced by helping the patient in performing their everyday activities and providing assistance to the patient while toileting, bathing, etc. Furthermore, the involvement of a psychiatrist is important as the patient is alone and she might require support and guidance to improve her life quality (Min et al. 2022; Al-Tammi and Alhamdan 2021). Involving a dietician is important for this patient as it will help in preparing a diet plan based on which the patient can get adequate nutrients that can help her to stay fit (Imsland et al. 2018). tThe nutritionist, will educate the patient on portion control and help the patient by prescribing a special diet for managing her weight as well as helping her with improved vision (Imsland et al. 2018). The nurse can educate the patient about the importance of undergoing cataract surgery, as this will help the patient to make the correct decision about the treatment (Strungaru et al. 2019). Informed consent needs to be obtained from the patient and her family as this will help in reducing the chances of facing any legal action. As the patient is suffering from blurred vision, the nurse can search for the personal as well as self-care items that are within the patient’s reach and orient her to their placement. Offering the patient their elbow to grasp while walking can help her believe that someone is trying to protect them (Nizami, Gulani and Redmond 2021).
Lastly, the nurse can involve the social worker so that individual support can be provided in a difficult time and ensure that the patient is safe with them. A geriatric social worker will encourage the client to pursue stimulating activities, as this can help the client cope with their issues (Kohutnicki et al. 2022). Moreover, a counselor is to be involved, which can include the patient and their family members and help them to understand the complications associated with cataracts and why it is important to undergo the surgical process (Min et al. 2022). Furthermore, the family is to be counseled so that they can provide support and care to the patient. As the patient cannot see things clearly, this can lead to immense stress and a sense of dependence. Therefore, a psychiatrist can be involved to identify any mental health issues so that an effective intervention can be proposed (Min et al. 2022).
The next nursing problem is drug overdose. The patient lacked knowledge regarding the importance of medication, and thus she took all medications together to compensate for the skipped morning dose of medicine. This can lead to a potential issue, which can be life-threatening. Timely and accurate medication should be administered to facilitate the recovery rate (Nizami, Gulani and Redmond 2021). Not taking metformin on time can result in uncontrolled levels of blood glucose that can lead to serious complications. Whereas metoprolol is used to treat high blood pressure, failing to take this medication on time can result in high blood pressure disrupting normal body function. The nurse can educate the patient about the complications associated with not taking medications on time (Nizami, Gulani and Redmond 2021). Furthermore, the nurse can help the patient with medication adherence by preparing a routine regarding the medication. The nurse can educate the patient’s son, who resides locally, about the medication, and a list is to be provided based on which her son can give accurate and timely medication to the patient. The nurse can refer the patient to the pharmacist so that the effectiveness of the medication can be evaluated (Nizami, Gulani and Redmond 2021).
Conclusion
The patient is old and has been diagnosed with a cataract. The patient has a history of hearing loss, diabetes, etc. and the two nursing problems include blindness and drug overdose. It is important to educate the patient about the medical condition and help them develop skills that contribute to the self-management of the condition. Involving the family members in the care plan is an effective approach to addressing the needs of the patient and providing additional support. Involving counseling can assist in managing the signs and symptoms of the patient’s medical condition and lowering the risk of a fall. It is recommended to involve a social worker to cope with aging. The mental health of the patient can be improved by involving them in group activities, communicating with them, and listening to their pain and suffering. This will help reduce the burden of negative thoughts and contribute to overall patient outcomes. Involving a pharmacist, dietician, psychiatrist, etc. can help to improve the patient’s health.
References
Al-Tammi, R. and Alhamdan, M. 2021. Psychosocial Support Provided for Old People during Coronavirus Crisis and its Relationship with Eudemonic Well-being. Dirasat: Human and Social Sciences, 48(4).
Becker, C. Schneider, C. Aballéa, S. Bailey, C. Bourne, R. Jick, S. and Meier, C. 2018. Cataract in patients with diabetes mellitus—incidence rates in the UK and risk factors. Eye, 32(6), pp.1028-1035.
Gali, H.E. Sella, R. and Afshari, N.A. 2019. Cataract grading systems: a review of past and present. Current opinion in ophthalmology, 30(1), pp.13-18.
Grassi, G. 2018. Metoprolol in the treatment of cardiovascular disease: a critical reappraisal. Current Medical Research and Opinion, 34(9), pp.1635-1643.
Imsland, A.K. Reynolds, P. Jonassen, T.M. Hangstad, T.A. Elvegård, T.A. Urskog, T.C. and Mikalsen, B. 2018. Effects of three commercial diets on growth, cataract development and histopathology of lumpfish (Cyclopterus lumpus L.). Aquaculture Research, 49(9), pp.3131-3141.
Kiziltoprak, H. Tekin, K. Inanc, M. and Goker, Y.S. 2019. Cataract in diabetes mellitus. World journal of diabetes, 10(3), p.140.
Kohutnicki, A.F. 2022. Peri-Operative Optimization: Social Determinants of Health.
Min, J.S. Jun, I. Ryu, S. Kim, E.K. Kim, T.I. and Seo, K.Y. 2022. Relationship between dry eye symptoms after cataract surgery and psychiatric status. The ocular surface, 23, pp.201-203.
Moin, T. Schmittdiel, J.A. Flory, J.H. Yeh, J. Karter, A.J. Kruge, L.E. Schillinger, D. Mangione, C.M. Herman, W.H. and Walker, E.A. 2018. Review of metformin use for type 2 diabetes prevention. American journal of preventive medicine, 55(4), pp.565-574.
Nizami, A.A. Gulani, A.C. and Redmond, S.B. 2021. Cataract (Nursing).
Schwartz, B. Pierce, C. Madelaire, C. Schou, M. Kristensen, S.L. Gislason, G.H. Køber, L. Torp?Pedersen, C. and Andersson, C. 2021. Long?Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study. Journal of the American Heart Association, 10(18), p.e021310.
Strungaru, H. Pereira, N. Salmonson, H. Nguyen, H. Rudnisky, C.J. Drader, K. Harris, K. and Damji, K.F. 2019. Optimizing preoperative requirements for outpatient cataract surgery at the Royal Alexandra Hospital. Canadian Journal of Ophthalmology, 54(3), pp.306-313.
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