Cataract Diagnosis in Mrs. Nancy Winter
This paper is a case report of a 68-year-old Mrs. Nancy Winter, a lady who is a retired office worker. Mrs. Winter is a self-described single woman who has 2 children, a son who is living locally and a daughter who is living interstate. Mrs. Winter lives alone with her dog in a two-story terrace house which needs cleaning and repair. Mrs. Winter has requested and would like to know her alternatives for aged care services. A community nurse visits her house to assess her. She has been recently diagnosed with a cataract in her left eye. She has reported feeling blurred vision and dizzy at times. Additionally, she has a medical history of hypertension, diabetes mellitus, and hearing loss due to otosclerosis. She has been taking Metformin and Metropol twice daily as prescribed to her by the GP. However, it is found that she is careless with her health which could have led to her present issues. She lives alone but due to her medical condition and careless attitude, needs someone to take care of her. An inter-professional community plan of care has been recommended to her based on her ACAT assessment. This paper will explore her primary medical diagnosis, medical management, nursing diagnoses, and the nurse’s role in an inter-professional care plan.
In her recent diagnosis, it was found that Mrs. Winter has a cataract in her left eye. Most cataract cases are caused by aging which causes changes in the tissue which makes the eye lens. Fibers and proteins present in the lens start to break down leading to cloudy and hazy vision. The case of Mrs. Winter indicates that she has some of the potential risk factors for cataracts including diabetes, hypertension, and obesity.
The most common cause for the development of age-related cataracts is the increase in lens’ oxidative stress. This oxidative stress can be attributed to diabetes mellitus (Nartey 2017). This happens because if blood sugar is left unchecked, it can cause damage to blood vessels in the whole body. There are tiny blood vessels in the eye that can also be damaged by high blood sugar in the aqueous humor (space between eyeball and lens which supplies oxygen and nutrients to the lens) leading to eye conditions like cataracts. When blood sugar levels are uncontrolled, it can cause the enzyme in the lens to convert glucose to sorbitol and a higher concentration of sorbitol in the lens can lead to vision loss (Basina 2021).
Moreover, there have been several explanations linking hypertension to cataracts. People with hypertension have been seen to have elevated plasma levels of TNF- α and IL-6 that are linked with intense inflammation with increased levels of C-reactive protein and foster the formation of cataracts. In addition, hypertension can also lead to conformational alterations in the lens capsule causing interference in potassium ions transportation in lens epithelial cells. This process ultimately leads to lens short-circuit current disorder that works to protect the development of cataracts (Yu et al. 2014). Hence, it can be drawn that Mrs. Winter’s age and medical condition (diabetes and hypertension) could have led to the development of cataracts.
Medical Management of Mrs. Nancy Winter
Currently, Mrs. Winter is taking Metoprolol 25 mg and Metformin 500 mg. Metoprolol is used both with or without medication for treating hypertension, myocardial infection, angina, atrial fibrillation, and atrial flutter (Morris & Dunham 2018). It belongs to the drug class called beta-blockers. This medicine blocks the action of several natural chemicals inside the body (like epinephrine) on the blood vessels and the heart. It relaxes blood vessels and slows the heart rate. The medicine can be taken both through oral as well as intravenous routes. It is a cardioselective beta-1 adrenergic receptor inhibitor that, when taken orally by adults in less than 100 mg doses, can effectively block beta 1-receptors without affecting the beta-2 receptors (Heusch & Kleinbongard 2020).
The side effects of metoprolol consist of depression, fatigue, bronchospasm, hypotension, bradycardia, dizziness, cold extremities, diarrhoea, hypotension, bronchospasm, tinnitus, and a fall in exercise tolerance, and a decrease in libido. Since the medicine may cause dizziness, it is advised that the person takes extra care while getting up and lying down to relieve these effects. Moreover, alcohol consumption should be avoided. Other medicines (prescription or non-prescription) should be avoided without discussion with doctors.
Metformin is used to control blood sugar levels. This medicine comes as a tablet, liquid, or an extended-release tablet to be taken by mouth. The regular tablet of this medicine is taken with meals twice or thrice a day while the extended-release tablet is taken only once with the evening meal. The medicine decreases glucose’s intestinal absorption and the production of hepatic glucose and enhances sensitivity to insulin by improving utilization and uptake of peripheral glucose (Dumitrescu et al. 2015).
Metformin’s indications include the prevention of type 2 diabetes, gestational diabetes, antipsychotic-induced weight gain management, and prevention and treatment of PCOS (Calette Corcoran & Jacobs 2018). The side effects include vomiting, nausea, weakness, gas, upset stomach, metallic taste in the mouth, and diarrhea. The precautions include taking the medicine with meals to help in the reduction of bowel or stomach side effects that generally occur in the treatment’s beginning. The tablet shall not be crushed, broken, or chewed. It should be swallowed with water.
The client has been diagnosed with a cataract owing to which she is facing blurred vision. Cataract surgery might be helpful for reversing cataracts caused by diabetes. However, a potential nursing problem that might arise as a result of the surgery is that high blood sugar can increase the risk of bleeding and infection as well as adversely affect wound healing (Basina 2021). Hence, preoperative counseling plays a crucial role. It should be ensured that before surgery, the patient shows evidence of periocular or ocular infections and have good glycemic control. In diabetic patients, there are certain organisms (like Enterococci, Klebsiella, and Staphylococcus aureus), that are more prevalent (Grzybowski et al. 2019). A thorough ophthalmologic examination must be done pre-surgery. Studies suggest that if better preoperative care is done (management of retinopathy, hypertensive and glycemic control, better technique for phacoemulsification), there are lesser chances of complications along with improved visual outcomes after cataract surgery in diabetics. But, Mrs. Winter is careless with taking medications properly and on time which can be a problem because a high blood sugar post-operation will be harmful to her.
Complications and Preoperative Counseling
The patient here is on metoprolol for hypertension. This is a beta-blocker medicine, the use of which has been linked to an increased likelihood of cataract surgery. This is because beta-blockade modifies proteins and alters the cellular balance of the lens which ultimately impacts lens transparency (Yu et al. 2014). This can pose a potential nursing problem. There is a study that suggests that beta-blockers can hasten the development of cataracts. Because of this, the ophthalmologist might recommend the doctors to change her medication to ACE inhibitors in place of beta-blockers. Moreover, the potential side effects of metoprolol consist of blurred and unclear vision (Mayo Clinic 2022). Mrs. Winters has already reported such symptoms. She has been feeling blurred and patchy. These side effects along with her cataract can be problematic to handle. Her bedroom too is on the second floor which can be a possible threat to her safety.
The interprofessional care plan is a shared and collaborative plan that includes joint care of the patient from an interprofessional medical team (van Dongen et al. 2016). This is done through joint input and shared decision-making. For a better healthcare plan with complete considerations of the patient’s medical conditions as well as health goals, an interprofessional team (healthcare professionals from different disciplines) communicate and collaborate on a regular basis to achieve the patient’s desired health outcomes.
The aim of interprofessional care is to improve patients’ health outcomes by using valuable insights and various unique perspectives of healthcare professionals from different disciplines. This helps to provide the team with a more comprehensive and holistic view of the patient’s conditions for a better patient-centred approach to care (Homeyer et al. 2018).
Interprofessional care also reduces medication errors that might occur as a result of a healthcare professional from one discipline not knowing about the other medical complications of the patient (Farzi et al. 2017). Due to the continuous communication between doctors, GPs, nurses, and pharmacists, these errors can be reduced to a minimum.
Furthermore, since the interprofessional care model helps to prevent errors in medication and improve medical outcomes, it leads to a better patient experience as well as decreased health costs. It also helps to start medical treatment faster because in healthcare, many times, treatment gets delayed because the patient waits for a physician who in turn is waiting for the consultation of another physician or for lab results from radiology. Interprofessional collaboration, due to the continuous and uninterrupted communication between the complete healthcare team of the patient, delivers the correct information to the correct person at the correct time.
Nurses play a key role in facilitating interprofessional care for patients. When a patient meets with multiple health practitioners including pharmacists, doctors, nurses, physical therapists, and social workers, it can lead to care overlap, charting errors, and misdiagnoses (Balogh et al. 2015). However, these can be avoided through effective communication which RNs can facilitate among the patient and the whole team.
Moreover, nurses can provide unique perspectives on the treatment plans of the patients (Molina-Mula & Gallo-Estrada 2020). They can partner and lead in teams across a spectrum of care including hospitals, public health, and home health. Nurses effectively identify any relevant information which will have to be reported to health professionals of different disciplines (De Baetselier et al. 2021). They review the care plan for ensuring continuity among disciplines. Hence, through continuous communication and collaboration, nurses facilitate interdisciplinary care plans for the clients.
Conclusion
As per the above nursing diagnosis, the nursing problems identified were in relation to Mrs. Winter’s diabetes which could potentially complicate her cataract surgery outcomes. As per the diagnosis, Mrs. Winter must be given preoperative counselling before her surgery. She must be aware of the preventions and possible complications of the surgery. She also must keep her blood sugar under control; however, she is careless with medications and measuring blood glucose levels. Hence, to manage these problems, Mrs. Winter’s interprofessional team must include a nurse (for counselling and education), an ophthalmologist (for her cataract), and an endocrinologist (for managing her diabetes).
Secondly, the nursing problem identified in relation to her medication was that beta-blocker medicine causes blurred vision as well as hastens the development of cataracts. Owing to this, she will need assistance in her daily routine activities. For managing this problem, her interprofessional team should include a nurse, cardiologists, GP, ophthalmologist, and a pharmacist. This team can work to decrease medication complications through joint decision-making. Due to the side-effects of the current medication on her vision, Mrs. Winter needs assistance with her daily routine which can be provided by a nurse.
Conclusion
To conclude, the above paper was a case report of a 68-year-old patient, Mrs. Nancy Winter, who has recently been diagnosed with cataract. She has a medical history of hypertension and diabetes. Cataract can be attributed to her age and other medical condition since research suggests that there is an association between diabetes and hypertension with eye conditions like cataract.
She is taking Metoprolol (a beta-blocker) for hypertension. Side effects of this medication include diarrhoea, hypotension, tinnitus, fatigue, etc. Avoiding consumption of alcohol and other medicines (without doctors’ advice) is a precaution for metoprolol. She is also taking Metformin for her diabetes whose side effects include vomiting, nausea, weakness, upset stomach, etc. Precautions are to take the medicine only with meals and it shall only be swallowed and not chewed.
On nursing diagnosis, it was found that high blood sugar can increase the risk of infection and bleeding after cataract surgery, hence, proper glycemic control is crucial to avoid this. But, Mrs. Winter is careless with her medication and blood glucose control. She is also on a beta-blocker medication which increased her risk of cataracts and causes blurred vision.
Interprofessional care is helpful in improving patient outcomes through by decreasing medication errors and better coordination between health team of the patient. An RN helps in an interprofessional healthcare plan by facilitating communication and providing useful insights into a patient’s medical condition. Key members to be included in Mrs. Winter include an ophthalmologist, endocrinologist, GP, cardiologist, and pharmacist.
Reference list
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