Risk of Falling Due to Diabetic Retinopathy

This patient, Tina Jones, is suffering from diabetic retinopathy.Diabetic retinopathy refers to the deterioration of the blood vessels found in the retina, and it affects both eyes typically by causing liquid leakage into the eye due to weakened blood vessels. This causes blurred vision leads to falls. Therefore, the patient is diagnosed with the risk of falling

Justification of the Diagnosis

This diagnosis has been arrived at because Tina has diabetic retinopathy which has been evidenced by her elevated blood pressure (BP 138/90) and the high blood sugar (glucose 238). Additionally, the condition is further indicated by Tina’s interfered physic mobility as she has reported having fallen once and has unnoticed limb movements.

Reviewed Scholarly Article to Understand the Condition

The article used to gain further knowledge regarding diabetic retinopathy is “Diabetic retinopathy: current understanding, mechanisms, and treatment strategies” Written and reviewed by Duh, E. J., Sun, J. K., andStitt (2017).

Summary of the Article

The authors indicate that diabetes affects the retinal neurovascular unit along with the interdependent tissues. The people diagnosed with diabetes Type 1 and Type 2, of which Tina is, are at higher risk for diabetic retinopathy which manifests typically when a person has elevated blood sugar which in turn weakens blood vessels found in the eye leading to leaking of fluid into the eye causing blurred vision, one of the major causes of physical injuries resulting from falls (Duh, Sun, &Stitt, 2017). Diabetic retinopathy is most prevalent in people with diabetes whoseblood sugar levels goes unchecked.

Scholarly Article for Evidence-BasedPracticeTreating the Patient

The articles are “Frontiers in public health” byPhelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016),“Diabetic retinopathy: current understanding, mechanisms, and treatment strategies” Written and reviewed by Duh, E. J., Sun, J. K., andStitt (2017) and “Clinical diabetes and endocrinology” by Shah, A. R., & Gardner, T. W. (2017).

Evidence-Based Practice When Treating the Patient

Therapeutic Nursing Interventions

The nurse establishes the factors that affect the safety needs to facilitate the identification of the interventions that need to be established (Shah & Gardner, 2017). The patient’s environment is modified to enhance safety. This is important because if the patient happens to be unfamiliar with the arrangement of furniture and other equipment, the risk of falling elevates (Phelan et al., 2016). There is need to assess her vision to enable to establish the extent of lighting required for the patent to see thus the patient has to make regular visits to the ophthalmologist(Phelan et al., 2016). The patient should be instructed to ask for help when moving to prevent her from falling. Install the side rails on raised places to avoid slipping over when the patient gets disoriented (Duh, Sun &Stitt, 2017). The items the patient is likely to use most of the time should be within her reach since stretching to reach items may disrupt her balance thus contributing to falls.

Ineffective Peripheral Tissue PerfusionDue To a Diabetic Neuropathy

Tina is also diagnosed with Ineffective Peripheral Tissue Perfusioncaused by diabetic neuropathy. This diagnosis has been established because Tina has a Type 2 DM which disables the body to secreteadequate insulin or inhibit the body from using theproduced insulin.

Justification of the Diagnosis

The excess free glucose damages the blood vessels resulting in thevasculaturenarrowing. In turn, the narrowing hinders the tissues from getting adequate blood. The patient also has hyperlipidemia, a condition that causes lipid deposition in the arteries through the process of atherosclerosis. These two conditions have substantially narrowed the blood vessels causing the heart to strain much more to pump blood resulting in the high blood pressure. It is because of the Type 2 DM combined with hyperlipidemia that the patient has a compromised peripheral circulation as well as ineffective tissue perfusion, both of which are evidenced by the impaired healing of the patients wound. The patient has a significantly diminished sensation caused by neuropathy, and thus she does not recognise the compromise to her peripheral tissue perfusion.

Reviewed Scholarly Article to Understand the Condition

The articles used to gain further insight are “International journal of molecular sciences”by Volmer-Thole, M., andLobmann, R. (2016) and “Pharmacology & Therapeutics” by Edwards, J. L., Vincent, A. M., Cheng, H. T., & Feldman, E. L. (2008).

Summary of the Articles

Neuropathy is a type 1 and type 2 diabetes complication, and according to Volmer-Thole and Lobmann, (2016), approximately 15 per cent of the patients with DM develop foot ulcers. This condition damages the peripheral somatic or the autonomic nerves due to diabetes mellitus (Edwards et al., 2008)., and it progresses as the severity of the disease advances. Depending on the of type fibre type affected, the signs and symptoms vary whereby if it is the large fibre, proprioception and light touch are impaired whereas the small fibre disease results in pain and temperature impairment (Edwards et al., 2008). This leads to paresthesias, neuropathic pain and or dysesthesias.

Scholarly Article for Evidence-Based Practice WhenTreating the Patient

“World Journal of diabetes”by Yazdanpanah, L., Nasiri, M., &Adarvishi, S. (2015), “International Journal of molecular sciences”by Volmer-Thole, M., andLobmann, R. (2016).

Summary of Scholarly Articles

According to Yazdanpanah, Nasiri, and Adarvishi (2015), the patient should be given abx to improve her WBC and then monitor her temperature and the WBC trend to provide adequate information about a possible systemic infection. The extremities circulation status should be monitored to heal the wound and thus prevent the patient from further complications due to impaired tissue perfusion (Volmer-Thole&Lobmann, 2016). The patient should have frequent CMST checks to enable the doctor to establish whether the extremities are adequate blood supply and are perfusing appropriately. Since the patient has a reduced sensation, she could not tell whether the dressing is too tight or even if she has impaired circulation. Therefore, it is crucial to assess the bandage to ensure it is done correctly.

References

Duh, E. J., Sun, J. K., &Stitt, A. W. (2017). Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI insight, 2(14), e93751. Advance online publication. doi:10.1172/jci.insight.93751

Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls. Frontiers in public health, 4, 190. doi:10.3389/fpubh.2016.00190

Shah, A. R., & Gardner, T. W. (2017). Diabetic retinopathy: research to clinical practice. Clinical diabetes and endocrinology, 3, 9. doi:10.1186/s40842-017-0047-y

Yazdanpanah, L., Nasiri, M., &Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World journal of diabetes, 6(1), 37-53.

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