Develop discharge instructions specific to the case. Case scenario: 40 Year old Mr. Stevenson presents to the eye clinic for his routine eye check up. He has got a history of NIDDM (Non insulin dependant Diabetes Mellitus) for 10 years. He complains of progressive blurring of vision since his last visit an year ago. He is unable to say which eye seems to be worse. He verbalize difficulty in reading street signs while driving. He has no other complaints like eye pain, floaters or diplopia. He admits that he was going through tough times with disrupted marriage and divorce issues due to which he is unable to concentrate on his diabetes management. He feels that his recent family disputes and stress has made his blood sugar levels to worsen. He tries to cope up with stress by over eating and taking in of lot of junk foods. He reports missing of diabetes medications many a times. He has a recent history of hospitalization with diabetic ketoacidosis 3 months back with a blood sugar level of 410mg/dl on admission. He is a known case of hyperlipidemia, type 2 DM, obesity and hypertension. His current medications includes lisinopril, metformin, simvastatin and hydrochlorothiazide. He is a chain smoker for almost 15 years and reports occassional social drinking. There is no family history of any ocular diseases like blindness or diabetic retinopathy. He has no past history of eye trauma, eye surgeries. No prior diabetes related eye manifestations. On eye assessment his pupils are round and equally reacting to light. Visual acuity is 20/40 on both eyes. Intraocular pressure is normal (15mmHg on both eyes). Physician advised for a Fluroscein angiography. The results showed abnormal vasculature (microanuerysm with leakage). Neovascularization of disc of the right eye was also reported. He was diagnosed with proliferative Diabetic retinopathy of both eyes. Nursing problems: * Visual disturbance * Knowledge deficit * Stress and anxiety * Smokoing and alcoholism * Obesity, hyperlipidemia,hypertension and type 2 DM Essential Nursing indicators: * To teach the patient about management of proliferative diabetic retinopathy including injection of medication endothelial growth factor inhibitors into the eye that may prevent formation of new blood vessels and also prevents fluid build up in eye causing raise IOP. * To teach the patient about available surgical options (viterectomy),or laser treatment, photocoagulation etc for treating diabetic retinopathy * Teach and provide visual aids like those which enlarges the images and enhances vision * Advice for necessary change in home environment to prevent injury and risk for trauma due to decreased vision * Other areas of nursing care involves lack of knowledge regarding importance of adherence to diabetic management as the patient verbalizes missing of medications, poor dietary control and over eating. * Nurse can also teach him coping strategies to deal with stress and anxiety * The patient is a potential candidate for other microvascular and macrovascular complications as he has got hyperlipidemia, hypertension, DM and obesity * Nursing care must also focus on life style modification, weight management, collaboration with dietician for menu planning and teaching on dietary management, exercise training etc