NUR 635 Topic 15 DQ 1

Sample Answer for NUR 635 Topic 15 DQ 1 Included After Question

Debbie, a 39-year-old female, presents with a red eye and discharge. No issues of vision are reported. She does complain of eye irritation that is intermittent. Based on the limited information, it appears Debbie is suffering from conjunctivitis. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • How would you distinguish between types of conjunctivitis (allergic, bacterial, or viral) to properly treat Debbie?
  • Be sure to include the following characteristics: systemic symptoms, itching, ocular discharge, and conjunctival appearance.
  • Please develop treatment strategies for the following types of conjunctivitis: allergic, bacterial, or viral.
  • Be sure to include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication. Include spectrum of coverage, if applicable, and mechanism of action.
  • Determine monitoring, side effects, and drug-drug interactions associated with each medication.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 15 DQ 1

Title: NUR 635 Topic 15 DQ 1

How would you distinguish between types of conjunctivitis (allergic, bacterial, or viral) to properly treat Debbie?

Allergic conjunctivitis is caused by an acute type I hypersensitivity to common allergens. Allergic conjunctivitis has a protracted course, with the severity of symptoms waxing and waning throughout the allergy season. With vernal limbal conjunctivitis, there is an accumulation of eosinophils along the limbus; with vernal palpebral conjunctivitis, large papules form under the conjunctiva of the upper eyelid (Wagner, 2011). 

Viral conjunctivitis is highly contagious and is characterized by watery discharge. The amount of vascular injection can be variable. Viral conjunctivitis is usually caused by adenovirus, but can also be caused by other viruses such as herpes simplex virus (HSV). HSV may be one of the most problematic causes of conjunctivitis. This virus can lead to herpetic keratitis and possibly loss of vision. Corticosteroids, sometimes used as palliative care in cases of viral conjunctivitis caused by other viruses, are contraindicated in conjunctivitis caused by HSV. The disease is almost always unilateral and monocular. Upon close examination, dendrites or small opacities may be observed. Herpetic conjunctivitis should be in the differential whenever a patient is not responding to antibiotic therapy. Patients with conjunctivitis thought to be caused by HSV should always be referred to an ophthalmologist (Wagner, 2011).

Bacterial conjunctivitis is a self-limiting disease, typically lasting 7 to 10 days without antibiotic treatment. Viral conjunctivitis usually lasts longer than bacterial conjunctivitis. If conjunctivitis does not resolve with antibiotics after 3 to 4 days, the physician should suspect that the infection is viral. Like viral conjunctivitis, bacterial conjunctivitis is highly contagious (Wagner, 2011).

Symptoms

Allergic: Symptoms include itchy eyes, watery or stringy discharge, chemosis, eyelid edema, rhinitis, and an “allergic shiner.” In addition to seasonal allergic conjunctivitis, there are vernal limbal or palpebral types (Wagner, 2011).

Viral: Patients with herpetic conjunctivitis may complain of severe pain. The eyelids may also be involved they can be red, edematous, and display multiple vesicles. The corneal reflex in a patient with herpetic conjunctivitis will be irregular, not be sharp and crisp (Wagner, 2011).

Bacterial: Bacterial conjunctivitis is characterized by mucopurulent discharge with matting of the eyelids. Common clinical findings in acute bacterial conjunctivitis include burning and stinging. While bacterial conjunctivitis can present in only one eye, it is usually present in both eyes or will spread to the contralateral eye (Wagner, 2011).

Treatment:

Allergic: Treatment includes, applying a cold compress, using artificial tears and anti-allergy eye drops or oral medications (Karakus, n.d.).

Viral: Treatment for viral conjunctivitis is aimed at symptomatic relief and not to eradicate the self-limiting viral infection. The resolution of conjunctivitis can take up to 3 weeks. Treatment includes using artificial tears for lubrication four times a day or up to ten times a day with preservative-free tears. Cool compresses with a wet washcloth to the periocular area may provide symptomatic relief (Solano et al., 2023).

Bacterial: Ofloxacin, use 1 drop in the affected eye every two to four hours, while you are awake, for two days. Then, use 1 drop in each eye four times a day for up to five more days (Mayo Clinic, 2023). 
Monitoring
Allergic: Limit exposure to pollen, grass and other airborne allergens that cause seasonal allergic conjunctivitis (Karakus, n.d.). 

Viral: Patients need to be educated that the condition is harmless and will resolve spontaneously. Hand washing should be emphasized since the infection is highly contagious (Solano et al., 2023).

Bacterial: Follow medication orders or the directions on the label. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Puffiness or swelling of eyes are signs of an allergic reaction, such as hives, itching, rash, swelling of face or lips, tightness in chest, troubled breathing, or wheezing. Check with the provider if this occurs Mayo Clinic, 2023). 

References:

Karakus, S. (2021, October 15). Allergic conjunctivitis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/allergic-conjunctivitis 

Mayo Foundation for Medical Education and Research. (2023b, December 1). Ofloxacin (ophthalmic route) side effects. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/ofloxacin-ophthalmic-route/side-effects/drg-20065155 

Solano D, Fu L, Czyz CN. Viral Conjunctivitis. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470271/

Wagner, R. S. (2023, October 2). Differentiating bacterial conjunctivitis from allergic and viral conjunctivitis. Healio. https://www.healio.com/news/pediatrics/20120331/bacterial-conjunctivitis-from-allergic-and-viral-conju 

A Sample Answer 2 For the Assignment: NUR 635 Topic 15 DQ 1

Title: NUR 635 Topic 15 DQ 1

Viral conjunctivitis is the cause of about 80% of all conjunctivitis cases. Viral conjunctivitis spreads via touch from person to person making outbreaks common, especially among children in schools or daycare centers. Bacterial conjunctivitis also spreads by touch, either through hand-to eye contact or hand-to-nose contact. Based on the Center for Disease Control and Prevention, this type of conjunctivitis is more common in kids than adults and occurs most frequently in the winter months. Allergic conjunctivitis is a result of an abnormal response in the body to an allergen. Histamine is released causing inflammation and swelling that result in red, teary, itchy eyes. Common allergens include pollen, dust, pet dander, mold, or smoke.

Viral conjunctivitis symptoms include red, burning eyes with watery discharge. It typically starts in one eye but can infect both eyes. Bacterial conjunctivitis typically presents with red, sore, painful eye with a thick, yellow discharge. Allergic conjunctivitis leads to watery, itchy, red eyes. It can also lead to puffy eyelids and photosensitivity (Dean McGee Eye Institute, 2023). The type of discharge Debbie is experiencing would help to determine if her conjunctivitis was viral or bacterial. If her eyes are red and weeping a clear fluid, this is indicative of a viral conjunctivitis. If she is experiencing purulent or mucopurulent discharge, this would indicate bacterial conjunctivitis. 

Symptom management with artificial tears, cold-compress, and antihistamines is indicated in the treatment of viral conjunctivitis. Patient education is important. It is vital to educate them that this is a condition that will resolve spontaneously. Proper hand washing should be emphasized as it is highly contagious. Sick children should be kept out of school to avoid spreading the infection (Solano, Fu, & Czyz, 2023). 

Bacterial conjunctivitis should be treated with an antibiotic eyedrop or ointment. It should be used for five to seven days. Redness, irritation, and eye discharge should begin to improve within 24 to 48 hours. Tobramycin to the affected eye, 1-2 drops every four hours for five to seven days would be an appropriate treatment plan for bacterial conjunctivitis (Hutnik & Mohammad-Shahi, 2010). Tobramycin may cause blurred vision; caution should be used when driving or participating in any activity that requires the patient to see clearly. Contact lenses should be avoided until the infection is cleared. 

An appropriate treatment strategy for allergic conjunctivitis would include a histamine-1 receptor antagonist. These drugs provide immediate symptomatic relief. Emadine 0.05% one drop twice a day would be an appropriate treatment strategy (Rosenthal & Burchum, 2021). 

 Dean McGee Eye Institute. (2023). The three types of conjunctivitis. Oklahoma University College of Medicine. https://dmei.org/blog/the-three-main-types-of-conjunctivitis/

Solano, D., Fu, L, Czyz, C. (2023). Viral conjunctivitis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470271/#:~:text=There%20is%20no%20single%20treatment,to%20reduce%20discomfort%20and%20scarring

 Hutnik, C., Mohammad-Shah, M. (2010). Bacterial Conjunctivitis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000772/

Rosenthal, L., Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. (2nd ed.). Elsevier.