Exam (elaborations)
NR511 Week 3 Case study
- Course
- Institution
NR511 Week 3 Case study
[Show more]
Seller
Follow
solutions
Reviews received
Content preview
Week 3 Case Study Part 1Patient is a 19 year old Male who presents today with a complaint of bilateral eye discomfort that began 2-3
days ago. The eye discomfort is reported as a 2/10 on the pain scale and is described as a constant “gritty” or
sand like feeling. He further reports his eyes are itchy and have watery drainage or tearing. He reported having
redness that temporary relieved with OTC visine, but the eye irritation continued. The patient does not recall
any recent trauma or foreign object in his eyes. He denies any crusting or purulent drainage. He does note that
he has an occasional runny nose with intermittent congestion but no sneezing. His past medical history includes
seasonal nasal allergies which flares up only in spring and is controlled with Loratadine 10mg and Fluticasone
Nasal Spray in peak season. The patient further denies any ear pain, throat pain or redness, fever, chills, SOB or
wheezing.
Physical assessment essentially negative with the exception of noted pale and boggy nasal turbinate’s as well as
mild to moderate swelling and clear drainage. Bilateral eyes with noted photosensitivity and diffuse conjunctiva
redness and tearing. Visual acuity remains 20/20 bilaterally (uncorrected), no foreign object noted, no mass,
lesions or crusting on lids. Fundiscopic examination WNL.
Differential Diagnoses:
-Allergic conjunctivitis is caused by a type I immune response to an allergen. The allergen binds to a mast cell
and crosslinking to IgE occurs, leading to mast cell degranulation and initiation of an inflammatory cascade
(Leonardi, Castegnaro, Valerio &Lazzarini, 2015). This results in release of histamine from mast cells, as well
m
as other mediators, including tryptase, chymase, heparin, chondroitin sulfate, prostaglandins, thromboxane, and
er as
leukotrienes. Histamine and bradykinin immediately stimulate nociceptors, resulting in itching, increased
co
vascular permeability, vasodilation, redness, and conjunctival injection (Leonardi, Castegnaro, Valerio &
eH w
Lazzarini, 2015).
o.
-Viral/Infective conjunctivitis occurs as a result of reduced host defenses and external contamination. Infectious
rs e
pathogens can invade from adjacent sites or by a blood-borne pathway and replicate within the conjunctival
ou urc
mucosal cells (Epocrates, 2018). Both bacterial and viral infections initiate a leukocyte or lymphocytic
inflammatory cascade leading to the attraction of red and white blood cells to the area. These white blood cells
reach the conjunctival surface and accumulate there by easily moving through the dilated and highly permeable
o
capillaries (Leonardi, Castegnaro, Valerio & Lazzarini, 2015).
aC s
-Dry eye disease (DED) is a multifactorial ocular surface disease characterized by a loss of homeostasis of the
vi y re
tear film due to tear film hyperosmolarity and instability, ocular surface inflammation and damage, and
neurosensory abnormality. This results in ocular discomfort, dryness, and visual disturbance (Epocrates, 2018).
ed d
Rank the Differential
-Allergic conjunctivitis – patient also has history of seasonal allergies that relieves by oral antihistamine, which
ar stu
he has not been taking.
-Viral Conjunctivitis
-Dry eye Disease
is
Additional Testing and Procedures:
Th
-No testing or procedure needed at this time since patient is suspected to have allergic conjunctivitis.
sh
References:
Epocrates Athena Health. (2018). Epocrates Drug. Retrieved from https://online.epocrates.com/drugs
Leonardi, A., Castegnaro, A., Valerio, A., Lazzarini, and D. (2015).Epidemiology of allergic conjunctivitis:
clinical appearance and treatment patterns in a population based study. Allergy and Clinical
Immunology, 15(5). 482-488. https://doi: 10.1097/ACI.0000000000000204
This study source was downloaded by 100000805705997 from CourseHero.com on 12-09-2021 21:19:52 GMT -06:00
https://www.coursehero.com/file/36776619/NR511-W3-Case-studydocx/
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller solutions. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $2.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
82871 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now