Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 NUR 6111 Week 4 EENT
- Institution
- William Paterson University
NUR 6111 Adv Nursing Practice 1
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● Ophthalmic Disorders○ Conjunctivitis
■ conjunctiva is the transparent mucosal tissue that lines the eye and inner
surface of the eyelids
■ Conjunctivitis is a broad term for a group of conditions that result in
swelling, inflammation, or infection of the conjunctiva
■ This inflammation can be hyperacute, acute, or chronic in presentation
■ Conjunctivitis can be bacterial, viral, or allergic.
■ Commonly referred to as “pink eye.”
■
■
■ Viral
● 70% of all infectious cases are viral
○ 65-90% is caused by adenovirus (common cold)
● Other viral agents: herpes simplex virus (HSV), rubella, measles,
varicella-zoster (chickenpox/shingles), Epstein-Barr
(mononucleosis) and Molluscum contagiosum (pox virus)
● It lasts 5-14 days
● Contagious as long as they are tearing for at least 1 week
● Through the tears is where the shedding viral particles are spread.
■ Viral Clinical Presentation/Chief Complaint
● Recent URI (spread through coughing) or exposure to sick
contacts
● Ocular s/s: onset of red eye, excessive watery discharge,
burning/itching, photophobia, watering, and foreign body sensation
● Classically, it begins in one eye and then involves the other eye
within a few days
● Patients are usually able to recall the precise moment symptoms
began
, ● Approximately 50% of the patients will have bilateral involvement
● It resolves spontaneously after 1-2 weeks
■ Viral Treatment
● VIRAL: self-limiting & resolves after 5-14 days and treatment is
supportive
● Pharmacological
○ No longer recommend antibiotic treatment prophylactically
to prevent a bacterial infection
○ Antihistamine/decongestant drops
● Non-pharmacological
○ Supportive
○ Ocular decongestants
○ artificial tears
○ cool compresses
● REFER TO OPHTHALMOLOGIST IF S/S DO NOT RESOLVE
AFTER 7-10 DAYS OR WITH CORNEAL INVOLVEMENT
■ Bacterial
● Acute conjunctivitis is the most common bacterial infection.
○ Adults: typically, Staphylococcus aureus is most common.
○ Children: typically Haemophilus influenzae and
Streptococcus pneumoniae.
■ Bacterial Clinical Presentation/Chief Complaint
● Most commonly, spreads through direct contact with contaminated
fingers
● Can be categorized as hyperacute, acute, or chronic based on s/s
○ Hyperacute: associated with gonorrhea in sexually active
adults
■ S/S: copious, purulent yellow or green discharge,
pain, & diminished vision loss; both eyes are “sticky
or glued shut”, worse in the morning
■ Sudden onset and rapid progression
○ Acute: most common form of bacterial conjunctivitis (S.
aureus)
■ S/S: persist for less than 3-4 weeks
○ Chronic: s/s that persist for at least 4 weeks with frequent
relapses
■ Refer to ophthalmologist
■ Bacterial Treatment - Mild to Moderate
● Primary
○ azithromycin ophthalmic drops 1% (AzaSite)
■ 1 drop BID x 2 days, then 1 drop daily x 5 days
○ erythromycin ophthalmic ointment 0.5% (Ilotycin)
■ Apply 1cm ribbon to the affected eye up to 6x a day
for 7-10 days
, ○ polymyxin B/trimethoprim ophthalmic drops (Polytrim)
■ 1 gtt q 3 hours for 7-10 days
● Secondary
○ bacitracin ophthalmic ointment, 500units/g
■ Apply to the affected eye every 3-4 hours
○ sulfacetamide ophthalmic drops 10% (Bleph-10)
■ 1-2 drops into affected eye(s) every 2-3 hours
■ Bacterial Treatment - Moderate to Severe
● **Includes contact lens wearers**
● Primary (fluoroquinolones) for 7 days
○ ofloxacin ophthalmic 0.3% (Ocuflox)
■ 1-2 gtts in affected eye q 2-4 hours x 2 days, then
1-2 gtts QID x 5 days
○ moxifloxacin ophthalmic 0.5% (Avelox)
■ 1 drop into the affected eye 3x a day
○ levofloxacin ophthalmic 0.5% (Iquix)
■ 1-2 drops into the affected eye every 2 hours, up to
8x a day for 2 days, & then every 4 hours, 4x daily
■ Acute Allergic
● Common agent: hay fever
● Allergic substances: pollen, dust mites, animal dander, molds,
contact lenses/solutions, and cosmetics
● Seasonal allergic conjunctivitis
○ secondary to environmental allergens
■ ragweed as 75% of the cases (most common)
●
● Clinical Presentation/Chief Complaint
○ 75% of patients with allergic rhinitis present with allergic
conjunctivitis
○ c/o: Associated headache and fatigue; positive family
history of hay fever or atopy
○ s/s present simultaneously in both eyes
(burning/itching/erythema)
○ Clear/stringy/white discharge, if present
○ conjunctiva will be boggy
● Acute Allergic Treatment
○ Identify allergens and eliminate them.
○ Symptoms usually resolve once the allergen is removed
○ Oral histamine (Benadryl, Allegra, or Claritin) can be used
to control ocular s/s
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