Case Presentation 1

1. Casey Coon RN, BS, FNP-S Case Presentation 1

2. Krista- 5 year old female Presents to the Pediatrician’s office with her mother Chief Complaint: bilateral eye discharge for 2 days Pediatrician’s Office

3. Mother states K has had bilateral eye discharge for 2 days now. She has been waking up with her eyes crusted shut for the past 2 mornings and she has had to use a warm, wet washcloth to get them open. She also has had a stuffy nose and a cough for the last few days. History of Present Illness

4. Past Medical History

5. Review of Systems

6. Health status: Appears to be a healthy 5 year old female, no acute distress Health risks: PT is at risk for multiple contagious diseases due to her age and school status Disability: Does not appear to have any disabilities Family Problems: Does not appear to have family problems at this time Health status/risks, Disability and Family Problems

7. Exam

8. Blepharitis Episcleritis Iritis Acute Angle Closure Glaucoma Acute Bacterial Conjunctivitis Acute Viral Conjunctivitis Differential Diagnosis?

9. Acute Bacterial Conjunctivitis Common causes of bacterial conjunctivitis, an inflammation of the bulbar and/or palpebral conjunctivas, include staphylococci, streptococci, gonococci, and Chlamydia. Signs and symptoms of bacterial conjunctivitis include the following: Follicles or papillae on the inflamed conjunctiva Discharge: More purulent than in viral conjunctivitis, with more mattering of the eyelid margins and greater associated difficulty prying the eyelids open following sleep Enlarged preauricular lymph node: Unusual in bacterial conjunctivitis but found in severe conjunctivitis caused by N gonorrhoeae Eyelid edema: Often present in bacterial conjunctivitis, but mild in most cases; severe eyelid edema in the presence of copious purulent discharge raises the suspicion of N gonorrhoeae infection (Yeung, 2013). Diagnosis

11. Polytrim 1 drop into both eyes TID for 7 days Polytrim (polymyxin B sulfate and trimethoprim ophthalmic solution) is a sterile antimicrobial solution for topical ophthalmic use. Polytrim Ophthalmic Solution is indicated in the treatment of surface ocular bacterial infections, including acute bacterial conjunctivitis Safe for use in pediatrics (Drugs.com, 2004). Treatment

12. Education was given to mother to ensure that K washes her hands often and uses hand sanitizer • K needs to stay home from school for the rest of today and tomorrow • Instructions on giving your child eye drops • Wash your hands. • Get your child into any of these positions to give the eye drops:  • tilt your child’s head back • lay your child flat on his or her back • ask someone to hold your child in a safe position • wrap your baby or young child in a light blanket or sheet to keep his or her arms and legs still • Shake the bottle • Remove the top from the bottle and throw away the plastic seal. • Gently pull down your child’s lower eyelid. • Avoid touching the dropper against your child’s eye, eyelashes or any other surface. • Hold the dropper above your child’s eye and squeeze one drop into the lower eyelid. • Release the lower eyelid and let your child blink a few times to make sure the drop is spread around the eye. • Wipe away any excess with a clean tissue. • If you are using another type of eye drop, wait a few minutes before giving it. This will stop the first drop being washed out by the second before it has had time to work. (Great Ormand Street Hospital for Chilldren, 2013). Education

13. Questions/ Comments?

14. Drugs.com. (2004). Polytrim. Drugs.com. Retrieved from http://www.drugs.com/pro/polytrim.html Great Ormand Street Hospital for Children. (2013). How to give your child eye drops. Our Hospital Site. Retrieved from http://www.gosh.nhs.uk/medical-conditions/medicines-information/how-to-give-your-child-eye-drops/ Yeung, K. K. (2013, March). Bacterial Conjunctivitis. Medscape. Retrieved from http://emedicine.medscape.com/article/1191730-overview References