Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation. Atleast 2 APA refernces each
Response 1
The purpose of this week’s discussion is to create a treatment plan for V.S. based off the given case study information. V.S. has conjunctivitis of the left eye. The specific goals of treatment for conjunctivitis is to relieve symptoms and to clear the infection (Woo & Robinson, 2020). There are numerous forms of conjunctivitis but given the information the symptoms this is more than likely a form on bacterial conjunctivitis. The discharge color, age of the patient, being immunocompromised with a cold prior, and only one eye being infected suggests this is a bacterial infection (Watson et al., 2018). Treatment therefore would be a broad spectrum ophthalmic antibiotic. I would suggest bacitracin which should not affect the patient’s sulfa allergy (Nguyen, 2020). To monitor success the patient should be seen by his pediatrician within a week to see if symptoms have resolved.
Education to include for this patient would be that the ointment can cause blurred vision directly after administration but should clear soon after (Woo & Robinson, 2020). If symptoms worsen in the affected eye or spread to the unaffected eye the patient should contact his pediatrician for reassessment to see if this condition is viral. If this occurs treatment should be stopped due to risk for a drug resistance (Nguyen, 2020). Another adverse reaction that would cause me to change treatment would be any sign of hypersensitivity such as swelling, hives, nausea, or vomiting. If this occurs I would recommend a medication such as erythromycin in ophthalmic form.
An over the counter method for treating bacterial conjunctivitis would be artificial tears for relief of dryness symptoms and saline flushes to wash out the pus (CDC, 2019). Lifestyle changes would include proper hand hygiene, avoiding touching the eye in general, not sharing things such as glasses, and not rubbing the eye. This is the medication I would choose for this patient due to its low risk of interactions to other drugs and/or foods.
Response 2
V.S., age 12 Hispanic male, presents with a feeling that there is sand in his eye. He had a cold a week ago and woke up this morning with his left eye crusted with yellowish drainage. On physical examination, he has injected conjunctiva on the left side, no adenopathy, and no vision changes. His vision is 20/20. Fluorescein staining reveals no abrasion. He is allergic to sulfa.
Diagnosis: Conjunctivitis
The goal of treatment for V.S. would be to clear his infection and make sure he doesn’t rub his eyes because that can cause the infection to get worse and spread to other individuals. According to Azari and Arabi (2020), “bacterial conjunctivitis can spread from person to person, from hand-to-eye contact or via eye contact with contaminated objects. Alternatively, changes in the usual bacteria that live on the conjunctiva can cause conjunctivitis. Bacteria can also spread by large respiratory tract droplets” (p. 374). Bacterial conjunctivitis is most often treated with ophthalmic antibiotic eyedrops and ointments. Since V.S. is allergic to sulfa, Bleph or antibiotics with similar derivatives would not be utilized because they are sulfacetamide sodium. Ophthalmic fluoroquinolones can be prescribed such as Moxeza (moxifloxacin), Zymar (gatifloxacin), or Romycin (erythromycin).
The parameters for monitoring success would be to see the alleviation of redness and itchiness in the patient’s eyes. According to Saher et al. (2016), most cases of viral or bacterial conjunctivitis are mild. The infection will usually clear up in 7 to 14 days without treatment and without any long-term consequences. However, in some cases, viral conjunctivitis can take 2 to 3 weeks or more to clear up. I would educate the parents to administer the drug as prescribed. I would urge the parents to continue giving the antibiotics even if the infection seems to subside. According to Shetty et al. (2020), it has been widely accepted that stopping antibiotic treatment early encourages bacteria to develop antibiotic resistance. As a result, current medical advice is to finish taking a prescribed course of antibiotics as recommended by a healthcare professional, even if you start to feel better.
I would educate the parents to assist in alleviating some discomfort V.S. can take ibuprofen or another over-the-counter pain killer. He can also use over-the-counter lubricating eye drops (artificial tears) if his eyes feel excessively dry. In addition, a warm, damp washcloth over your eyes for a few minutes. Nausea, diarrhea, and headaches can be adverse effects seen in the agents mentioned above. A second line treatment would be Bacticin (bacitracin). V.S. should be encouraged to drink plenty of water and take his antibiotics with water. According to Azari and Arabi (2020), moxifloxacin should not be taken with dairy products such as milk or yogurt, or with calcium-fortified juice. They could make the medication less effective.