NR 511 WEEK 3 CASE STUDY DISCUSSION PART 2 WITH ANSWERS

NR 511 WEEK 3 CASE STUDY DISCUSSION PART 2 WITH ANSWERS Dr. Norton and class, 1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case) At this time, I would diagnosis this patient with allergic conjunctivitis. This diagnosis would be made based on the patient’s history, subjective, and objective findings. Common clinical manifestations of allergic conjunctivitis include bilateral eye discomfort, itchiness, tearing, gritty or foreign body sensation, and photophobia (Berger, Granet, & Kabat, 2017). Bilateral itching is often a primary complaint for those with allergic conjunctivitis (Epocrates, 2019). Subjective findings, such as bilateral eye discomfort, itchiness, and tearing with watery drainage, are suggestive of allergic conjunctivitis diagnosis for this patient. Objective findings, such as diffuse redness and tearing in bilateral conjunctiva, are suggestive of allergic conjunctivitis diagnosis as well. It is relevant to mention that the patient did not present exudate or purulent drainage, fever, upper respiratory symptoms, and lymphadenopathy since these findings would have been more consistent with conjunctivitis from infectious origin (Berger et al., 2017). Allergic conjunctivitis is most commonly seasonal and often associated with patients with a history of atopic dermatitis, hay fever, or asthma. Even though this patient denies a history of atopic dermatitis, hay fever, or asthma, this patient has a history of seasonal nasal allergies. Given his recent move to Illinois for school, there is a potential for new allergens that he is exposed to. 2. Identify the corresponding ICD-10 code. The corresponding ICD-10 code for allergic conjunctivitis is H10.45 (Epocrates, 2019). 3. At this time, I would prescribe the following medications: Cetirizine (Zyrtec) 10 mg Disp# 30 Sig: 1 tab by mouth daily RF: PRN According to Mounsey & Gray (2016), clinical guidelines for the management of allergic conjunctivitis support the use of antihistamines and mast cell stabilizers, either alone or as a combination regimen. Antihistamines are highly effective and safe in treating patients with allergic conjunctivitis. day) Fluticasone nasal spray (Flonase) 50 mcg per actuation Disp# 1 unit (oz) Sig: 1 puff in each nostril BID (maximum of 2 puffs/actuation in each nostril per RF: PRN Decongestant and corticosteroids are widely used to provide effective treatment in alleviating signs and symptoms of allergic conjunctivitis (Leonardi, Castegnaro, Valerio, & Lazzarini, 2015). The active ingredient in Flonase is fluticasone propionate, which is a corticosteroid. Therefore, this type of nasal spray may help relieve symptoms of watery eyes, nasal congestion, and runny nose. Visine-A (pheniramine/naphazoline) Ophthalmic Solution OTC Disp# 0.5 oz Sig: 1-2 gtts each eye Q6H PRN Do not exceed over 2 weeks RF: PRN An adjunct therapy to resolve symptoms of allergic conjunctivitis include the combination of an antihistamine and decongestant in eye drops (Moroney, 2018). Naphazoline in over-the-counter Visine ophthalmic solution is a decongestant that will relieve red eyes by constricting the blood vessels supplying the white of the eye (Moroney, 2018). Pheniramine is an antihistamine that will help reduce allergic reactions by blocking histamine in the body. This type of combination is an effective treatment to significantly reduce relief of redness and itchiness. However, prolonged use of this ophthalmic solution may cause “rebound redness” in the eye (Moroney, 2018). Additional Testing: Based on the patient’s subjective and objective finding, I would not order any additional testing or procedures at this time. Differential diagnosis of allergic conjunctivitis can be challenging because of symptoms that can mimic other serious conditions. According to Bowling (2015), there is no evidence to explore additional testing or procedures if the signs and symptoms are consistent with seasonal allergic conjunctivitis and if there is no indication from a patient’s history to suggest some other disease conditions. In this case study, there is lack of discharge, lymphadenopathy, fever, and crusting of the eyelids. Therefore, no further additional testing is required to confirm diagnosis. Patient Education: - It is important to educate the patient on frequent hand-washing and avoid any allergen that may cause symptoms of conjunctivitis (Pflipsen, Massaquoi, & Wolf, 2016). To avoid or eliminate allergens, I would provide examples such as frequent vacuuming and dusting, changing air filter in the house, pet control, use of hypoallergenic pillow/mattress covers, and reduce smoking in the house. It is also beneficial for the patient to avoid touching or rubbing the eyes. - It is important to educate the patient on reducing eye irritation by decreasing the amount of time spent on electronic devices. - Nonpharmacologic treatment can be used to reduce the symptoms. Cold compresses over the eye are recommended to reduce eye irritation (Pflipsen et al., 2016). OTC ophthalmic eye drops can help reduce eye discomfort and itchiness. Referral: - No referral is necessary at this time since the signs and symptoms are consistent with allergic conjunctivitis (Bowling, 2015). 4. Provide an active problem list for this patient based on the information given in the case. Active Plan List: - Recreational use of marijuana: Encourage patient to reduce use of marijuana smoking as this can be an irritant. The smoke may exacerbate allergies and increase eye irritation (Leonardi, Castegnaro, Valerio, & Lazzarini, 2015). - Alcohol consumption of 3-6 beers per weekend: Drinking alcohol will interact with taking antihistamines and increase the likelihood of drowsiness (McCance & Huether, 2014). 5. Are there any changes that you would also make to this patient’s overall treatment plan at this time? Most patients with allergic conjunctivitis respond to treatment. If a causative agent can be determined, education must be provided on avoiding the allergen and reducing the severity of symptoms (Bowling, 2015). Seasonal allergic conjunctivitis is one of the most common forms of ocular symptoms in the primary care setting. Therefore, I would not change the overall treatment for this patient at this time. 6. Provide an appropriate F/U plan. If the symptoms do not improve in 5-7 days or if the patient reports visual changes or increased light sensitivity, I would refer the patient to an opthamologist for consultation.