NR 511 WEEK 3 CASE STUDY DISCUSSION PART 1 WITH ANSWERS

NR 511 WEEK 3 CASE STUDY DISCUSSION PART 1 WITH ANSWERS NR511 Week 3 Case Study Part 1 CC: “eye discomfort” History of present illness: This patient is a 19-year-old male who presents to the student health center today with complaints of bilateral mild to moderate eye discomfort describe as “gritty” and “like sand in my eye” with some tearing and itching which started 2-3 days ago. He rates his discomfort a 2/10 and constant. There is no aggravating or relieving factors noted. He has reported using OTC Visine which temporarily resolved the redness only. ROS: Constitutional: Negative. Denies fever, chills, or recent illnesses HEENT: Negative. Denies the use of contact or glasses. Denies any eye injuries, trauma, or visual changes or dryness. Denies crusting of the eye lids, mucoid, or purulent drainage. The patient reported having redness, itching, tearing and FB sensation. Patient reported his last eye exam was a “few years ago”. He denies having any ear pain but reports having an occasional runny nose with intermittent nasal congestion, denies sneezing. He has a past medical hx of seasonal nasal allergies that is aggravated in the spring and controlled with the use of loratadine 10mg and fluticasone nasal spray. He denies chest pain, cough, SOB, wheezing, lymph node tenderness, swelling, redness, or ST. PSH: Denies having a PSH Allergies: Denies allergies Social Hx / habits: He currently lives in Phoenix, and he is a current freshman student at the University of Awesome located in central Illinois. The patient denies the use of cigarettes, but to smoking marijuana and drinks between 3-6 beers on the weekend. Physical Exam: Constitutional: Young adult male in NAD, alert, oriented and cooperative VS: Temp–97.9, P–68, RR-16, BP 120/75, Hgt, 6’0”, Wgt 195lbs Head: Normocephalic Visual Acuity uncorrected is 20/20, sclera is white bilaterally. No evidence of crusting, lesions, or masses on lids noted. There is slight photophobia noted bilaterally. Conjunctiva with diffused redness and tearing bilaterally without mucoid or purulent drainage noted. Further examination of bilateral eyes is negative for FBs beneath the eye lids or on the cornea to gross examination. Examination of the fundus noted WNL. Tympanic membrane intact no tenderness noted. Inspection of the nose revealed pale and boggy turbinates with mild to moderate swelling, clear nasal drainage and patent nares. Thyroid is midline, no palpable masses. Lung sounds clear with auscultation and S1 and S2 noted and no M/G/R. Differential Diagnoses Allergic rhinitis is characterized as one of the most common incurable diseases affecting adults, considered the most common incurable diseases in children, and also considered the fifth most common incurable diseases in the United States (Siedman, Gurgel, & Lin, 2015). Allergic rhinitis is prompted after exposure to triggers (allergens) via an IgE mediated response through the nose. Allergic rhinitis is associated with a congested or runny nose; anterior and posterior rhinorrhea, red or watery eyes; pale discoloration of the turbinates; and an itchy nose, some of the symptoms the patient in the case study has been noted to have (Varshney & Varshney, 2015). Allergic conjunctiva is characterized as an inflammation of the lining of the eye known as the conjunctiva. Associated symptoms of allergic conjunctiva include the erythema, itching around the eyes, and an increase of tears or watery eyes, light sensitivity (Castegnaro, Lazzarini, Valerio, & Leonardi, 2015). Allergic conjunctiva is also associated with exposure or triggers (allergens) via an IgE hypersensitivity reaction. Corneal abrasion is caused by damage or irritation of the epithelium cells (the most superficial) layer of the eye which are supplied by pain fibers by cranial nerve number 5 the (trigeminal nerve). Irritation of the epithelium cells causes pain, irritation, and the sensation of a FB in the eye (Willmann & Melanson, 2019). Analyze the differential Allergic rhinitis has the associated signs and symptoms of red or watery eyes, pale discoloration of the turbinates, mild to moderated swelling, and clear nasal drainage. In the case study, the patient’s symptoms are equal to those described with allergic rhinitis with the exception of sneezing. Allergic conjunctiva has the associated signs and symptoms which include inflammation of the conjunctiva, erythema, itching, and an increase of teary or watery eyes. The patient symptoms that could be positive for allergic conjunctiva because the patients’ symptoms did include redness, itching, tearing and FB sensation but denies crusting of lids or mucoid or purulent drainage. Corneal Abrasion is the injury or trauma to the epithelium of the eye. The patient could have pain, photophobia, irritation and the feeling of FB in the eye. The patients’ symptoms could lead to a possible diagnosis of corneal abrasion with the exception of the abrasion coming from the patient wearing his contacts which he had denied. Rank differential diagnosis Allergic conjunctiva Corneal abrasion Allergic rhinitis Additional procedures or test Laboratory testing such as the Total IgE or Quantitative IgE which detects the IgE antibodies in the blood. Blood test for allergies can detect allergies to foods, medicines, dust mites, molds, pollens, animal dander and insect stings. The most common way to test for allergies would be the skin test also known as the scratch test. Skin test can produce results faster, usually in 20 minutes (acai, 2014) American College of Allergy, Asthma & Immunology, 2014.