Nr 602 Week 3 Case Study Part 2

Primary Care of Childbearing and Childrearing Family Practicum Week Three Sick Child Clinical Case Presentation Chamberlain College of Nursing Course Number: NR 602 DATE teria for Summary Post should include all of the following required elements: Summary post written in paragraph(s) type format (No SOAP note for Summary Post); discuss primary and any applicable secondary diagnoses along with treatment plan for each diagnosis. Scholarly and evidence based in-text citation support for all of the listed diagnoses; Scholarly and evidence based in-text citation for each treatment plan. Differential diagnoses are eliminated. Summarize your peer's posts to your presentation. *Remember not to use any patient identifiers in your posting (this would be full names or disclosure of clinic name, preceptor name, et cetera). Please include age, gender, and race. Summary, My Primary diagnosis is erythema infectiosum [fifth disease] (B08.3), my differentials are acute supportive otitis media without spontaneous rupture of ear drum bilateral (382.00) and acute nasopharyngitis (J00) and other specified disorders of eye and adnexa (H57.89). Initially the baby had fever, congestion, then developed rash on her cheeks that turned bright red. At day of encounter there was a red, lacelike rash that was on cheeks, congestion, bilateral TMs intact, but slightly erythematous, bilateral turbinates’ edematous and eurythmic with clear nasal drainage. Posterior pharynx shows erythema. Primary Diagnosis: Eythema infectiosum which is an infection that causes a rash, fever, and other symptoms. It is caused by a virus called "human parvovirus B19." Another name for erythema infectiosum is "fifth disease." Fifth disease is common in children. Adults can also get it. If a pregnant woman gets fifth disease, it can be dangerous for her unborn baby, but this is rare. Education to parents that most people with fifth disease get better without treatment, it is viral and antibiotics are not effective. If your child has itching or joint pain, recommend Motrin. To lower your chances of getting fifth disease by not sharing food and drinks with other people, washing your hands often, and teaching your children to wash their hands. Treatment: CPT: (B08.3) Erythema infectiosum Education to parents to lower your chances of getting fifth disease by not sharing food and drinks with other people, washing your hands often, and teaching your children to wash their hands. CPT: (382.00) Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral: Patient to will start oral antibiotics: Amoxicillin 400 MG/5 ML Oral susr-give 3.5.5 Ml bu mouth 2 times per day for 10 days #70 CPT: (J00) Acute nasopharyngitis: Patient is currently being treated with antibiotic for otitis media. Use bulb syringe and nasal saline as directed. Increase fluid intake. Tylenol as needed for fever/discomfort. Follow up for fever for three days after starting antibiotic. CPT: (H57.89) Other specified disorders of eye and adnexa Discussed use of warm wash cloths and massage of nasal bridge. MOP educated on the classic signs and symptoms of conjunctivitis and that the lacrimal canniculi connects the sinuses to the lacrimal duct opening at the medial epicanthus, thus drainage occurs when viral URI are present. This is not necessary indicative of conjunctivitis. MOP instructed to follow up for redness, drainage, photophobia, and or inconsolable crying. Viral and Bacterial conjunctivitis should be ruled out. The patient with this type of conjunctivitis will typically complains of itching, burning, and increased tearing. My patient’s conjunctiva was normal bulbar and palpebral conjunctiva. There was is a clear watery mucoid discharge, no sign of crusting or discharge. A patient with conjunctivitis may have conjunctival edema, follicles on the palpebral conjunctiva, and lid edema. There are usually signs of an upper respiratory tract infection or a history of no recent contact with another person with disorders of eye. Viral conjunctivitis is most common cause of infectious conjunctivitis, but not all red eyes are due to infections. (Watson & Khoo, 2018). Allergic conjunctivitis; environmental: uniquely identifying “bumps” on the conjunctiva: follicles. There is bilateral itching, with a watery discharge. The patient may have a history of atopy. The conjunctiva and lids are swollen and reddened. This results in the release of histamine from mast cells, which stimulates nociceptors, which cause itching, increased vascular permeability, vasodilation, redness, and infection. (Leonardi, Castegnaro, Valerio, & Lazzarini, 2015). Epocrates. (2019). Erythema infectiosum. Retrieved from Epocrates. (2019). Acute allergic conjunctivitis. Retrieved from Leonardi, A., Castegnaro, A., Valerio, A., Lazzarini, D. (2015). Epidemiology of allergic conjunctivitis: Clinical appearance and treatment patterns in a population based study. Allergy and Clinical Immunology, 15(5). 482-488. doi:10.1097/ACI. Watson, S., Cabrera-Aguas, M., & Khoo, P. (2018). Common eye infections. Australian prescriber, 41(3), 67–72. doi:10.18773/austprescr.2018.016 . 1. Summarize the history and physical (H&P) findings: date of visit: 20 OCT 2017 10 month old female, he has chief complaint of bilateral eye discomfort for past 3 days. 2. Differential diagnoses: a. Allergic conjunctivitis; environmental: uniquely identifying “bumps” on the conjunctiva: follicles. There is bilateral itching, with a watery discharge. The patient may have a history of atopy. The conjunctiva and lids are swollen and reddened. This is a seasonal occurrence, most common in fall and spring, and may be accompanied by sneezing, rhinorrhea, and throat itching. Allergic conjunctivitis caused by a type I immune response to an allergen. The allergen binds to a mast cell and crosslinking to IgE occurs, leading to mast cell degranulation and initiation of an inflammatory cascade (McCance & Huether, 2014). This results in the release of histamine from mast cells, which stimulates nociceptors, which cause itching, increased vascular permeability, vasodilation, redness, and infection. (Leonardi, Castegnaro, Valerio, & Lazzarini, 2015). b. Viral conjunctivitis should also be ruled out. The patient with this type of conjunctivitis typically complains of itching, burning, and increased tearing. The conjunctiva is brilliant red, diffuse, and peripheral. There is a watery mucoid discharge, with a moderate amount of mucoid debris. The patient may also have conjunctival edema, follicles on the palpebral conjunctiva, and lid edema. There are usually signs of an upper respiratory tract infection or a history of recent contact with another person with red eye. Viral conjunctivitis is most common cause of infectious conjunctivitis, but not all red eyes are due to infections. Viral conjunctivitis occurs as a result of reduced host defenses and external contamination. Infectious pathogens can invade from adjacent sites or by a blood-borne pathway and replicate within the conjunctival mucosal cells. (Watson & Khoo, 2018) c. . Bacterial pink eye is less common than viral pink eye and has symptoms that are different from both viral pink eye and allergies. You may have a crusty yellow or green purulent discharge from your eyes, your eyelids can often be stuck together, and the redness is often only in one eye (though it can be in both). Pink eye caused by bacteria, viruses, or STDs can spread easily from person to person, and it is very contagious. Bacterial pink eye is a less frequent cause of conjunctivitis, is more common in children. (Watson & Khoo, 2018) 3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. a. Diagnosis #1: Allergic conjunctivitis would the top of my differential. Patient has positive findings include bilateral eye discomfort, itching, and tearing with water drainage. Patient has negative findings of sneezing or throat itching, and no evidence of eyelid swelling. There no drainage or crusty discharge reported. b. Diagnosis #2: Infectious conjunctivitis needs to be ruled out first because it is highly contagious. Patient does have positive findings include eye redness and tearing. Patient has negative findings of fever, eye drainage or crusty discharge reported. This can be ruled out. c. Diagnosis #3: Bacterial conjunctivitis should be ruled out, it is also highly contagious. Antibiotics may need to be considered if it is bacterial conjunctivitis. Patient does positive findings of watery drainage, and redness. Patient has negative findings of eye drainage or crusty discharge. This can be ruled out. d. Diagnosis #4: Corneal abrasion is the least likely diagnosis from the list. Patient has positive findings of eye discomfort, redness, and describes feeling “like sand caught in your eye and gritty sensation Patient has negative findings of light sensitivity bilaterally. Visual acuity remains 20/20 bilaterally. This can be ruled out. 4. Rank the differential in order of most likely to least likely. Allergic conjunctivitis, infectious conjunctivitis, bacterial conjunctivitis and corneal abrasion 5. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence. 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 difficult to diagnosis because symptoms that can be similar to 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. Seasonal allergic conjunctivitis is one of the most common forms of ocular symptoms in the primary care setting. Allergy testing could be recommended, but it is not necessary required unless it is a recurrent case. If a causative agent can be determined, education must be provided on avoiding the allergen and reducing the severity of symptoms (Bowling, 2015). One of the most important things to consider as a clinician dealing with complaints of eye discomfort is when to refer to an ophthalmologist. While the subjective nature of the pain experience is important, a diagnosis can be made from differentiating whether the pain is coming from the eye itself or from one of the surrounding structures (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The potential for complications related to vision damages can be high. In this case study, it is evident that we do not need immediate referral to an ophthalmologist References Bowling, E. (2015). What’s trending in ocular allergy treatment. Optometry Times, 7(2), 1-29. Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The advanced practice nursing (4th ed.). Philadelphia, PA: F. A. Davis Company Leonardi, A., Castegnaro, A., Valerio, A., Lazzarini, D. (2015). Epidemiology of allergic conjunctivitis: Clinical appearance and treatment patterns in a population based study. Allergy and Clinical Immunology, 15(5). 482-488. doi:10.1097/ACI. McCance, K.L., & Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp.1488). St. Louis, MO: Mosby. Ross, M., & Deschênes, J. (2017). Practice patterns in the interdisciplinary management of corneal abrasions. Canadian Journal of Ophthalmology, 52(6), 548-551. doi:10.1016/.2017.03.016 .