A Review of Clinical Manifestations Diagnosis And Management Essay

SUBJECTIVE

Patient initials: ES     Age: 4 years     Sex: Male    Race: White

CC: Right eye redness, pain, and discharge for 4 days

HPI: The patient is a 4-year-old boy brought into the ED by his mother with complaints of pain, redness, and discharge from the right eye for the past 4 days. The discharge is greenish and sticky and is associated with itching. The mother reports that the discharge is too much and requires frequent cleaning and the right is shut closed in the mornings. There are no associated fevers, visual changes, nausea, vomiting, or diarrhea. He has also not had any difficulty in breathing, coughing, or wheezing. There is no history of trauma to the eye and denies any contact with sick individuals. He has not used any medications for the symptoms. A Review of Clinical Manifestations Diagnosis And Management Essay

Past Medical/Surgical Hx: No history of hospitalizations or surgeries

Birth Hx: He was born at term via SVD, weighed 3.2kgs with no complications.

Nutritional Hx: Was exclusively breastfed for 5 months and introduced on infant formula and other soft foods. He is currently eating well.

Immunization Hx: Has received all recommended vaccinations according to his age

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Developmental Hx: Up to date

Allergies: No known food/drugs/environmental allergies

Family/Social Hx: He is the second born of 2 children. Older sister is 7 years. He attends daycare. The mother is a stay-at-home mom, while the father is an attorney. They have health insurance cover.

ROS:

Respiratory: No difficulty in breathing, no cough

Cardiovascular: No shortness of breath during feedings

CNS: No convulsions or loss of consciousness

OBJECTIVE

VS: BP 104/56 mmHg, HR 98, Temp 36.5, RR 22b/min, SPO2 100 RA

General: Appears to be well and has appropriate interactions with his environment. He is alert and not in any obvious distress or pain.

HEENT: The right eye sclera is pink and intact, the conjunctiva is erythematous with active discharge, which is greenish yellow and purulent smelling. The left eye has no discharge and the sclera is slightly pink. Extraocular movements intact in both eyes, no nystagmus. The pupils and equally reactive to light and dilated at 2mm. Visual aquity 20/20. Nares patent, no sinus tenderness A Review of Clinical Manifestations Diagnosis And Management Essay

Neck/Throat: Neck is soft and symmetrical, no swelling or lymphadenopathy, Tonsils +1 , no exudate, uvula and tongue midline and intact.

Respiratory: Bilateral chest wall expansion, no scars or lesion, trachea is central. Equal air entry

Cardiovascular: S1 S2 heard, no murmurs

Abdomen: No tenderness or masses, bowel sounds active in all quadrants

ASSESSMENT

Diagnosis:

Bacterial conjunctivitis– Is an inflammation of the conjunctiva that presents with eye redness, tearing, and discharge. Bacterial infection is more common in children and mostly results from Staphylococcus aureus (Mahoney et al., 2023).

Differentials:

• Viral conjunctiva- May also be viral causes like adenoviruses and rubella (Solano et al., 2022).
• Allergic conjunctivitis
• Hyper-acute bacterial conjunctivitis- a severe form of conjunctivitis mostly due to infection with Neisseria gonorrheae (A. Azari & Arabi, 2020).

PLAN

1. Give antibiotics- Erythromycin 0.5% ointment 1 inch 4 times a day for 7 days to cover staphylococcus aureus, streptococcus penumoniae, and M. catarrhalis (Mahoney et al., 2023).
2. Advise on proper hand hygiene and avoidance of sharing of personal effects like handkerchiefs, tissues, or towels with infected people
3. Advise mom that the child may need to stay from school until the discharge subsides
4. Educate on eye hygiene including washing the affected eye from inwards to outwards using a single clean cotton.
5. Reassure the mother that the infection is self-limiting and will likely resolve after 2-5 days of treatment but they should seek care if any visual changes occur or if lack of improvement at 2 days. A Review of Clinical Manifestations Diagnosis And Management Essay

References

10. Azari, A., & Arabi, A. (2020). Conjunctivitis: A systematic review. Journal of Ophthalmic and Vision Research. https://doi.org/10.18502/jovr.v15i3.7456

Mahoney, M. J., Bekibele, R., Notermann, S. L., Reuter, T. G., & Borman-Shoap, E. C. (2023). Pediatric conjunctivitis: A review of clinical manifestations, diagnosis, and management. Children, 10(5), 808. https://doi.org/10.3390/children10050808

Solano, D., Fu, L., & Czyz, C. N. (2022, May 10). Viral conjunctivitis – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK470271/

Subjective:

Chief complain: “eye pain”

PMH: None.

Allergies: None.

HPI: 4-year-old male accompanied by his mother presented to the emergency department with a four-day history of right eye redness discharge and pain. Today the left eye was noted to be reddened as well. His mother notes that his right eye is closed shut in the mornings and requires cleaning throughout the day. The discharge is green and sticky. Mild itching. He denies any pain or visual changes to the eyes. No nausea, vomiting or diarrhea noted. Denies fevers and trauma to the eye. He eats and drinks well. No allergies to pets or seasonal allergies. No respiratory symptoms. Denies any sick contact. Attends daycare daily. No recent antibiotic use. Immunizations are up to date.  A Review of Clinical Manifestations Diagnosis And Management Essay

Objective:

Vital signs : Bp 104/56, HR 98, temperature 36.4, RR 22, Spo2 100 % on R/A

General: appears well, alert, and oriented, coherent, interactive with mom and dad and walking around in emerge. Normal behavior as per parents.

Skin: warm, pink, and dry. No lesions, no nevi

Neck: supple and symmetric, no lymphadenopathy, thyroid not palpable, no masses, lumps

Lungs: O/A clear bilat

Cardiovascular: S1 and S2 normal with no murmur.

Abdomen: soft and nontender. Bowel sounds are present to all 4 quadrants.

Eyes: Right eye sclera Is pink and intact, erythema to the conjunctiva and large amount of green and yellow purulent discharge noted. No lesions or edema. The left eye sclera is slightly pink and intact with no discharge. Both lashes span outwards and evenly distributed. No nodules. Extraocular movement is intact, and eyes move parallel and symmetric. No nystagmus. Pupils equal round and reactive to light at 2 mm. VA :20/20

Thorax: posterior pharynx Rise and falls symmetrically, tonsils 1+ with no exudate, uvula and tongue are midline and intact.

Nose: No sinus tenderness.

Lymphatics: No lymphadenopathy.  A Review of Clinical Manifestations Diagnosis And Management Essay

Assessment:

4-year-old male with a four-day history of purulent discharge and redness to the right eye and now redness to the left eye. He does not have any respiratory symptoms or any known allergies. Based on current symptoms this appears to be bacterial conjunctiva. Differential diagnosis includes viral, allergic conjunctiva or hyper acute bacterial conjunctiva.

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Plan:

Treatment- often self-limiting, however due to the severity of the infection it would be reasonable to prescribe erythromycin 0.5 % ointment 1-inch QID x 7 days. To treat S.aureus, S.pneumoniae and H. influenzae and M.catarrhalis.

School – Bacterial and viral conjunctivitis are both highly contagious and spread by direct contact with secretions or contact with contaminated objects. Infected individuals should not share handkerchiefs, tissues, towels, cosmetics, linens, or eating utensils. The safest approach to prevent spreading to others is to stay home until there is no longer any discharge, but this is not feasible for most students and for those who work outside the home. Most daycare centers and schools require that students receive 24 hours of topical therapy before returning to school.  A Review of Clinical Manifestations Diagnosis And Management Essay

Hygiene – Proper hand and eye hygiene. Cleanse affected eyes by wiping from the inner canthus outward using a single tissue or cotton ball. Clean eyelashes several times a day with weak solution of no tears baby shampoo and water. Cold compresses to comfort, 10 to 15 minutes on then off.

Significant improvements should be noted two to five days after the start of treatment.

Return to the emergency department for fever, visual changes and lack of improvement after 2 days.  A Review of Clinical Manifestations Diagnosis And Management Essay