Ms. Burns, a 23 year old woman, submitted a Health Service Request form for cold symptoms that had been ongoing for 2-3 days. She arrives for Nurse Sick Call and you immediately note two things – she is wearing “eye-liner” and her eyes are bloodshot. Ms. Burns tells you that she has been having symptoms for the last 48 hours, including a yellowish discharge from her eyes. She also complains of burning in her eyes and that they feel like sand is under the lids. She denies that her eyes are painful. No one else is sick in the unit as far as she knows. She does usually suffer from seasonal allergies, but typically not at this time of the year. She has no chronic conditions per her health record (which you reviewed prior to calling her into the examination room) and which she confirmed. Her last menstrual period was 2 weeks ago [why do we need this information].
The Physical Exam
Vital Signs: blood pressure: 116/72; pulse: 74 beats per minute; Respirations: 16 breaths per minute; temperature: 98.4℉; oxygen saturation level: 98% Height: 5’6″ Weight: 176
Snellen Eye Test results, conducted before coming into the exam room – OS 20/30; OD 20/40; and 20/30 OU.
Her eyes are “bloodshot” and her conjunctiva is red bilaterally. Her right eyelid is slightly swollen (not quite 1+). Her nares are patent bilaterally without exudate. There is yellow mucopurulent, thick drainage in her right eye. The nasal turbinates are pink and slightly swollen. Her lungs are clear bilaterally without adventitious sounds. Auscultation of her heart reveals S1 S2 without murmurs, gallops or rubs. Her abdomen is soft, non-tender to palpation, non-distended with active bowel sounds heard in all four quadrants.
Nursing Protocol/Guideline for Eye Complaints*
You refer to the Nursing Protocol/Guideline for Eye Complaints, and you note that Ms. Burns’ presentation and symptoms are consistent with bacterial conjunctivitis, and so you contact the Provider for orders. Based upon your assessment and Ms. Burns’ subjective information, the Provider orders moxifloxcin 0.5% eye drops bilaterally TID for seven days. Before she leaves the exam room, you provide Ms. Burns with patient education for bacterial conjunctivitis and schedule her for a follow-up in Nursing Sick Call in three days to check her progress.
Patient Education
Patient education for the patient with conjunctivitis includes proper hand washing technique and the proper instillation of eye drops and eye ointments (as applicable). Patients should be reminded that it is important to complete the course of medication prescribed, even if they are feeling better in a few days. Disease transmission should be discussed, and patients should be cautioned that rubbing the affected eye may cause the infection to spread to the other eye or to other people. In addition, sharing items such as towels and washcloths may also cause others to become infected. Eye make-up (yes, you know that there is “eye makeup” in our correctional facilities!) and contact lens should not be used until the infection is completely gone.
Please share any experiences you have had in your practice with patients presenting with red eye in our comments section, below.
*As always, your company or facility policies, procedures and Nursing Protocols/Guidelines take precedence over any written recommendations on this website.
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