The opportunity to attend a 11-year-old female patient complaining of red left eye and edematous eyelids.
Clinical Experience Week 5
This week I had the opportunity to attend a 11-year-old female patient complaining of red left eye and edematous eyelids. Her mother states the child complains of “sand in my left eye.” Patient noticed redness three days ago. Denies having any allergies. Symptoms have gotten worse since she noticed having the problem. Eye infections can result from a variety of pathogenic organisms, usually bacteria and viruses. Many of these infections are self-limited, and most respond well to treatment. However, severe, or untreated infections can lead to visual impairment. These conditions can also be caused by other events that can trigger the inflammatory process (e.g., trauma, allergens, and irritants). The nurse practitioner should ask the patient if he or she is experiencing blurry vision and if the patient has had any prior surgery. Also, if the patient experienced any trauma to the eye. The nurse practitioner should include in his history of present illness if there is something that relieves the symptoms (Alfonso et al., 2018).
Upon assessment the patient sclera was very red and dry, crusty exudates; unable to open eyes in the morning with the left being worse than the right. The patient does not complain of blurry vision. Eye redness mainly located around the limbus, which is where the cornea transitions into the sclera may indicate another more serious diagnosis such as angle closure glaucoma or keratitis. Viral conjunctivitis is the most common cause and is usually due to adenovirus. Viral infections normally produce a watery or mucus like discharge that is usually scant and stringy or ropelike. The eye also feels gritty, like there is sand in it. Viral conjunctivitis usually starts in one eye and then goes to the other eye (La Rosa et al., 2019). Viral conjunctivitis can be accompanied by other viral syndromes such as an upper respiratory tract infection. Bacterial conjunctivitis is usually due to Streptococcus pneumoniae, Haemophilus, Moraxella catarrhalis in children, and Staphylococcus aureus in adults. Bacterial infections usually produce a mucopurulent yellow-green exudate (puslike) in one eye or both eyes. Bacterial conjunctivitis can be accompanied by other disorders such as otitis media. Allergic conjunctivitis is due to allergens (e.g., dust and pollen) that stimulate an IgE response. Allergic conjunctivitis can be accompanied by rhinitis and occurs more often in patients with a history of atopy (Azari, & Arabi, 2020).
Since Viral and bacterial conjunctivitis are highly contagious through direct contact, a health promotion intervention for this patient would be prevent transmission of the infection (e.g., hand washing, limiting contact, proper eye hygiene, and discarding contaminated ophthalmic products) (La Rosa et al., 2019). During my clinical experience, I learned to maintain a positive attitude with my patients. Patients require advocacy of their problems, allowing them to share what they are willing, and educating them to make informed decisions. Most of the time, I could briefly share my personal experiences with their conditions and support them in whatever decisions they make. After this week’s clinical experience, I am confident I can perform a physical patient examination and evaluation successfully. Collaboration is a significant aspect of healthcare, helping patients receives appropriate healthcare services. I endeavor to cultivate critical thinking as I complete my clinical experiences, learning practical skills from my mentors and caring for my patients in the process.
References
Alfonso, S. A., Fawley, J. D., & Lu, X. A. (2018). Conjunctivitis. Primary Care: Clinics in Office Practice, 42(3), 325-345.
Azari, A. A., & Arabi, A. (2020). Conjunctivitis: a systematic review. Journal of ophthalmic & vision research, 15(3), 372.
La Rosa, M., Lionetti, E., Reibaldi, M., Russo, A., Longo, A., Leonardi, S., … & Reibaldi, A. (2019). Allergic conjunctivitis: a comprehensive review of the literature. Italian journal of pediatrics, 39(1), 1-8.
Edited by Prats Gonzalez, Daniel on Sep 20 at 10:27pm
10 hours ago
Did you face any challenge, any success? If so, what were they?
This week we had different nurse practitioners working in the clinical, so I got to see how different providers handle their workload and see different personal approaches to practitioner and patient interaction. Originally, I was nervous about working with different people, but I have been learning so much from them. It is also nice to see how well they all work together and jump in wherever needed to help the practice run smoothly.
We had a 44-year-old patient who has a long history of type 1 diabetes, she also has three children with the same type of diabetes. Her blood sugars are not well managed, and her hemoglobin A1C was not even able to be recorded accurately the result just indicated it was greater than 14. When discussing this over with the patient, she was very surprised that it was so high. When we asked about her checking her blood sugars regularly and taking her insulin when she was supposed to, she admitted that she has not. The patient is a single mother with three children all with type 1 diabetes. Her insurance has not been covering her insulin completely and was told it will cost her $400 to refill it. She also mentioned that between the family they only currently have one working glucose monitor, the other ones are broken, as well as the insurance company was not covering the family testing supplies completely. This was very concerning for us as providers. The patient also has only been prescribed Lantus and Levemir insulin but was not set up on a sliding scale insulin. The patient explained it had to do with the cost of the insulin.
Since the patient body is not making insulin for itself, it is important for the patient monitor her blood sugar routinely and insure she is taking the correct medication. If your sugar are elevated she should be taking additional short active insulin. They patient was educated on the risk of continuing to have uncontrolled blood sugar and possible complications, like hospital visit, loss of limbs (Dunphy et al, 2019).
This patient also has three children with type 1 diabetes. Young adults are at a much higher risk of mismanaging their diabetes and if they see their mother doing the same thing, they will follow her lead. As her children get older, they will also have to navigate with decisions on health insurance and how to get medications and testing supplies covered (Sawyer et al, 2022).
We gave the patient a sample of the Dexcom continuous monitor and instructed her on how to use. We also instructed her to have her children get on same kind of monitoring device and gave her education on programs to help with getting her and her children more help with supplies and medication. She did mention on her previous medical plan she had better coverage and plans on switching back to plan that will cover more for the new year. She is working on getting her younger children on Medicaid to help with their medications and testing supplies. Her older children are starting their own jobs and she is hopeful she can help them pick insurance plans that will have best coverage. She also understands she needs to set a better example for her children, and make correct changes so she can live longer for her children.
References
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care: Art and Science of Advanced Practice Nursing (5th ed.). F.A. Davis Company.
Sawyer, B., Hilliard, E., Hackney, K. J., & Stastny, S. (2022). Barriers and Strategies for Type 1 Diabetes Management Among Emerging Adults: A Qualitative Study. Clinical Medicine Insights: Endocrinology & Diabetes, 1–10. https://doi.org/10.1177/11795514221098389
10 hours ago
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