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Assignment NR 602 Midterm -Chalazion Soap Note Sample

Assignment: NR 602 Midterm -Chalazion Soap Note Sample

Chalazion

A chalazion is a chronic sterile inflammation of the eyelid resulting from a lymphogranuloma of the meibomian glands that line the posterior margins of the eyelids (see Fig. 29-7). It is deeper in the eyelid tissue than a hordeolum and may result from an internal hordeolum or retained lipid granular secretions.

Clinical Findings

Initially, mild erythema and slight swelling of the involved eyelid are seen. After a few days the inflammation resolves, and a slow growing, round, nonpigmented, painless (key finding) mass remains. It may persist for a long time and is a commonly acquired lid lesion seen in children (see Fig. 29-7).

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Management

  • Acute lesions are treated with hot compresses.
  • Refer to an ophthalmologist for surgical incision or topical intralesional corticosteroid injections if the condition is unresolved or if the lesion causes cosmetic concerns. A chalazion can distort vision by causing astigmatism as a result of pressure on the orbit.

Complications

Recurrence is common. Fragile, vascular granulation tissue called pyogenic granuloma that enlarges and bleeds rapidly can occur if a chalazion breaks through the conjunctival surface.

NR 602 Midterm -Chalazion Soap Note

Types of Conjunctivitis

Assignment NR 602 Midterm -Chalazion Soap Note Sample

Assignment NR 602 Midterm -Chalazion Soap Note Sample

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Type Incidence/Etiology Clinical Findings Diagnosis Management*
Ophthalmia neonatorum Neonates: Chlamydia trachomatis, Staphylococcus aureus, Neisseria gonorrhoeae, HSV (silver nitrate reaction occurs in 10% of neonates) Erythema, chemosis, purulent exudate with N. gonorrhoeae; clear to mucoid exudate with chlamydia Culture (ELISA, PCR), Gram stain, R/O N. gonorrhoeae, chlamydia Saline irrigation to eyes until exudate gone; follow with erythromycin ointment

For N. gonorrhoeae:ceftriaxone or IM or IV

For chlamydia: erythromycin or possibly azithromycin PO

For HSV: antivirals IV or PO

Bacterial conjunctivitis In neonates 5 to 14 days old, preschoolers, and sexually active teens: Haemophilus influenzae(nontypeable), Streptococcus pneumoniae, S. aureus, N. gonorrhoeae Erythema, chemosis, itching, burning, mucopurulent exudate, matter in eyelashes; ↑ in winter Cultures (required in neonate); Gram stain (optional); chocolate agar (for N. gonorrhoeae) R/O pharyngitis, N. gonorrhoeae, AOM, URI, seborrhea Neonates: Erythromycin 0.5% ophthalmic ointment

≥1 year old: Fourth-generation fluoroquinolone

For concurrent AOM: Treat accordingly for AOM

Warm soaks to eyes three times a day until clear

No sharing towels, pillows

No school until treatment begins

Chronic bacterial conjunctivitis (unresponsive conjunctivitis previously treated as bacterial in etiology) School-age children and teens: Bacteria, viruses, C. trachomatis Same as above; foreign body sensation Cultures, Gram stain; R/O dacryostenosis, blepharitis, corneal ulcers, trachoma Depends on prior treatment, laboratory results, and differential diagnoses

Review compliance and prior drug choices of conjunctivitis treatment

Consult with ophthalmologist

Inclusion conjunctivitis Neonates 5 to 14 days old and sexually active teens: C. trachomatis Erythema, chemosis, clear or mucoid exudate, palpebral follicles Cultures (ELISA, PCR), R/O sexual activity Neonates: Erythromycin or azithromycin PO

Adolescents: Doxycycline, azithromycin, EES, erythromycin base, levofloxacin PO

Viral conjunctivitis Adenovirus 3, 4, 7; HSV, herpes zoster, varicella Erythema, chemosis, tearing (bilateral); HSV and herpes zoster: unilateral with photophobia, fever; zoster: nose lesion; spring and fall Cultures, R/O corneal infiltration Refer to ophthalmologist if HSV or photophobia present

Cool compresses three or four times a day

Allergic and vernal conjunctivitis Atopy sufferers, seasonal Stringy, mucoid exudate, swollen eyelids and conjunctivae, itching (key finding), tearing, palpebral follicles, headache, rhinitis Eosinophils in conjunctival scrapings Naphazoline/pheniramine, naphazoline/antazoline ophthalmic solution (see text)

Mast cell stabilizer (see text)

Refer to allergist if needed

See text for dosages.

NR 602 Midterm -Chalazion Soap Note

Blepharitis

Blepharitis is an acute or chronic inflammation of the eyelash follicles or meibomian sebaceous glands of the eyelids (or both). It is usually bilateral. There may be a history of contact lens wear or physical contact with another symptomatic person. It is commonly caused by contaminated makeup or contact lens solution. Poor hygiene, tear deficiency, rosacea, and seborrheic dermatitis of the scalp and face are also possible etiologic factors. The ulcerative form of blepharitis is usually caused by S. aureus. Nonulcerative blepharitis is occasionally seen in children with psoriasis, seborrhea, eczema, allergies, lice infestation, or in children with trisomy 21.

Clinical Findings

  • Swelling and erythema of the eyelid margins and palpebral conjunctiva

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  • Flaky, scaly debris over eyelid margins on awakening; presence of lice
  • Gritty, burning feeling in eyes
  • Mild bulbar conjunctival injection
  • Ulcerative form: Hard scales at the base of the lashes (if the crust is removed, ulceration is seen at the hair follicles, the lashes fall out, and an associated conjunctivitis is present)

Differential Diagnosis

Pediculosis of the eyelashes.

Management

Explain to the patient that this may be chronic or relapsing. Instructions for the patient include:

  • Scrub the eyelashes and eyelids with a cotton-tipped applicator containing a weak (50%) solution of no-tears shampoo to maintain proper hygiene and debride the scales.
  • Use warm compresses for 5 to 10 minutes at a time two to four times a day and wipe away lid debris.
  • At times antistaphylococcal antibiotic (e.g., erythromycin 0.5% ophthalmic ointment) is used until symptoms subside and for at least 1 week thereafter. Ointment is preferable to eye drops because of increased duration of contact with the ocular tissue. Azithromycin 1% ophthalmic solution for 4 weeks may also be used (Shtein, 2014).
  • Treat associated seborrhea, psoriasis, eczema, or allergies as indicated.
  • Remove contact lenses and wear eyeglasses for the duration of the treatment period. Sterilize or clean lenses before reinserting.
  • Purchase new eye makeup; minimize use of mascara and eyeliner.
  • Use artificial tears for patients with inadequate tear pools.

Chronic staphylococcal blepharitis and meibomian keratoconjunctivitis respond to oral erythromycin. Doxycycline, tetracycline, or minocycline can be used chronically in children older than 8 years old.

NR 602 Midterm -Chalazion Soap Note

Hand-Foot-Mouth Syndrome

Enteroviruses

Nonpolio Enteroviruses

Of the more than 100 serotypes of nonpolio RNA enteroviruses, 10 to 15 serotypes account for most diseases. They are grouped into four genomic classifications: human 495enteroviruses (HEVs) A, B, C, and D. Coxsackieviruses and echoviruses are subgroups of HEVs. Hand-foot-mouth, herpangina, pleurodynia, acute hemorrhagic conjuncti­vitis, myocarditis, pericarditis, pancreatitis, orchitis, and dermatomyositis-like syndrome are manifestations of infection. These enteroviruses are the most common cause of aseptic meningitis and have also been associated with paralysis, neonatal sepsis, encephalitis, and other respiratory and GI symptoms. The specific serotype may not be unique to any given disease (Abzug, 2011).

As evidenced by the name, enteroviruses concentrate on the GI tract as their primary invasion, replication, and transmission site; they spread by fecal-oral contamination, especially in diapered infants. They are also transmitted via the respiratory route and vertically either prenatally, during parturition, or possibly by way of breastfeeding by an infected mother who lacks antibodies to that particular serotype. Transplacental infection can lead to serious disseminated disease in the neonate that involves multiorgan systems (liver, heart, meninges, and adrenal cortex).

Enteroviruses have worldwide distribution, occurring in temperate climates during the summer and fall and in tropical climates year round. In known cases, infants younger than 12 months old have the highest prevalence rate (>25%), and HEVs account for 55% to 65% of hospitalizations for suspected infant sepsis. Illness occurs more frequently in males; those living in crowded, unsanitary conditions; and in those of lower socioeconomic status (Abzug, 2011). Infection can range from asymptomatic to undifferentiated febrile illness to severe illness. Young children are more likely to be symptomatic. The incubation period is 3 to 6 days (less for hemorrhagic conjunctivitis). After infection, the virus is shed from the respiratory tract for up to 3 weeks and from the GI tract for up to 7 to 11 weeks; it is viable on environmental surfaces for long periods.

Nonpolio enteroviral infection is not a reportable disease, nor is it routinely tested for in the clinical setting, so the overall incidence rate is not known. The CDC administers the National Respiratory and Enteric Virus Surveillance System (NREVSS) and the National Enterovirus 496Surveillance System (NESS) to monitor detection patterns of respiratory and enteric adenoviruses. The 2014 outbreak of an illness in children referred to as acute flaccid myelitis bears some similarity to infections caused by viruses, including enterovirus; epidemiologic studies are ongoing (CDC, 2015f).

Clinical Findings
History.

General symptoms include:

  • A mild upper respiratory infection (URI) is common and may include complaints of sore throat, fever, vomiting, diarrhea, anorexia, coryza, abdominal pain, rash, and headache.
  • Nonspecific febrile illness of at least 3 days: In young children, there is an undifferentiated abrupt-onset febrile illness (101° to 104° F [38.5° to 40° C]) associated with myalgias, malaise, irritability; fever may wax and wane over several days.
  • Onset of viral symptoms within 1 to 2 weeks after delivery for neonates infected transplacentally.
Physical Examination.

General findings include mild conjunctivitis, pharyngeal infection, and/or cervical adenopathy. Other findings include:

  • Skin: Rash may be macular, macular-papular, urticarial, vesicular, or petechial. May imitate the rash of meningitis, measles, or rubella.
  • Herpangina: There is a sudden onset of high fever (up to 106° F [41° C]) lasting 1 to 4 days. Loss of appetite, sore throat, and dysphagia are common, with vomiting and abdominal pain in 25% of cases. Small vesicles (from one to more than 15 lesions of 1 to 2 mm each) appear and enlarge to ulcers (3 to 4 mm) on the anterior pillars of the fauces, tonsils, uvula, and pharynx and the edge of the soft palate. The vesicles commonly have red areolas up to 10 mm in diameter. This self-limiting infection usually lasts 3 to 7 days.
  • Acute lymphonodular pharyngitis: This manifests as an acute sore throat lasting approximately 1 week.
  • Hand-foot-mouth disease: This is a clinical entity evidenced by fever, vesicular eruptions in the oropharynx that may ulcerate, and a maculopapular rash involving the hands and feet. The rash evolves to vesicles, especially on the dorsa of the hands and the soles of the feet, and lasts 1 to 2 weeks (Fig. 24-1).
  • Important information for writing discussion questions and participationHi Class,

    Please read through the following information on writing a Discussion question response and participation posts.

    Contact me if you have any questions.

    Important information on Writing a Discussion Question

    • Your response needs to be a minimum of 150 words (not including your list of references)
    • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
    • Include in-text citations in your response
    • Do not include quotes—instead summarize and paraphrase the information
    • Follow APA-7th edition
    • Points will be deducted if the above is not followed

    Participation –replies to your classmates or instructor

    • A minimum of 6 responses per week, on at least 3 days of the week.
    • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
    • Each response needs to be at least 75 words in length (does not include your list of references)
    • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
    • Follow APA 7th edition
    • Points will be deducted if the above is not followed

    Welcome to class

    Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.

    I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

    Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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    Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

    Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

    I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

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