Please reply to the 2 following discussion posts separately with separate reference lists.
1. [Cathy Nguyen] The FNP should ensure they gather adequate patient history. In this case, the patient is a child; thus, they may need to collect patient information from their parent. The FNP should ask about the onset, severity, associated symptoms, relieving factors, and any history regarding the patient’s current medical concern. Since the patient presents with copious nasal discharge and soft-tissue swelling around the left eye, the healthcare provider may perform a physical examination focusing on the eyes, sinuses, nose and throat. Based on the patient’s presenting symptoms, they likely have an infection. Viral conjunctivitis may be a possible diagnosis for the patient. This infection is often characterized by swelling of the eye, a runny nose, and a sore throat (Johnson et al., 2022). The patient presents with some of these symptoms and thus may have the condition. The FNP should develop a treatment plan that aims at symptom relief. They may prescribe eye drops and analgesics such as paracetamol for pain relief to the patient. The FNP should educate the parent and child on non-pharmacological treatment approaches such as observing proper eye and oral hygiene, cleaning eyelids with a wet cloth, and applying warm compresses several times daily (Johnson et al., 2022). If the symptoms persist, the FNP will need to refer the patient to an ENT specialist or ophthalmologist, depending on the symptoms.
Difference in Treatment Plan
Adults than children are at risk of viral conjunctivitis caused by the herpes simplex virus (Johnson et al., 2022). In this case, adults aged 35 may need laboratory tests to detect if their infection may be caused by herpes simplex. If the virus is present, they may need antiviral therapy and eye drops for symptom relief (Cagini et al., 2020). Without the virus, the FNP may recommend letting the disease take its course. The infection is likely to resolve without treatment. The practitioner may need to offer education on proper hygiene and avoid anything that aggravates the symptoms. Unlike a 35-year-old patient, a 65-year-old patient may need medical attention. A 65-year-old has poor immunity; thus, the condition may progress to a severe state or take longer to resolve (Lee et al., 2018). The 65-year-old may need antiviral therapy, eye drops, and fluid replenishment therapy as they risk losing a lot of fluid through sweating due to fever.
References
Cagini, C., Mariniello, M., Messina, M., Muzi, A., Balducci, C., Moretti, A., Levorato, L., & Mencacci, A. (2020). The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial. International Ophthalmology, 40(12), 3209–3215. https://doi.org/10.1007/s10792-020-01503-4
Lee, S. B., Oh, J. H., Park, J. H., Choi, S. P., & Wee, J. H. (2018). Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clinical and Experimental Emergency Medicine, 5(4), 249–255. https://doi.org/10.15441/ceem.17.261
Johnson, D., Liu, D., & Simel, D. (2022). Does This Patient with Acute Infectious Conjunctivitis Have a Bacterial Infection? JAMA, 327(22), 2231. https://doi.org/10.1001/jama.2022.7687
2. [ARLENE BALINAO] When a patient complains of coughing, a thorough medical history and evaluation are needed to decide on the best course of action: investigating the start, duration, and symptoms that go along with them, and job history, employment, and lifestyle elements including smoking, vaping, recent infections, and respiratory allergies. A comprehensive history and discussion with the patient about the start and type of the cough can help make a diagnosis in roughly 80% of cases (Dunphy et al., 2019).
The FNP should inquire about the following: • When did the cough initially start? What conditions such as a recent respiratory infection, exposure to noxious substances, or starting a new medication may have caused the cough. Is the cough related to hobbies or work? • When does the cough start—when the patient wakes up, before bed, when exercising, or throughout the night? • What circumstances tend to aggravate or aggravate the cough? Is the cough made worse by physical activity, exposure to substances, body posture, or cold air? Are there existing respiratory illnesses like COPD and asthma with the patient? • Has the patient noted any practices, such sitting up straight or avoiding contact with specific substances, that tend to alleviate the cough? What remedies have been attempted to get the cough under control? • How does the cough feel? Is it throaty, dry, and hacking, wet, raspy, deep, or deep? If the patient coughs up sputum, ask the patient to describe the quantity (e.g., 1 teaspoon, 1 tablespoon), color (e.g., yellow, gray, green, brown, clear, white, blood-tinged), and consistency of the sputum produced each day (e.g., thick, ropy, frothy, or tenacious). When—for example, morning or evening—is the productive cough most productive? (Dunphy et al., 2019).
Differential diagnoses for cough include:
1) Allergic rhinitis or postnasal drip: Fluticasone propionate (Flonase), 50 mcg/spray, two nasal sprays each naris per day, is used to treat allergic rhinitis or postnasal drip. Four to six weeks for a follow-up visit unless symptoms persist for more than 3 days in which case appointment call is sooner (Cash & Glass, 2017).
2. Upper respiratory infections are treated with pseudoephedrine (Sudafed) 60 mg or 120 mg, by every 6 to 12 hours by mouth, guaifenesin with dextromethorphan (Robitussin DM, Mytussin) 10 ml, by mouth, every 4 hours, and acetaminophen 500 mg, by mouth every 6 to 8 hours, as needed for headaches. It is not required to follow up unless symptoms get worse or last longer than 7 days (Cash & Glass, 2017).
3.) Influenza: Treatment for influenza is like that for upper respiratory infections. Oseltamivir (Tamiflu) and zanamivir (Relenza) are not advised because it has been more than two days (Cash & Glass, 2017). Ibuprofen 200-400 mg, by mouth every 4-6 hours, as needed for body pains and 400 mg, by mouth every 6 hours, as needed for fever. The patient is advised to be vaccinated before flu season. If symptoms do not go away, make an appointment for a follow-up in 7–10 days (Cash & Glass, 2017).
4.) Acute bronchitis: Guaifenesin with dextromethorphan (Robitussin DM, Mytussin), 10 ml, by mouth every four hours, is used to treat acute bronchitis (Cash & Glass, 2017). Before symptoms last more than two weeks, antibiotics are not indicated. Follow-up should be done within 48 hours of starting antibiotic therapy and within 7 to 10 days if symptoms don’t go away (Cash & Glass, 2017).
5.) Bacterial pneumonia: Azithromycin (Zithromax) 500 mg, by mouth, loading dose, then 250 mg, by mouth daily on days 2 through 5 treat bacterial pneumonia (Cash & Glass, 2017). Call back within 24 hours for follow-up, return to the clinic if symptoms continue after 48 hours of antibiotic treatment, or arrange a return appointment for two weeks. Antitussive medications must be avoided (Cash & Glass, 2017).
Additionally, adequate rest, adequate environment humidity control, and fluid intake also aid in reducing coughing and thinning mucus. Another option is to inhale the steam from a hot shower (Dunphy et al., 2019). It is crucial to inform the patient and their family about any potential occupational or environmental triggers for cough and how to minimize irritating exposure. For example, if a family member smokes, the clinician must inform the patient and the family about the risks of secondhand smoke. Simple actions like replacing air filters might help eliminate environmental irritants (Dunphy et al., 2019).
References
Cash, J. C., & Glass C. A. (2017). Family Practice Guidelines (4th ed). Springer Publishing
Company.
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care, The Art and
Science of Advanced Practice Nursing – An Interprofessional Approach. Davis Plus
