Sample Nursing Paper on Infectious Conjunctivitis a Case Study of a Resident at a Nursing

: Background of the Case Study

Infectious conjunctivitis refers to the inflammation of the conjunctiva a membrane covering sclera due to viral or bacterial infection. Infectious conjunctivitis caused by bacteria is known as Bacterial conjunctivitis while viral conjunctivitis is caused by contagious viruses. Common symptoms associated with infectious conjunctivitis are reddening of the eye and sensitivity to light. Bacterial conjunctivitis can be treated by the use of antibiotic eye droplets as well as gentle washing and cleaning of the eyelids with a warm wet face washcloth. A severe degree of viral conjunctivitis can be treated by the use of corticosteroid eye drops Roat M. (2019).

The likely micro-organism to cause John’s eye infection is Staphylococcus aureus which is a bacterial micro-organism. The remaining micro-organisms are highly unlikely to cause infectious conjunctivitis since; Legionella pneumophila is a type of bacteria that causes lung infection and subsequently acute pneumonia WC Jr. (19960. Plasmodium ovale is a species of plasmodia parasitic protozoa that causes human malaria. Lastly, Adenoviruses can affect the lining of the eyes but their symptoms are distinctive from John’s symptoms since an individual infected by these viruses exhibit fever, coughs, pink eye, and or diarrhea.

Question 2: Mechanism of Action and Adverse Reactions.

Gentamicin is a bactericidal antibiotic made up gentamicin C1, C1a, and C2 components and its mechanism of action that entails inhibition of synthesis of bacterial proteins by the aminoglycoside component of gentamicin which bind the 30S ribosomes as well as causing increased misreading of messenger RNA which is highly dependent on the concentration of the antibiotic Tangy F., et al (1984). This mechanism of action is responsible for killing bacteria their functional proteins have been rendered nonfunctional and these proteins are essential for growth and repair Bullock, S., & Manias, E. (2017). At low levels of concentration of gentamicin, the polysomes are less affected while the ribosomes are highly affected, on the other hand, high concentration levels of gentamicin the polysomes are highly inhibited while the ribosomes are less inhibited. Their functions in synthesis are being recovered slowly by slowly.

When gentamicin antibiotic is administered to a person with infectious conjunctivitis it may lead to the following adverse side effects; burning or stinging sensation of the ocular but only temporarily and in cases where the side effects are extreme the individual should see a doctor as soon as possible for further medical checkup. The drug might cause serious allergic reactions that prompt an individual to also see a doctor who will provide suitable treatment for the individuals reacting to gentamicin treatment. According to Cunha, J. (2019), continued use of gentamicin may lead to fungal eye infections. Burchum, J. R., & Rosenthal, L. (2019) indicate that the use of gentamicin may lead to damage to the eighth cranial nerve.  As much as gentamicin is an effective drug in treating infectious conjunctivitis it is clear that it exhibits several side effects.

Question 3: Physiological Basis of Signs

Basing on the case study, John had red, swollen eyes, pain in the eye and had a purulent sticky discharge from his eye. This is enough evidence to conclude that John was suffering from bacterial conjunctivitis. This claim is backed up by Haq A., Wardak H, and Kraskian N. (2013) who attributed to the fact that common symptoms of bacterial conjunctivitis are red eye accompanied by the discharge of a purulent sticky substance from the eye. The main causative agent of these symptoms is the bacteria Staphylococcus aureus which attaches itself to the host’s eye tissues and eroding his/her immune response. Staphylococcus aureus is both aerobic and facultative anaerobic organism that forms large yellow or white colonies that attach themselves on nutrient-rich agar media. The bacterial organism is characterized by being hemolytic in the blood agar thus being the reason behind John’s red-eye. Staphylococcus aureus has strains that produce coagulase enzymes that are sticky and purulent hence explaining the presence of the same discharge on John’s eye.

The swelling of John’s eye is attributed to the fact that Staphylococcus aureus is a salt-tolerant bacterium that can thrive well in the saline/salty nature of the eye caused by tears. It oxidizes negatively and catalyzes positively.

Question 4: Infection Control Issues

Infection control attempts to look into factors that relate to the spread of infections in a health care setting as well as prevention methods of the same, monitoring and management Minhas S., et al (2011). Elderly people in nursing homes are susceptible to being attacked by numerous infections on account of their weakened immune system. A study carried out by Boustcha, E., & Nicolle, L. E. (1995) to determine the incidences, preventive measures, and etiology of conjunctivitis in residents of a long term care facility it was found out that conjunctivitis was common in facilities with increased occurrences in highly impaired residents more. Basing on John’s age (88) years old, his immunity is likely to be affected by the age and that’s why he probably got infected with bacterial conjunctivitis.

In nursing homes especially for the elderly case of conjunctivitis, the infection may be sporadic or outbreak-associated Smith P., et al (2008). Upon carrying out bacterial isolation the bacteria Staphylococcus aurous responsible for causing infectious conjunctivitis appeared the most in the isolate, therefore in a nursing home residents are likely to be infected by conjunctivitis as it spreads rapidly. The nursing home in the case study might have had a sporadic or outbreak-associated case of conjunctivitis transmitted majorly by hand cross-contamination. This is highly supported Australian Government Department of Health and Ageing National Health and Medical Research Council (2013)  that living in communally in nursing homes increases contact between people and also the risk of infection mostly when the residents have experienced difficulties in performing day to day activities.

Question 5: Transmission of Infection

In nursing homes, the spread of infectious bacteria is high as both residents and staff members play a focal role in carrying and transmitting the infections majorly through body contact. Therefore there is a need to practice proper sanitation measures like washing of hands and disinfecting of surfaces.

In the case study, a patient Mary living next door to John was diagnosed with the same eye infection as John. This could have occurred probably due; to contact between a health care worker taking care of John and Mary. She might have not cleaned her hands and taken proper safety measures after handling John’s eye problem. Therefore she acted as an agent for the spread of the infection to Mary.

Staphylococcus aureus can land of surfaces or objects residents may pick these bacteria from the contaminated surfaces unknowingly and contribute to the spread and infection of conjunctivitis. There might have been some contact between John and Mary hence the infection might have occurred when his Staphylococcus aurous contaminated hand skin scales were shed onto surfaces Mary touched or onto Mary’s hands.

Sharing of newspapers, books, and other readable materials by the residents of the nursing homes could lead to transfer of the infectious conjunctivitis from one person to the other. In this case, it could be possible that John and Mary might have shared reading materials without proper sanitation of their hands or the materials. In this chain of infection, health workers are susceptible to getting infected too in case they don’t take the necessary precautions while handling the infected patients.

Question 6: Breaking Chain of Infection

Once a chain of infection has been discovered of a certain disease necessary measures have to be taken to inhibit further spread by breaking the chain of infection. Boland, M., Santall, J & Video Education Australasia. (2011) indicate that controlling infections in a health care setting is a vital responsibility that should be taken and shared by all health staff. Centers for Disease Control and Prevention (2016) explained a chain of infection as when a microorganism exits from the host via an exit portal and enters into a susceptible host through an entry portal. Shaw K (2016) attributes that since nurses are ever in contact with patients and carry out many intervention measures, each contact and intervention plays a key role in inhibiting the rise of the spread of infection. Measures that nurses can adopt to break the chain of infection in the nursing home mentioned in the case study are:

Establishing the number of cases of infectious conjunctivitis as well as infection trends of the same. In this case, John was the noted patient to have been diagnosed with bacterial conjunctivitis; therefore the best measure would have been isolation and treatment of the eye problem accompanied by taking safety measures while handling the patient. Such safety measures are ensuring high levels of sanitation for both the patient and the nurse handling John’s problem. Cleaning of surfaces likely to be touched by the patient is necessary. When nurses have taken proper safety measures one link for infection will have been broken hence the spread of the infection will be prevented. According to Shaw K (2016), this is true as when one or more links of infections are broken then the infection will not take place.

Decontamination and washing of patients’/residents’ personal effects such as eye drop medicines, wash cloths, and towels. These are items that contribute to the spread of infectious conjunctivitis if shared between residents. Nurses are to ensure that they use clean and different wash clothes for different patients when treating bacterial conjunctivitis. In this case study, the nurse handling John or Mary should ensure that sharing of their personal effects does not happen as well as ensuring high levels their decontamination. Nurses should have on their protective gear like gloves while handling the two residents of the nursing home. These gloves have to be disposed of and new fresh gloves used for the next patient. According to Lehne, R. A., Moore, L., Crosby, L., & Hamilton, D. (2013), the best way for decontamination is cleaning of hands with lots of water and soap as well as contaminated surfaces. Upon employing the use of these measures the chain of infection here will be broken in a nursing home.

 

 

References

Australian Government Department of Health and Ageing National Health and Medical Research Council (2013). Prevention and control of infection in residential and community aged care.

Boland, M. (Director), Santall, J. (Presenter), & Video Education Australasia. (2011). Infection control in healthcare [Videorecording]. Bendigo, Australia: VEA. Retrieved from https://www.worldcat.org/title/infection-contro-in-healthcare/0clc/808309911?loc=94043&tab=holdings&start_holfing=7

Boustcha, E., & Nicolle, L. E. (1995). Conjunctivitis in a long-term care facility. Infection Control and Hospital Epidemiology, 16(4), 210-216. Retrieved from https://pubmed.ncbi.nlm.nih.gov

Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs Forest, Australia: Pearson Australia.

Burchum, J. R., & Rosenthal, L. (2019). Lehne’s pharmacology for nursing care (10th ed.). St. Louis, MO: Elsevier/Saunders

Centers for Disease Control and Prevention (2016). Chain of Infection. Retrieved from www.nursingtimes.net

Cunha, P. J. (2019 February, 5th). Genoptic Side Effects. Retrieved from https://www.rxlist.com/genoptic-side-effects-drug-center-htm#consumerfdb

Drancourt, M. (2010). Infectious Diseases. 3rd Edition. Retrieved from. https://www.sciencedirect.com/topics/medicine-and-dentistry/bacterial-conjunctivitis.

Lehne, R. A., Moore, L., Crosby, L., & Hamilton, D. (2013). Pharmacology for

nursing care (8th ed.). St. Louis, MO: Saunders/Elsevier. Retrieved from. https://www.worldcat.org/title/pharmacology-for-nursing-care/oclc/803339627