What characteristics would the patient likely describe if the conjunctivitis is caused by a bacterial infection? 

If this patient had conjunctivitis caused by a bacterial infection it is likely that she would complain of itchiness, burning, redness in the eye and watering (Dunphy et al., 2022). She may also complain of exudates at the eyelid site that may be thick and yellow (Dunphy et al., 2022). Typically symptoms are worse in the morning after waking up (Dunphy et al., 2022).

What signs/symptoms would you expect to find during the physical exam?

When assessing the eye it would be important to inspect both eyes looking for inflammation of the cornea, if there is exudate then it is likely a bacterial infection (Dunphy et al., 2022). The eyelid may be swelling, it is important to assess the eyelid and eyelashes to look for any changes (Dunphy et al., 2022). The cornea should be assessed to look for decreased visual acuity can be related to a worsening infection or N. gonorrhea (Dunphy et al., 2022). Symptoms I would expect to see include unilateral or bilateral thick exudate, pain in the eye, and itching or burning (Dunphy et al., 2022).

What are the differential diagnoses for the patient?

Differential diagnosis including Chlamydia, N. gonorrhea, as well as adenovirus (Dunphy et al., 2022). Iritis should also be considered in there is inflammation of the iris or uveitis if a larger area of the eye is involved (Dunphy et al., 2022). Viral conjunctivitis is also a differential diagnosis that may be considered, symptoms would include an increase in tear production, itching and burning, and a watery discharge (Dunphy et al., 2022).

What symptoms, if present, would indicate the need to have another professional perform a dilated pupil exam?

If a patient is experiencing symptoms such as hyperemia with proptosis, a change in the optic nerve function, double vision, or a change in their typical visual acuity then a dilated pupil exam is warranted (Dunphy et al., 2022). If treatment is not successful for bacterial conjunctivitis then it is likely that a dilated pupil exam is warranted.

What treatment should be prescribed for the patient’s bacterial conjunctivitis? Include full prescribing information.

An antibiotic is needed if the patient has bacterial conjunctivitis. A topical treatment such as Erythromycin ointment 0.5%, 1cm applied to affected eye BID for 7 days (Arcangelo et al., 2021).

What additional patient teaching should be included?

Teaching should include a common side effect of erythromycin ointment including blurred vision following application of the ointment, this should resolve within a few minutes (Arcangelo et al., 2021). It is important to educate the patient that bacterial conjunctivitis is contagious and can spread through contact and secretions from the eye (Chan et al., 2022). The patient should be counseled to wash their hands often and avoid touching their eyes if possible. Warm compresses can also be used to help relieve crusted over eyes, particularly in the morning, wiping from the inner corner to the outside of the eye (Chan et al., 2022). The patient should be instructed that if the conjunctivitis does not improve following the end of treatment that they may need to be referred to ophthalmology for further testing and treatment.  

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