What is conjunctivitis?

Conjunctivitis is one of the most common and treatable eye infections in children and adults. Often called "pink eye," it is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid. This tissue helps keep the eyelid and eyeball moist. Conjunctivitis can be caused by a virus, bacteria, irritating substances (shampoos, dirt, smoke, and especially pool chlorine), allergens (substances that cause allergies) or sexually transmitted infections (STIs). Pink eye caused by bacteria, viruses, and STIs can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

What are the symptoms of conjunctivitis?

y y y y y y y y
Redness in the white of the eye or inner eyelid Greater amount of tears Thick yellow discharge that crusts over the eyelashes, especially after sleep (in conjunctivitis caused by bacteria) Other discharge from your eye (green or white) Itchy eyes (especially in conjunctivitis caused by allergies) Burning eyes (especially in conjunctivitis caused by chemicals and irritants) Blurred vision Increased sensitivity to light See your ophthalmologist (a doctor trained to treat eye conditions) or family doctor if you have any of these persistent symptoms. Ear infections also commonly occur in children who have bacterial conjunctivitis. The ophthalmologist will examine your eyes and possibly take a sample of fluid from the eyelid with a cotton swab. Bacteria or viruses that may have caused conjunctivitis can then be seen through a microscope.

How is conjunctivitis treated?

y
Bacteria Conjunctivitis caused by bacteria is treated with antibiotics, a type of medicine prescribed by your doctor. The antibiotic can be given as eye drops, ointments, or pills. Eye drops or ointments may need to be applied to the inside of the eyelid three to four times a day for five to seven days. It may be difficult to apply ointments inside of a childs eye. If the ointment gets as far as the eyelashes, it will most likely melt and enter the eye. Pills may need to be taken for several days. The infection should improve within a week. Take the medicine as instructed by your doctor, even if the symptoms go away. Virus Medicine cannot treat conjunctivitis caused by a virus. This type of conjunctivitis often results from a common cold. Just as a cold must run its course, so must this form of conjunctivitis, which will last from 4 to 7 days. You may, however, help relieve symptoms by applying a cold compress. Irritating substance To treat this type of conjunctivitis, use warm water for five minutes to wash the irritating substance from the eye. You should also avoid further exposure to the irritating substances. Your eyes should begin to improve within four hours after washing away the substance. If they do not, call your doctor. Allergies Allergy-associated conjunctivitis should be evaluated by your ophthalmologist and an allergist. It may disappear completely when the allergy is treated with antihistamines or the when the allergen is removed. Relieve symptoms temporarily by applying a cold compress on closed eyes. Ophthalmia neonatorum and STIs The same bacteria that causes the sexually transmitted infections chlamydia and gonorrhea can also infect the conjunctiva. This is called ophthalmia neonatorum and is most commonly spread during birth as the infant passes through the birth canal of an infected mother. Newborns are usually given eye drops immediately after birth to treat any possible infection. Conjunctivitis can also be spread through hand contact when rubbing the eyes or touching contact lenses after touching infected genitals. Oral antibiotics in the form of pill, eye drops, or ointment are usually prescribed for treatment. Washing hands thoroughly can help prevent the spread of this type of conjunctivitis. Being around a person who has conjunctivitis and wearing contact lenses may increase your risk of getting conjunctivitis, but the outcome is usually very good with treatment. The eyes can become re-infected. Call your doctor if symptoms last for more than three days after treatment.

What can I do to help relieve symptoms?

y y y y
Protect your eyes from dirt and other irritating substances. Remove contact lenses, if you wear them. Place cold compresses on your eyes. Wash your face and eyelids with mild soap or baby shampoo and rinse with water to remove irritating substances. Non-prescription "artificial tears," a type of eye drops, may help relieve itching and burning from irritating substances. (Note: Other types of eye drops may irritate the eyes and should not be used.) Do not use the same bottle of drops in the other eye if it is not infected.

How can I prevent spreading the infection?

y y y y y y y y y y y
Dont touch or rub the infected eye(s). Wash your hands often with soap and warm water. Wash any discharge from your eyes twice a day using a fresh cotton ball or paper towel. Afterwards, discard the cotton ball and wash your hands with soap and warm water. Wash your bed linens, pillowcases, and towels in hot water and detergent. Avoid wearing eye makeup. Dont share eye makeup with anyone else. Never wear another persons contact lens. Wear glasses instead of contact lenses. Throw away disposable lenses or be sure to clean extended wear lenses and all eyewear cases. Avoid sharing common articles such as unwashed towels, cups, and glasses. Wash your hands after applying the eye drops or ointment to your eye or your childs eye. Do not use eye drops in a non-infected eye that were used for an infected one. If your child has bacterial or viral conjunctivitis, keep him or her home from school or day care until he or she is no longer contagious.

SIGNS AND SYMPTOMS Red eye (hyperaemia), irritation (chemosis) and watering (epiphora) of the eyes are symptoms common to all forms of conjunctivitis. However, the pupils should be normally reactive and the visual acuity normal. [edit]Viral Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the other. Viral conjunctivitis, commonly known as "pink eye" shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary injection' of iritis, but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. [edit]Bacterial

Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. Another symptom that could be caused by bacterial conjunctivitis is severe crusting of the infected eye and the surrounding skin. However, contrary to popular belief, discharge is not essential to the diagnosis. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye. However, it is dormant in the eye for three days before the patient shows signs of symptoms.
[edit]Chemical
[4] Chemical eye injury is due to either an acidic or alkali substance getting in the eye. Alkalis are typically

worse than acidic burns.[5] Mild burns will produce conjunctivitis while more severe burns may cause the cornea to turn white.[5] Litmus paper is an easy way to rule out the diagnosis by verifying that the pH is within the normal range of 7.07.2.[4] Large volumes of irrigation is the treatment of choice and should continue until the pH is 68.[5] Local anaesthetic eye drops can be used to decrease the pain.[5] Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals, above all, with caustic alkalis such as sodium hydroxidethere may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis. [edit]Other Inclusion conjunctivitis of the newborn (ICN) is a conjunctivitis that may be caused by the bacteria Chlamydia trachomatis, and may lead to acute, purulent conjunctivitis. self-healing.
[6] [6]

However, it is usually

Conjunctivitis is identified by irritation and redness of the conjunctiva. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.

CAUSES
Conjunctivitis is most commonly caused by viral infection, but bacterial infections, allergies, other irritants and dryness are also common etiologies for its occurrence. Both bacterial and viral infections are contagious. Commonly, conjunctival infections are passed from person-to-person, but can also spread through contaminated objects or water. The most common cause of viral conjunctivitis is adenoviruses[citation needed]. Herpetic keratoconjunctivitis (caused by herpes simplex viruses) can be serious and requires treatment with acyclovir. Acute hemorrhagic conjunctivitis is a highly contagious disease caused by one of two enteroviruses, Enterovirus 70 and Coxsackievirus A24. These were first identified in an outbreak in Ghana in 1969 and have spread worldwide since then, causing several epidemics.[7]

Differential diagnosis
Conjunctivitis is a relatively non-specific symptom.[1] Even after bio microscopy, laboratory tests are often necessary if proof of etiology is needed. A purulent discharge (a whitish-yellow, yellow or yellow-brown substance more commonly known as pus) strongly suggests a cause from fecal matter, unless there is known exposure to toxins. It can also be caused by bacteria from feces, pet hair, or by smoke or other fumes. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious. Itching (rubbing eyes) is the hallmark symptom of allergic conjunctivitis. Other symptoms include past history of eczema, or asthma. A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on bio microscopy. Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation. Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of conjunctivitis.

Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula. Many people who have conjunctivitis have trouble opening their eyes in the morning because of the dried mucus on their eyelids. There is often excess mucus over the eye after sleeping for an extended period.

Diagnosis

These are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities. Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate that many bacteria implicated in lowgrade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so false negative results are common.[citation needed] Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.

Management
Conjunctivitis resolves in 65% of cases without treatment, within 2 5 days. The prescribing of antibiotics to most cases is not necessary. [8] [edit]Allergic For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops. [edit]Bacterial Bacterial conjunctivitis usually resolves without treatment. Antibiotics, eye drops, or ointment are thus only needed if no improvement is observed after 3 days.[9] In patients receiving no antibiotics recovery was in 4.8 days, immediate antibiotics 3.3 days, delayed antibiotics 3.9 days. No serious effects were noted either with or without treatment.[10][11]

[edit]Viral Although there is no specific treatment for viral conjunctivitis, symptomatic relief may be achieved with cold compresses[12] and artificial tears. People are often advised to avoid touching their eyes or sharing towels and washcloths. [edit]Chemical Conjunctivitis due to chemicals is treated via irrigation with Ringer's lactate or saline solution. Chemical injuries (particularly alkali burns) are medical emergencies as they can lead to severe scarring, and intraocular damage.Do not touch your eyes. Even if you washed your hands still no touching. This may cause it to spread on to another eye.

Nursing Dx:

Conjunctivitis Risk for impaired skin integrity related to eye discharge and tearing Risk for infection related to contagious disease and ability to spread to other eye or other people Risk for situational low self-esteem related to hyperemia of eyes
Risk factors for pink eye include:

  

Exposure to an allergen for allergic conjunctivitis Exposure to someone infected with the viral or bacterial form of conjunctivitis Using contact lenses, especially extended-wear lenses

Wilms Tumor (Nephroblastoma)

Description
y y y y y y y

Wilms tumor is a type of kidney cancer that occurs in children. Is a malignant tumor. It accounts for 6% of all childhood cancers. It generally grows to a large size before it is diagnosed, usually before the child reaches age 5. The tumor expands the renal parenchyma, and the capsule of the kidney becomes stretched over the surface of the tumor. Staging if from I (limited to kidney) to IV (matastasis) and stage V, which indicates bilateral involvement (rare). The tumor may metastasize to the lymph nodes, lungs, liver, and brain.

Causes & Risk Factors

y y

y y

Wilms tumor is the most common form of childhood kidney cancer. The exact cause of this tumor in most children is unknown. A missing iris of the eye (aniridia) is a birth defect that is sometimes associated with Wilms tumor. Other birth defects linked to this type of kidney cancer include certain urinary tract problems and enlargement of one side of the body, a condition called hemihypertrophy. It is more common among some siblings and twins, which suggests a possible genetic cause. The disease occurs in about 1 out of 200,000 to 250,000 children. It usually strikes when a child is about 3 years old. It rarely develops after age 8.

Assessment 1. A firm, non-tender mass in the upper quadrant of the abdomen is usually the presenting sign. It may be on either side. 2. Abdominal pain which is related to rapid growth of the tumor. 3. As the tumor enlarges, pressure may cause constipation, vomiting, abdominal distress, anorexia, weight loss and dyspnea. 4. Less common manifestation are hypertension, fever, hematuria, and anemia. 5. Associated anomalies includes aniridia (absence of the iris), hemihypertrophy of the vertebrae, and genitourinary anomalies.

Diagnostic Evaluation 1. 2. 3. 4. Abdominal untrasound detects the tumor and assesses the status of the opposite kidney. Chest X-ray and CT scan may be done to identify matastasis. MRI or CT scan of the abdomen may be done to evaluate local spread to lymph nodes. Urine specimens show hematuria; no increase in vanillylmandelic acid and homovanillic acid levels as occurs with neuroblastoma. 5. Complete blood count, blood chemistries, especially serum electrolytes, uric acid, renal function tests, and liver functions tests, are done for baseline measurement and to detect metastasis.

Primary Nursing Diagnosis

y

Knowledge deficit of the disorder and therapy

Medical Management
y y

If your child is diagnosed with this condition, avoid prodding or pushing on the child's belly area, and use care during bathing and handling to avoid injury to the tumor site. The first step in treatment is to stage the tumor. Staging helps doctors determine how far the cancer has spread and to plan for the best treatment. Surgery to remove the tumor is scheduled as soon as possible. Surrounding tissues and organs may also need to be removed if the tumor has spread. Radiation therapy and chemotherapy will often be started after surgery, depending on the stage of the tumor.

Nursing Interventions
y

Observe the surgical incision for erythema, drainage or separation. Report any of theses changes.

y y y y y y y y y y y y y

Monitor for elevated temperature or sign of infection post-operatively. Monitor I.V. fluid therapy and intake and output carefully, including nasogastric (NG) drainage. Encourage the parents to ask questions and to understand fully the risk and benefits of surgery. Prepare the child for surgery, explain the procedures at the appropriate developmental level. Continue supporting the parents during the postoperative period. Insert NG tube as ordered. Many children require gastric suction postoperatively to prevent distention or vomiting. When bowel sounds have returned, begin administering small amounts of clear fluids. Administer pain control medications as ordered in the immediate postoperative period. Allow the child to participate in the selection of foods. As the child recovers, encourage child to eat progressively larger meals. If unable to eat because of radiation and chemotherapy provide I.V. fluids, hyperalimentation, or tube feedings as indicated. Prepare child and family for fatigue during recovery from surgery and with radiation treatments. Plan frequently rest periods between daily activities. Prepare the child and parents for loss of hair associated with chemotherapy and encourage use of hat as desired. Reassure the hair will grow back.

Wilms' tumor or Wilms' tumour (see spelling differences) or nephroblastoma is cancer of thekidneys that typically occurs in children, rarely in adults. Its common name is an eponym, referring to Dr. Max Wilms, the German surgeon (18671918) who first described this kind of tumor.

 Wilms tumours are either sporadic or familial (1-2%); it may be associated with hemihypertrophia or genitourinary malformations (10%) and part of a recognized syndrome (2%). The syndromes predisposing to Wilms tumours are: WAGR (Wilms tumour, aniridia, genitourinary abnormalities and mental retardation),  Denys-Drash syndrome (DDS): mesangial sclerosis, male pseudohermaphrodism and Wilms tumours, Beckwith-Weideman (BWS): exomphalos, macroglossia, gigantism and Simpson Golabi Behemel syndrome (SGBS): overgrowth, mental impairment, craniofacial anomalies.

 Wilms tumors can also be seen in association with Trisomy 18.