{ "name": "Conjunctivitis", "slug": "conjunctivitis", "url": "https://nursingplex.com/care-plans/conjunctivitis", "category": "Ophthalmic & Sensory", "summary": "Eye inflammation; hygiene, contagion prevention and drop administration teaching.", "nursing_diagnoses": [ "Acute pain", "Risk for infection transmission", "Disturbed visual sensory perception" ], "overview": [ "Conjunctivitis is inflammation of the conjunctiva from viral, bacterial, allergic or chemical causes. Viral disease — usually adenovirus — produces watery discharge, often begins in one eye and spreads to the other, and is highly contagious for up to two weeks. Bacterial disease produces thick purulent discharge that mats the lids on waking. Allergic disease is bilateral, intensely itchy and seasonal.", "Most cases are self-limiting, so nursing care centers on comfort, correct instillation of drops, and above all interrupting transmission. In the newborn, conjunctivitis is never routine: gonococcal ophthalmia neonatorum appears in the first days of life and can perforate the cornea, and chlamydial disease appears at 5–14 days. Sudden severe pain, photophobia or vision change in any patient signals corneal involvement and needs urgent referral." ], "key_facts": [ { "label": "Discharge tells the cause", "text": "Watery = viral, thick purulent = bacterial, stringy with itching = allergic." }, { "label": "Contagion", "text": "Viral and bacterial forms spread by hands and shared items; allergic conjunctivitis is not contagious." }, { "label": "Red flags", "text": "Severe pain, decreased vision, photophobia, corneal opacity or a fixed pupil — refer urgently." }, { "label": "Newborn", "text": "Purulent discharge in the first 48 hours suggests gonorrhea; onset at 5–14 days suggests chlamydia, which also causes pneumonia." }, { "label": "Contacts", "text": "No contact lens wear until the eye has been clear and off drops as directed; discard the current lenses and case." } ], "nursing_priorities": [ "Relieve discomfort and remove crusting so the patient can see and rest.", "Prevent spread to the other eye, to household members and in school or work settings.", "Teach and verify correct eye-drop or ointment technique.", "Detect corneal involvement or vision change early.", "Identify and remove allergens or irritants when the cause is not infectious." ], "assessment": { "subjective": [ "Gritty, burning or foreign-body sensation rather than deep pain", "Itching, especially bilateral and seasonal, in allergic disease", "Blurred vision that clears after blinking away discharge", "Report of lids stuck shut in the morning", "Exposure to a sick contact, a new cosmetic, chlorine or contact lens overwear" ], "objective": [ "Conjunctival injection with a clear cornea and normally reactive pupil", "Watery, mucopurulent or stringy discharge; matted lashes and crusting", "Lid edema, chemosis, follicles or papillae on the inner lid", "Preauricular lymph node tenderness, typical of viral disease", "Photophobia, corneal haze or reduced visual acuity — abnormal and urgent", "In neonates: lid edema with copious purulent drainage" ], "related_factors": [ "Viral or bacterial inoculation from hands, towels, cosmetics or contact lenses", "Seasonal or environmental allergens", "Chemical or smoke irritation, chlorinated water", "Passage through an infected birth canal in newborns", "Immunosuppression or poor hygiene in crowded settings" ] }, "goals": [ "The client will report eye comfort improved to a tolerable level within 24–48 hours.", "The client will demonstrate correct hand hygiene and eye-drop instillation before leaving the visit.", "The client will have no infection of the unaffected eye or of household contacts.", "The client will maintain baseline visual acuity and report any vision change immediately.", "The client will show resolution of redness and discharge within the expected timeframe for the cause." ], "interventions": [ { "title": "1. Assessing the eye and detecting complications", "points": [ "Document visual acuity in each eye at baseline; a drop in acuity moves this from a minor illness to an emergency.", "Inspect discharge type, lid condition, corneal clarity and pupil response; a cloudy cornea or irregular pupil requires urgent referral.", "Ask about severe pain and photophobia — simple conjunctivitis itches and burns but does not cause deep aching pain.", "Obtain cultures or swabs as ordered before starting topical antibiotics in severe or neonatal cases." ] }, { "title": "2. Comfort and eye hygiene", "points": [ "Cleanse lids from the inner to the outer canthus with a separate clean cotton ball or gauze for each wipe and each eye.", "Apply warm compresses to loosen bacterial crusting; use cool compresses for allergic itching and swelling.", "Offer preservative-free artificial tears for lubrication and dim the room or use sunglasses for photophobia.", "Advise against rubbing the eye, which spreads infection and worsens inflammation.", "Do not patch an infected eye — trapping warm discharge encourages bacterial growth." ] }, { "title": "3. Medication administration and teaching", "points": [ "Teach hand hygiene before and after every instillation and keep the dropper tip from touching the eye, lashes or any surface.", "Have the patient tilt the head back, pull down the lower lid and place the drop in the conjunctival sac, not on the cornea.", "Apply gentle punctal pressure for 30–60 seconds to reduce systemic absorption and improve local effect.", "Space different drops at least 5 minutes apart and give ointment last because it blurs vision.", "Stress finishing the whole antibiotic course; stopping when the eye looks clear invites relapse.", "Give erythromycin ointment prophylaxis to newborns as ordered and treat the mother and her partner when a sexually transmitted cause is found." ] }, { "title": "4. Preventing transmission", "points": [ "Teach frequent hand washing, especially after touching the face, and no sharing of towels, pillows, washcloths or eye makeup.", "Discard eye cosmetics used during the infection and replace contact lenses, solution and case.", "Advise changing pillowcases and towels daily and cleaning shared surfaces and electronics.", "Explain school and workplace exclusion rules; most settings allow return 24 hours after starting antibiotics or when discharge stops.", "Treat the eyes separately during care to avoid moving organisms from one to the other." ] }, { "title": "5. Allergic and irritant management", "points": [ "Help identify the trigger — pollen, pets, dust, chlorine, cosmetics — and plan avoidance.", "Administer topical antihistamine or mast cell stabilizer drops as prescribed and explain that relief builds over days for stabilizers.", "Irrigate copiously with saline or clean water immediately after any chemical splash and then seek care.", "Advise cool compresses and refrigerated artificial tears for symptom relief without rebound." ] } ], "patient_teaching": [ "Wash hands often and never share towels, pillows or eye makeup while the eye is red.", "Instill drops correctly without touching the eye with the tip, and finish the full course.", "Return immediately for eye pain, light sensitivity, decreased vision or a white spot on the cornea.", "Stay out of contact lenses until cleared, and replace lenses and case before resuming.", "Expect viral conjunctivitis to last one to two weeks and to look worse before it improves.", "Keep newborns' scheduled follow-up when eye infection was treated, since chlamydia can also cause pneumonia weeks later." ] }