6. Provide an appropriate F/U plan F/U in 14 days if symptoms are not resolved or sooner if they become worse, etc., (Mashige, 2017). Otherwise, if symptoms have resolved return to the clinic in 1 month to do a full physical and establish primary care.
References Centers for Disease Control and Prevention. (2018). Healthy Weight. Retrieved from Mashige, K. (2017). Ocular allergy. Health SA, 22 , 112-122. DOI:10.1016/j.hsag.2016.07.001 Pflipsen, M., Massaquoi, M., & Wolf, S. (2016). Evaluation of the painful eye. Am Fam Physician 93 (12), 991-998. Rx List. (2019a). Claritin (loratadine). Retrieved from Rx List. (2019b). FLONASE (fluticasone propionate). Retrieved from Rx List. (2017). Patanol (olopatadine hydrochloride). Retrieved from PART ONE RESPONSE TO TEACHER Vijayarani Suresh Jessica, Very good discussion to this case study patient. Your differential diagnoses, pathophysiology statements are appropriate. However the formatting order is incorrect. Please remember to follow the order of questions assigned in the case study. Additionally, you stated fluorescein dye test will be used for this patient . What other tests would you consider and why ?? will it be reimbursed by the insurance ? and that is cost effective. You used Mayo clinic as references. Those are not evidence based . They are patient education materials. Please remember to use appropriate evidence based research to support your argument. Thanks
Dr. Suresh: The questions you asked me are: What other tests would you consider and why? Will it be reimbursed by the insurance? Is it cost effective? What other tests would you consider and why? The reason I ran the fluorescein dye test is to rule out my worst and least likely differential, corneal abrasion. According to Pflipsen et al. (2016) the eye stain test is the best way to determine if there is an ablation on the corneal. A lateral scratch would suggest a foreign body abrasion and circular would mean it originated from a contact lense (Pflipsen et al., 2016) It would not be prudent to treat other disease processes if there was an abrasion on the eye. To test for allergic conjunctivitis, I could use an allergy skin prick test to detect an IgE mediated reaction followed by other laboratory tests (Mashige, 2017). I could check for eosinophils in conjunctival scrapings, however, the test is inconclusive and does not rule out allergies (Mashige, 2017). Will it be reimbursed by the insurance? The eye stain test should be covered under most insurances, it is a diagnostic tool to determine damage to the cornea. As an NP it would behoove me to ensure I know the insurance status of my patient at the time of treatment. If they are self-pay or do not have quality insurance, other diagnostic tools should be employed, especially if I do not fully suspect that there is an abrasion.