BIO Case Study: John's Infectious Conjunctivitis and Treatment

This case study examines an 88-year-old resident, John, in a high-dependency aged care facility who develops infectious conjunctivitis. The assignment explores the likely causative agent, Staphylococcus aureus, and the rationale behind the prescription of gentamicin eye drops, an aminoglycoside antibiotic. The case study delves into gentamicin's mechanism of action, potential side effects, and the psychological impact of conjunctivitis on elderly patients. It further discusses infection control issues in aged care facilities, highlighting the vulnerability of residents to airborne microorganisms like methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. The spread of infection to another resident, Mary, is analyzed, alongside preventative measures nurses can implement, such as hand hygiene and proper antibiotic administration, to mitigate the spread of infection in the facility. The assignment uses APA 6th edition referencing.

Case Study

Table of Contents
Question 1..................................................................................................................................................3
Question 2..................................................................................................................................................3
Question 3...................................................................................................................................................4
Question 4:..................................................................................................................................................5
Question 5:..................................................................................................................................................5
Question 6:..................................................................................................................................................6

Question 1
1.1 Inflammation in the conjunctiva of eyes caused by bacteria or virus is called infectious
conjunctivitis. The most noticeable symptoms of infectious conjunctivitis is redness of eyes,
pain, and purulent release from eyes (Haddrill, 2019).
1.2 Of the listed four microorganisms Staphylococcus aureus bacteria is more likely to be the
cause of John’s eye infection. Because purulent discharge, pain are the signs of conjunctivitis by
Staphylococcus aureus.
 Legionella pneumophila: no, this bacterium is not responsible for conjunctivitis. It is the
causative agent of pneumonia and lung infection (Rathore, 2018).
 Plasmodium ovale: no, it is a kind of protozoa and it is responsible for non-falciparum
malaria (Okafor & Finnigan, 2019).
 Adenovirus: though adenovirus is a causative agent of conjunctivitis but in this case
study adenovirus is not the reason for it, because, doctor prescribes gentamicin which is a
drug used to stop the bacterial growth (Okafor & Finnigan, 2019).
 Staphylococcus aureus: This bacterium is supposed to be the causative agent of infectious
conjunctivitis to John. The signs and symptoms are similar to the Staphylococcus
infection. Also, doctor prescribes gentamicin that acts on bacteria (Bush, 2019).
Question 2
2.1 Gentamicin belongs to amino glycoside class of antibiotic used to inhibit the growth of
bacteria. It acts on necessary protein that bacteria use for their survival. Gentamicin binds with
ribosomal 30s subunits of bacteria which results inhibition of necessary protein synthesis. When
the drug binds with 16s rRNA of 30s ribosomal subunit, it leads to incorrect aminoacyl tRNA
bindings with mTNA codon site (Woodley et al., 2017). As a result, unstable complex
formation is observed between tRNA and elongation factor. Thus occuring of incorrect protein
formation is happened which may cause the death of bacteria. A second mechanism is
gentamicin binds with 23s ribosomal rRNA and interacts with a protein to identify the stop

codon. This creates a number of inactive ribosomes and stops to initiate the protein synthesis
(Chareyre, Barras & Mandin, 2019).
2.2 Excessive dosage of gentamicin eye drop may cause a number of side effects. Two possible
adverse reactions are:
 Use of this drug for prolonged periods may cause some fungal infections in eyes. Burning
sensation, blurred vision, thickening of eyes can be observed due to these fungal
infections. Some kinds of allergic reactions are also observed in the eyes that may lead to
the secretion of puss and close of eyes (Woodley et al., 2017).
 Damaging the part of the inner ear is also observed for amino glycoside class of
antibiotic. Symptoms are loss of hearing, lack of coordination, vertigo, unreal sound
hearing or tinnitus. Sometimes problem in balancing also can be observed due to the
damage of the vestibular apparatus of the inner ear ("Conjunctivitis | Pink Eye | Clinical
Definition | CDC", 2019).
Question 3
Hospitals, nursing homes are the common places of infectious diseases because of easy access of
bacteria, viruses and fungi. Most of the health care centers are unaware of the fact of
maintenance hygiene. Patients in hospitals and nursing home are more prone to various
infectious diseases and infectious conjunctivitis is one of them. Though conjunctivitis is a
common curable eye disease for humans but it may facilitate various psychological burdens for
aged people like John who is residing in an aged care facility center. John is suffering from
infectious conjunctivitis in his right eye. Based on the observation of examination, the eye was
red and swollen and purulent were discharged from his eyes ("Pink Eye", 2019).
Due to conjunctivitis patients are more likely to rub their eyes which are harmful and increase
the infection. John might be tensed and impulsive because of his eye’s condition. There will
be a problem to open and close his eyelids due to swollen condition. Thus, he may feel pain
in his right eye. Anxiety is the other psychological phenomenon that may be observed in this
case. He may prevent himself from care because of itching sensation. He may be feared of losing

his vision due to eye infection. As john is a resident of a care facility unit he might be tensed of
thinking about his financial capacity for the treatment (Kocur, Krug, Mariotti & McCoy, 2018).
Question 4:
Aged residents like John are more vulnerable to infections in the high dependency aged care
facility than those resides in the community. Because of the lower efficiency in the immune
system, old people are more susceptible to infections.
According to the research, old age nursing homes are the common place for methicillin resistant
Staphylococcus aureus and vancomycin resistant enterococci. These are airborne
microorganisms that colonize in the hospitals and nursing homes. methicillin resistant
Staphylococcus aureus and vancomycin resistant enterococci are becoming a serious concern
for the health care authorities in order to achieve infection control as they are irresistible. Thus
it is important to place the infected patients under surveillance condition to prevent the spread of
these germs (Mody, 2007).
Limited accessibility of medical professionals, limited resources, uncertainty in diagnosis, care
acuity is the important factors and connected to each other. These factors cumulatively can be
considered as the major infection control issue in the high facility nursing home for old age
citizens (Mody, 2007).
Question 5:
According to the case study, the conjunctivitis infection was spread to marry residing in the room
next door after 4 days. As conjunctivitis is an infectious eye disease thus spreading is a common
phenomenon observed in hospitals and nursing home. It can be spread from one person to
another through hands and eye contacts. Spreading of bacteria can also be possible through
breathing("Conjunctivitis | Pink Eye | Clinical Definition | CDC", 2019). Common objects used
by infectious person may be responsible for spreading of bacteria. Moreover, Staphylococcus
aureus is an airborne gram positive bacteria and easy to spread in surrounding environment
through air. Conjunctivitis spread rapidly in hospitals and nursing homes. Conjunctivitis is not
contagious until the symptoms start to develop. Old people are more susceptible to the

conjunctivitis disease because of their weak immune system. Weak immune system indicates the
lack of resistant power to the infectious diseases. Thus, it is important to start the treatment
procedure very quickly and separate the infected patients from others to resist the spreading of
bacteria. Conjunctivitis can be erased through easily through prompt action. John and Mary
should wear black eye glasses to avoid direct eye contact with others ("Conjunctivitis | Pink Eye |
Clinical Definition | CDC", 2019).
Question 6:
6.1 Conjunctivitis is a common contagious eye infection often observed in the care centers. Old
persons are more susceptible to this disease("Pink Eye", 2019). The two procedures that nurses
need to consider to prevent the infection in the high dependency aged care facility units are :
 Washing the hands and eyes of john with lukewarm water should be maintained by the
nurse. Repeated washing by lukewarm water limits the infection spreading from john to
other individuals. Soap must be used to wash the hands and other body parts as
detergent has the ability to destroy the bacterial colony ("Pink Eye", 2019).
 Proper Administration of antibiotics and eye drops should be maintained by the nurses to
reduce the infection as soon as possible. There are some side effects associated with
gentamicin. Thus, nurses should be careful at the time of medicine administration into
eyes. Excess administration of gentamicin eye drops may lead to other allergic infection.
Thus, it is important to maintain the amount of antibiotic eye drops for John to avoid
other diseases.

References
Bush, L. (2019). Staphylococcus aureus Infections - Infections - MSD Manual Consumer
Version. Retrieved 28 August 2019, from
https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-
bacteria/staphylococcus-aureus-infections
Chareyre, S., Barras, F., & Mandin, P. (2019). A small RNA controls bacterial sensitivity to
gentamicin during iron starvation. PLOS Genetics, 15(4), e1008078. doi:
10.1371/journal.pgen.1008078
Conjunctivitis | Pink Eye | Clinical Definition | CDC. (2019). Retrieved 28 August 2019, from
https://www.cdc.gov/conjunctivitis/clinical.html
Haddrill, M. (2019). Retrieved 28 August 2019, from
https://www.allaboutvision.com/conditions/conjunctivitis-types.htm
Kocur, I., Krug, E., Mariotti, S., & McCoy, M. (2018). Benefits of integrating eye care into
health systems. Bulletin Of The World Health Organization, 96(10), 666-666A. doi:
10.2471/blt.18.221887
Mody, L. (2007). Infection Control Issues in Older Adults. Clinics In Geriatric Medicine, 23(3),
499-514. doi: 10.1016/j.cger.2007.02.001
Okafor, C., & Finnigan, N. (2019). Malaria (Plasmodium Ovale). Retrieved 28 August 2019,
from https://www.ncbi.nlm.nih.gov/books/NBK519021/
Pink Eye. (2019). Retrieved 28 August 2019, from
https://www.cdc.gov/features/conjunctivitis/index.html
Rathore, M. (2018). Legionella Infection: Background, Pathophysiology, Epidemiology.
Retrieved 28 August 2019, from https://emedicine.medscape.com/article/965492-
overview
Woodley, D., Cogan, J., Hou, Y., Lyu, C., Marinkovich, M., Keene, D., & Chen, M. (2017).
Gentamicin induces functional type VII collagen in recessive dystrophic epidermolysis
bullosa patients. Journal Of Clinical Investigation, 127(8), 3028-3038. doi:
10.1172/jci92707