Comprehensive Nursing Pharmacology Q 2
The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She places it in which of the following area of the eye:
A. Under the eyelid.
B. On the cornea.
C. In the lower conjunctival sac.
D. By the optic disc.
Correct Answer: C. In the lower conjunctival sac.
The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed. Ophthalmia neonatorum (ON), also known as neonatal conjunctivitis, is an infection that causes inflammation of the conjunctiva during the first four weeks of life. The conjunctiva is a layer of thin tissue that covers the inner part of the eyelid and the white part of the eye. During the late 1800s, before antibiotics were discovered, 0.3% of infants (3 out of 1,000) were blinded from ON (Schaller & Klauss, 2001).
Option A: Care providers in some countries try to prevent ophthalmia neonatorum by giving all newborns eye ointment (such as erythromycin). The eye ointment is intended to kill or weaken bacteria in the eye–particularly gonorrhea–to protect the infant from getting pink eye, since pink eye from gonorrhea can cause serious eye damage and blindness if left untreated.
Option B: Automatic prophylaxis with erythromycin eye ointment for all newborns within 24 hours of birth is currently recommended by the U.S. Preventive Services Task Force (2019) and their recommendation is promoted by the American Association of Family Physicians. However, the American Academy of Pediatrics recently called for reevaluating state mandates for erythromycin eye ointment (AAP, 2018).
Option D: Instead, they propose a strategy of (1) prenatal screening for and treatment of gonorrhea and chlamydia, (2) testing unscreened people at the time of birth and treating as needed, (3) counseling parents to bring newborns with pink eye to immediate medical attention, and (4) continuing mandatory reporting of all cases of gonorrheal ON. The AAP recommends that routine erythromycin eye ointment is still appropriate in regions with high rates of gonorrhea and where prenatal screening and treatment is not widely accessible. Similarly, the Canadian Pediatric Society recently recommended that routine, required prophylaxis with erythromycin be stopped (Moore and MacDonald, 2015).