BSN III 5 C 5 Corneal Foreign Body Gizelle Mutya Magsino

8/14/2019 BSN III 5 C 5 Corneal Foreign Body Gizelle Mutya Magsino

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Corneal foreign body is foreign material on or in thecornea, usually metal, glass, or organic material.

Foreign bodies refer to any objects that are in the eye thatare not meant to be there. The foreign object may be in the

conjunctiva (a thin membrane that covers the actual eye) or in thecornea (the clear, dome-shaped surface that covers the front of theeye).Foreign body related abrasions are defects in the corneal epitheliumthat are left behind after the removal or spontaneous dislodging of acorneal foreign body. Foreign body abrasions are typically caused bypieces of rust, wood, glass, plastic, fiberglass, or vegetable materialthat have become embedded in the cornea. Trauma accounted for 66

percent of these or 4 percent of all cases; corneal abrasions or cornealor conjunctival foreign bodies accounted for 80 percent of the eyetrauma cases or 3 percent of all cases. A sampling of diagnoses infamily and general clinicians', internists', and pediatricians' offices inthe United States in 1985 found that eye complaints constitute 2percent of all patient visits; traumatic conditions and foreign bodieswere the reason for 8 percent of these visits.


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Tiny particles that strike the eye at moderate speed often become embeddedwithin the corneal surface. The patient reports a feeling of gravel or sand inthe eyeappropriately called the "foreign body sensation."

Tiny foreign bodies may be hard to spot without magnification provided byloupes or biomicroscope.

A foreign object can lodge itself onto the cornea and cause significantsymptoms of pain, tearing, light sensitivity, and blurred vision. Except in cases ofobvious trauma where debris strikes the eyes, the most common corneal foreign bodyis a rusted metallic particle. Small shards of metal seem to have an almost magneticattraction to the corneal surface, where they rapidly rust and become embedded. Theuse of safety goggles with any type of drilling, hammering, etc. can be preventative.

As the rusted particle sits on the cornea, the eye becomes progressivelymore irritated over a period of days with redness, pain, light sensitivity, and tearing.Often the particle is visible on the eye, but it may be nearly microscopic. Theophthalmologist has the equipment necessary in the office to remove these foreignbodies. Usually a scar remains, and there is risk of infection.

Foreign bodies are one of the most frequent causes of visits for ophthalmicemergencies. Sometimes, the foreign body may not be present at the time ofexamination, having left the residual corneal abrasion with resultant pain.Superficial corneal foreign bodies are much more common than deeply embeddedcorneal foreign bodies. The possibility of an intraocular foreign body must always beconsidered when a patient presents with a history of trauma.In major league baseball, 33% of all eye injuries are corneal abrasions; in the National

Basketball Association, corneal abrasions account for 12% of all eye traumas.


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This case study Ive chosen is somewhat different even

though its a minor injuries because I can get idea or knowledge abouteye injuries that would be helpful especially on how to take care onour eyes. A simple injury but with a knowledgeable source.

The incidence rate of ambulatory visits (983 per100 000 person-years)

for eye injuries was 58 times higher

than the incidence rate of hospitalizations(17 per 100 000person-years) for eye injuries. Orbital floor fractures, contusions,

and open wounds to the ocular adnexa and orbit accounted for 85% of eyeinjuries resulting in hospitalization, while 80%of ambulatory visits were forsuperficial wounds and foreignbodies. Hospitalization rates varied widelyacross demographicsubgroups. Men had twice the incidence rate as women,and theyoungest age group (17-24 years) had 6 times the incidence rate of the

oldest age group (35-65 years). Together, motor vehicle crashes and fightscaused nearly half of the hospitalizations. Ambulatory rates varied significantlyin relation to occupationbut not to demography. Tradespeople (eg, metal bodymachinist,welder, and metalworker) had incidence rates 3 to 4 times higher

than the overall population rate.


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General objectives:

In this case study we will be able to gain, obtain andbroaden our knowledge skills and attitude and to fully understandthe nature of the given complaint.

Specific objectives:

To identify and fully understand what is corneal foreign body.

To know the objectives of this case study.To be familiarize with patients profile.

To know further the clients status through Clinical Appraisal.

To assess the physical condition of the patient.

To identify and analyze the laboratory exams.

To review the anatomy and physiology and of the given disease.

To identify the prognosis of the patient.


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Name: Child HAge: 1 year and 6 monthsSex: Female

Date of Birth: May 28, 2007Civil Status: ChildAddress: Balagtas, BatangasNationality: FilipinoReligion: Roman CatholicDate of Admission: December 06, 2008Physician: Dr. HernandezChief complaint: Red eyeAdmitting Diagnosis: Corneal foreign body OSFinal Diagnosis: Corneal foreign body OS


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A. Past Health History

Child H had received all the vaccines needed for herimmunization. She had no record of any allergies with food,animals and insect bites. Child H has no illnesses until onetime she accidentally fall and irritate her eye because of thepresence of foreign body in her left eye. This is her first time tobe confined in the hospital.

B. Family History

Child H has a thirteen year old sister and a ten year oldbrother. According to Child Hs mother no one in the familyhas history of any disease. Aging is usually the cause of deathin the family. Furthermore, they have no record of mentaldisorder.

C. Personal HistoryAccording to Child Hs mother, she starts offering food

since Child H reaches 6 months. Child H is breastfed but whenshe reaches 1 year of age her mother decided to substitute itwith formula milk. Child H is fond of playing with her brotherand sister.


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D. Social History

According to Child Hs mother , she is just a housewife, a

high school graduate while her husband is working in Saudi Arabiaalso a high school graduate . She confess that her husbands earnings

is not enough for her three kids. In spite of financial problem they

maintain a good relationship with each other. About the home safety

she told me that it was a well environment, what happened to her

child was an accident because of her negligence.

E. Psychological HistoryFinancial problem is their major stressor, according to her

when problem comes she is very determined to solve it even ifsometimes she lost her hope. Her usual coping pattern is to borrowmoney to her relatives. As I talked to her, I observed that she isaccommodating.

F. History of Present IllnessIt was December 06, 2008 at around 1:10 pm when Child

H accidentally fell in the swing and irritate her eye because of thepresence of foreign body in her left eye. The attending physiciandiagnosed it as Corneal Foreign Body.


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Area assessed Method Findings Analysis

Skin

Hair and Scalp

Nails

Head

Eyes

InspectionPalpation

InspectionPalpation

InspectionPalpation

InspectionPalpation

Inspection

Light brownNo edemaMoisture in skin foldsBack to previous state whenpinchedNo lesionBlack hairEvenly distributed hairNo infection or infestationAbsence of seborrheaConvex curvatureReturned to previous state whenpinchedUngroomed nails

RoundedSymmetric facial movementAbsence of nodule/massesRed eye

NormalNormalNormalNormal

NormalNormalNormalNormalNormalNormalNormal

Abnormal. Poorhygiene

NormalNormalNormalAbnormal. presence offoreign body in the lefteye that causes eyeirritation.


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Eyebrows

EyelashesEyelids

Ears

Nose

Mouth

LipsTeethTongue

Inspection

InspectionPalpation

InspectionPalpation

InspectionPalpation

Equal in sizeHair evenlydistributedSymmetricallyalignedEqually distributedLids closesymmetricallyColor same as facialskinMobile and firmNo tenderness

With discharge

Same as body colorSymmetricallyalignedNot tender

With discharges

WhitishCentral position

No tenderness

NormalNormal

Normal

NormalNormal

Normal

NormalNormal

Abnormal. Poorhygiene. Excessivecerumen may obstructthe canal.NormalNormal

Normal

Abnormal. Indicatecolds

NormalNormal

Normal


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Neck

Thyroid gland

Chest and Lungs

Heart

Breast

Abdomen

Upper extremities

hand

InspectionPalpation

Palpation

Auscultation

Auscultation

InspectionPalpation

InspectionPalpation

InspectionPalpation

CoordinatedmovementNo lymph nodes

No enlargement ofthyroid glandRR=38 breaths/min.(normal 20-40)Crackles noted

124 beats/min.(normal 80-140)Diastole and systoleheardSkin uniform in colorEqual in sizeNo tenderness

Symmetrical contourActive bowel soundsless than 7 secondsNo tendernessSame as color skin

Strong grip

Normal

Normal

Normal

Normal

Abnormal. Indicatespresence of secretionscausing failure of lungs

to expand.Normal

Normal

NormalNormalNormal

NormalNormal

NormalNormal

Normal


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Pulse

Lower extremities InspectionPalpation

Distal pulses arepalpable

No edema

Normal

Normal


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Summary

General Survey

General Appearance: With good body movement .

Body and Breath odor: Foul mouth odor noted. Abnormal it indicatespoor hygiene.

Psychological Presence

Dress grooming and personal hygiene: Does not have proper hygiene.

Mood, manner and speech: Not cooperative and unable to speakbecause the patient is still a young toddler.

Vital Signs

Temperature: 36.6C

(Normal=37C)

Cardiac Rate: 124 beats/min.

(Normal=80-140 beats/min.)

Respiratory Rate: 38breaths/min.

(Normal=20-40 breaths/min.)

Weight : 10 kilograms


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Summary

The method used in assessing the patient are inspectionauscultation, percussion and palpation. As I assessed the patients conditionIve noticed some abnormalities.

Upon inspecting and palpating the patients skin Ive noticed that

there is no edema, skin back to previous state when pinched and the color ofthe skin is light brown, no presence of lesion. There is red eye due to Cornealforeign body in her left eye. Assessment for hair, scalp head are normal. Theears have discharges as well as the nose which indicate as an improperhygiene. Crackles heard as I auscultate the patients chest which indicatepresence of secretions causing failure of lungs to expand, but her respiratoryrate is within normal range 38 breaths/min. as well as the heart beats with 124beats/min. Also within the normal range. Upper and lower extremities has anormal findings.


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Tests Result Normal Values Analysis

WBC

Monocytes

Lympocytes

Basophils

Eosinophils

Platelet

11.77

0.010

.691

0.010

0.14

371

5000-1000 X 10 9/L

0.1-0.5 X 10 9/L

1.5-4.0 X 10 9/L

0.02-0.05 X 10 9/L

0-0.7 X 10 9/L

150-400 X 10 9/L

Abnormal. ElevatedWBC counts indicatebacterial infection.Normal

Lymphocytosis

Basophilia

Eosinophilia

Normal


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Tests Result Normal Values Analysis

Color

Characteristics

Specific Gravity

Reaction

Albumin

Sugar

Pus cell

RB

Light yellow

Slightly turbid

1.015

6.0

Negative

Negative

0-2/HPF

0-2/HPFAmorphous sulfate

Light yellow amber

1.015-1.025

Normal(4.5 - 8)

Negative

Negative

(0-4 HPF)

(0-4 HPF)

Normal

Presence of pus,bacterial cellNormal

Normal

Normal

Normal

Normal

NormalHighly acidic


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SummaryHematology III:According to her, her elevated WBC is abnormal which indicates bacterialinfection. As I analyse, her lymphocytes, basophils and eosinophils arebelow the normal range and that is abnormal. Monocytes and Platelet arenormal

Urinalysis:

For her Urinalysis I found out that her urines have some abnormalitieslike the presence of pus or bacterial cell and her amorphous sulfate ishighly acidic.


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The front portion of the eye is covered with a thin,transparent membrane called the cornea, which protects the interiorof the eye.

The cornea is composed of five layers: epithelium,Bowman's layer, stroma, Descemet's membrane, and endothelium.The epithelium is five or six cell layers thick and richly supplied with

free nerve endings only, since specialized receptors wouldcompromise corneal clarity. Bowman's layeris a collagenous layer 8to 10 g thick to which the basal epithelial cells adhere viahemidesmosomes. The stroma constitutes about 90% of the totalcorneal thickness. It consists almost entirely of an extracellularmatrix of collagen (and other glycoproteins), interspersed withfibroblasts and keratocytes. The regularity and organization of thecollagen fibril orientation are responsible for corneal clarity. The

cornea becomes cloudy when edema or new collagen synthesis altersthe spacing of these fibrils. The endothelium is a monolayer ofhexagonal cells rich in cytoplasmic organelles, especiallymitochondria. These cells actively pump fluid across an osmoticgradient from the corneal stroma to the aqueous cavity and thus areresponsible primarily for maintenance of corneal clarity. These cellsdo not replicate and therefore steadily decrease in number withadvancing age or disease.


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Choroids - the thin, blood-rich membrane that lies between the retina and the sclera;responsible for supplying blood to the retina.Ciliary's body - the part of the eye that produces aqueous humor.cornea - the clear, dome-shaped surface that covers the front of the eye.

Caruncle - a small, red portion of the corner of the eye that contains modifiedsebaceous and sweat glands.

Cellular mediators of infection must migrate in from adjacent limbal vessels unless

the cornea has been vascularized by an earlier process. Corneal physiology is bestsummarized by the renowned corneal specialist Dr. Herbert E. Kaufman: Thecornea breathes air and eats aqueous.

Anterior chamber - the front section of the eye's interior where aqueous humorflows in and out of providing nourishment to the eye and surrounding tissues.Aqueous humor - the clear watery fluid in the front of the eyeball.

Blood vessels - tubes (arteries and veins) that carry blood to and from the eye.

Iris - the colored part of the eye. The iris is partly responsible for regulating theamount of light permitted to enter the eye.Lens (also called crystalline lens) - the transparent structure inside the eye thatfocuses light rays onto the retina.


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Posterior chamber - the back part of the eye's interior.Pupil - the opening in the middle of the iris through which light passes to theback of the eye.Retina - the light-sensitive nerve layer that lines the back of the eye. The retina

senses light and creates impulses that are sent through the optic nerve to thebrain.Sclera - the white visible portion of the eyeball. The muscles that move the eyeballare attached to the sclera.Suspensory ligament of lens - a series of fibers that connect the ciliary body of theeye with the lens, holding it in place.

Upper eyelid - top, movable, superior fold of skin that covers the front of theeyeball when closed, including the cornea.Vitreous body - a clear, jelly-like substance that fills the back part of the eye.

Lower eyelid - lower, inferior, skin that covers the front of the eyeball when closed.Macula - the focusing portion of the eye that allows us to see fine details clearly.Optic nerve - a bundle of nerve fibers that connect the retina with the brain. Theoptic nerve carries signals of light, dark, and colors to the area of the brain (the visualcortex), which assembles the signals into images (i.e., our vision).


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Modifiable Factor Non Modifiable Factor

Environment Age

Small Particles Lodge in Cornea

Inflammatory Cascade

Dilatation ofsurrounding vessels

Red Eye

Subsequent edema of lids, conjunctiva cornea

Corneal Foreign Body OS


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Corneal foreign bodies generally fall under the category ofminor ocular trauma. Small particles may become lodged in thecorneal epithelium or stroma, particularly when projected towardthe eye with considerable force.

The foreign object may set off an inflammatory cascade,resulting in dilation of the surrounding vessels and subsequentedema of the lids, conjunctiva, and cornea. White blood cells alsomay be liberated, resulting in an anterior chamber reaction and/orcorneal infiltration. If not removed, a foreign body can causeinfection and/or tissue necrosis.


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Assessment Nursing

Diagnosis

Scientific

Explanation

Planning Intervention Rationale Evaluation

Subjective:Hindi kosiyanabantayandahilumalis akoat nagsisisiako.

Objective:ConfusedFeeling of

guilt

ParentalRoleConflictrelated tofeelings ofguilt aboutaccident.

Feeling ofguilt due toaccident ornegligenceis normalfeelings of aparentbecause notall timeseven thewatchfuleye parents

can makechild safe ifaccidentoccur noone shouldbe blame.

After 1 ofnsg.intervention themother willdemonstrateconfidencein herability tocare for herchild.

Ascertainparentsunderstanding ofchildsdevelopmental stageandexpectations for thefuture.Promoted

parentalinvolvement indecisionmaking &care asmuch aspossible.

To identifymisconceptions/strengths.

Enhances

sense ofcontrol.

After 1 ofnsg.intervention themother haddemonstratedconfidencein herability tocare for herchild.


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Promoteduse ofassertivene

ssrelaxationskills.Assistedparent tolearnproper

administration ofmedicationasindicated.

To helpindividualsto deal

withsituation/crisis.To knowthe propertreatmentsfor her

childsearlyrecovery.


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Discussedattachmentbehaviour

s such asco-sleeping,feedingchild andbabywearing.

Parentmay needcounselling tounderstand thataccidentcanhappenunder themostwatchfulcare.

Dealingwithchild/home carepressures

can strainthe bondbetweenparentand child.

To helpthem re-establishtheirfeelings ofworth asparents.


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Discussedthe needfor andsources ofsupervision.

To guideandsupervisethechildren


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Assessment NursingDiagnosis

ScientificExplanation

Planning Intervention Rationale Evaluation

Subjective:

Nakita kona mapulana angmata nganak ko.

Objective:Red eyeAmbulatoryhyperactive

Alteration

in comfortwith redeye relatedto presenceof foreignbody in lefteye.

An

physicalstatecharacterized byfeeling ofdiscomfort,restlessness

.

After 1 of

nursingintervention theclientslevel ofdiscomfortwill be

lessen.

Monitored

vital signs

Providedcomfortmeasures,calmactivities.

Frequent

assessmentof vitalsignsprovideinformation aboutany

improvement ordeterioration in thechildscondition.Topromotenonpharmacologicalmanagement

After 1 of

nursingintervention theclientslevel ofdiscomforthad been

lessened.


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Suggestedparent be

presentduringprocedure .Encourageadequaterest period

Tocomfort

child.

Topreventfatigue.


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Name ofDrug

Classification & Action

Indication Contraindication

Adversereaction

NursingResponsibility

MonitoringResponsibility

Chloramphenicol

Chloromycetin sodiumsuccinate

Anti-infectivesInhibits

bacterialproteinsynthesis bybinding to the5os subunit ofthe ribosome;bacteriostatic

Meningitisbacteremia

or othersevereinfections.

Contra-indicated in

patientshypersensitive to drug. Usecautiously inthose takingother drugsthat causebonemarrowsuppressionor blooddisorder.

CNS:confusio n,

delirium,headache,milddepressionEENT:decreasedvisual acuityoptic neuritisinn patientswith cysticfibrosis.

Obtainspecimen for

culture &sensitivitytests beforegiving firstdose.Obtain druglevelmeasurementMonitorpatient forsigns andsymptoms.

Maydecrease

hgb levelMaydecreasegranulocyte& plateletcount.May falselyelevate urinePABA levelsif givenduring abentiromidetest forpancreaticfunction.


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Name of Drug Classification& Action

Indication Contraindication

Adversereaction

NursingResponsibility

MonitoringResponsibility

TetanusToxoid

ImmunodilatorsPromotesimmunity totetanus byinductingantitoxin

production.

Primaryimmunization to preventtetanus.Boosterdose toprevent

tetanus.

Contraindicated in thosewithimmunoglobulinabnormalities. Also in pt.withthrombocytopenia/ othercoagulationdisordersthat could

contraindicate IMinjectionunlessbenefitoutweighrisk.

CNS: slightfever,headache,malaise.CV:tachycardia,hypotension.

Musculoskeletal: aches,pains.Skin:erythema,nodule atinjection site,

urticaria.

Obtainhistory ofallergies andreaction toimmunization.Determine

date of lasttetanusimmunization.

Nonereported.


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Child H who had been diagnosed with Corneal ForeignBody had a good prognosis. The patient undergone operation forremoval of foreign body under IV sedation that only take for twominutes. The patient manifest early signs of healing and her motheris now assisted for home care treatment for preparedness for

discharge.


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M Advised the patients mother to continue medication as prescribed. Fusidic acid eye drop 2x a day for 7 days

E Advised the mother about the patients safety while playing or on activity.T Demonstrated on how to perform postural drainage and back tapping.

H Bathe the baby with luke warm water , the clothes regularly clean andcut the nails of the baby.O Informed the patients mother to have a follow up check up.D Advised the mother to increase the patients fluid intake.

S Emphasized to them the importance of always praying to God and makingGod the center of their lives.


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Delmars Pediatric Nursing Care Plan, 3rd edition, Luxner

Delmars Manual of Laboratory and Diagnostic Test, Rick Daniels

Health Assessment in Nursing 3rd edition. Janet Weber & Jane Kelly

Maternal and Child Health Nursing. Pilliteri, Adele; Volume2.Lipincott

Nurses Pocket Guide. 11 edition. Doenges, Marilyn; F.A DavisCompany.Philadelphia

Nursing 2008 Drug Handbook. 28th edition. Lippincott

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BSN III 5 C 5 Corneal Foreign Body Gizelle Mutya Magsino