CAPITOL MEDICAL CENTER COLLEGES INC.

CASE STUDY
PERIORBITAL CELLULITIS to consider ABCESS

BUNDANG, Kenneth
CANO, Mary
CATIPON, Julian
CARA, Michael
CIFRA, Manuel Jr.
CLAR, Alan Jay
CORDOBA, Joan Angelique
CORTINA, Jemima Mia M.
CORRAL, Priscilla Chantal M.
CUARESMA, Katelyn

09/30/2010

MS. JENNY ALDANA-PUCAN RN, MAN.

Clinical Instructor

I. INTRODUCTION
 Background of the Study

Periorbital abscess is an enclosed collection of liquefied tissue, known as pus, in

the periorbital area of our eyes. Abscess is the last of tissue infection that begins with a
process called inflammation. There are four signs that characterized inflammation; these
are heat, swelling, redness, and pain. Abscess can also produce fever and discomfort.
There are many causes of abscess, but the most common is staph. Aureus.

 Significance of the Study

Importance of this study is not only for the benefit of the nursing students, but
also for the client. It helps us to identify the problem, the origin, signs and symptoms, as
well as the appropriate management for the said disease (Periorbital Abscess)

 Objectives
o General Objective

To be able to know the disease process in our body, the manifestation,

causes, effects to our clients physical, emotional, psychological, and social life,
and proper management or treatment that is appropriate for her healing.

o Specific Objective

-To enhance our skills and knowledge and familiarize ourselves to the
said disease that may help us in our future career.

-To identify appropriate intervention for this disease.

 Theoretical Framework
Infection from our environment can lead to different diseases. It is based
in the theory of Florence Nightingale which is the environmental theory that
tackles about the factors in our environment that affects our client health. The
missing component of her theory base in our case was the surrounding. Because
in our surrounding nowadays, we can acquire variety of diseases if we don’t
know how to clean it. Taking care of our surroundings can prevent this kind of
infection or any other diseases.

PHYSICAL ASSESSMENT
 ASSESSMENT
BODY PART NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS
TECHNIQUE

1. Skin Inspection Fair complexion, Fair complexion, NORMAL

absence of scars & absence of scars &
lesions. Good skin lesions. Good skin
Palpation turgor. turgor.

2. Scalp Inspection No lice & nits. No lice & nits. NORMAL

Palpation No lumps and No lumps and lesions.

lesions.

3. Hair Inspection Evenly distributed Evenly distributed NORMAL

hair, color varies black hair, Smooth in
mostly in black. texture & Shiny.

Smooth in texture
Palpation & Shiny.

4. Face Inspection Symmetrical face Symmetrical face NORMAL

movement, movement,
symmetrical symmetrical
nasolabial folds nasolabial folds

5. Eyes Inspection 20/20 vision, round 20/20 vision, round NORMAL

cornea, black color ; cornea, black color ;
white sclera. Reacts white sclera. Reacts
to light & to light &
accommodation. accommodation

6.Eyebrows Inspection Hair evenly Hair evenly NORMAL

distributed with distributed with skin
skin intact intact ,symmetrically
,symmetrically aligned with equal
aligned with equal movement.
movement.

7. Eyelids Inspection Skin intact, no (+) tenderness, Presence of

discharge, no erythematous, soft inflammation
discoloration. Lids tissue mass on the and tissue
 able to close infra orbital region damage
symmetrically. approximately
measuring 5.0 x 3.0
cm

8. Ears Inspection Same color as facial Same color as facial NORMAL

skin, symmetrical. skin, symmetrical.

Auricle with outer  

canthus of eyes
(+) palpable post
Palpation about 10 degree of
vertical, mobile firm auricular lymph
nodes. Presence of
and not tender,
free from lesions. infection

9. Hearing Inspection No voice tone No voice tone audible NORMAL

Acuity audible & able to & able to understand
understand spoken spoken words.
words.

10. Nose Inspection Midline & Midline & NORMAL

Symmetrical to Symmetrical to face,
face, no lesions, no no lesions, no nasal
nasal discharges or discharges or flaring
flaring uniform in uniform in color, air
color, air moves moves freely.
freely.

11. Mouth Inspection Proportional and Proportional and NORMAL

symmetrical with symmetrical with
face. face.

12. Lips Inspection Pink in color, Pink in color, smooth, NORMAL

smooth, no lesions. no lesions.

13. Teeth Inspection Complete without Complete without NORMAL

dentures. dentures.

14. Tongue Inspection Tongue floor is in Tongue floor is in NORMAL

central position, central position, pink
pink in color, moist, in color, moist, no
no lesions or lesions or swelling.
swelling.
15. Chest Inspection Symmetrical during Symmetrical during NORMAL
lung expansion & lung expansion &
recoil. recoil.
Palpation No lesions and No lesions and
abnormal grating abnormal grating
sound. sound.
Percussion
Resonance. Resonance.

No abnormal No abnormal breath

Auscultation breath sounds. sounds.

16.Heart Auscultation Normal rate, Normal rate, rhythm, NORMAL

rhythm, no no murmur.
murmur.

17. Abdomen Inspection No lesions, masses No lesions, masses & NORMAL

& tenderness. tenderness.

No abnormal bowel No abnormal bowel

Auscultation sounds. sounds.

Tympany. Tympany.
Percussion No lesions, masses No lesions, masses or
Palpation or tenderness tenderness

18.Upper Inspection Symmetrical to the Symmetrical to the NORMAL

Extremities body & no lesions. body & no lesions.
Palpation
No tenderness, no No tenderness, no
palpable mass palpable mass noted.
noted. Palpable Palpable Brachial &
Brachial & Radial Radial Pulse. Able to
Pulse. Able to move move freely without
freely without discomfort; able to
Inspection on
discomfort; able to adduct, abduct, flex,
abduction,
adduct, abduct, and extend.
adduction,
flex, and extend.
flexion,
extension.

19. Palms Inspection Pink in color hand, Pink in color hand, no NORMAL
no lesions. lesions.
20. Fingernails Inspection Nails are clean. Nails are clean. NORMAL

Pink nail beds Pink nail beds.

21. Lower Inspection Symmetrical to the Symmetrical to the NORMAL

Extremities body, no lesions body, no lesions
noted, muscle noted, muscle appear
appear equal with equal with good
good muscle tone. muscle tone.

22. Toenails Inspection Pink nail beds with Pink nail beds with NORMAL
capillary refill of 1-3 capillary refill of 2
seconds. seconds.

II. CLINICAL DISCUSSION

Pathophysiology

Because orbital cellulitis originates from large adjacent foci of fulminant infection (eg, sinusitis)
separated by only a thin bone barrier, orbital infection can be extensive and severe. Subperiosteal fluid
collections, some quite large, can accumulate; they are called subperiosteal abscesses, but many are
sterile initially.

Complications include vision loss (3 to 11%) from ischemic retinopathy and optic neuropathy
caused by increased intraorbital pressure; restricted ocular movements (ophthalmoplegia) caused by
soft-tissue inflammation; and intracranial sequelae from central spread of infection, including cavernous
sinus thrombosis, meningitis, and cerebral abscess.

Symptoms and signs of orbital cellulitis include:

swelling and redness of the eyelid and surrounding soft tissues, conjunctival hyperemia and chemosis,
decreased ocular motility, pain with eye movements, decreased visual acuity, and proptosis caused by
orbital swelling. Signs of the primary infection are also often present (eg, nasal discharge and bleeding
with sinusitis, periodontal pain and swelling with abscess). Fever, malaise, and headache should raise
suspicion of associated meningitis. Some or all of these findings may be absent early in the course of the
infection.

Subperiosteal abscesses, if large enough, can contribute to symptoms of orbital cellulitis such as swelling
and redness of the eyelid, decreased ocular motility, proptosis, and decreased visual acuity.

SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY

 PREDISPOSING FACTOR:
Congenital anomaly
Age
PRECIPITATING FACTORS:
Environmental
Injuries and Trauma
 
 
 

Blockage in the Lacrimal

Tissue Trauma gland Eye Irritation

Invasion of foreign objects:

Staphyloccocus Aureus, Streptococcus species, haemophilus
species and other basteria.

Body’s defend mechanism:

Phagocytic action
LEUKOCYTES migrate in the endothelium and accumulate in the tissue at the site
of injury

Chemical Mediators release

Kinin, Bradykinin, Prostaglandin

1. Inflammation; 2. Edema; 3. Swelling; 4. Exudates; 5. Pain; 6. Fever.

III. MEDICAL AND SURGICAL INTERVENTION

Incision and Drainage

Definition

An infected skin nodule that contains pus may need to be drained via a cut if it does not respond to
antibiotics. This allows the pus to escape, and the infection to heal.

Purpose

An abscess is a pus-filled sore, usually caused by a bacterial infection. The pus is made up of both live
and dead organisms and destroyed tissue from the white blood cells that were carried to the area to
fight the infection. Abscesses are often found in the soft tissue under the skin, such as the armpit or the
groin. However, they may develop in any organ, and are commonly found in the breast and gums.
Abscesses are far more serious and call for more specific treatment if they are located in deep organs
such as the lung, liver or brain.

Because the lining of the abscess cavity tends to interfere with the amount of the drug that can
penetrate the source of infection from the blood, the cavity itself may require draining. Once an abscess
has fully formed, it often does not respond to antibiotics. Even if the antibiotic does penetrate into the
abscess, it doesn't function as well in that environment.

Description

A doctor will cut into the lining of the abscess, allowing the pus to escape either through a drainage tube
or by leaving the cavity open to the skin. How big the incision is depends on how quickly the pus is
encountered.

Once the abscess is opened, the doctor will clean and irrigate the wound thoroughly with saline. If it is
not too large or deep, the doctor may simply pack the abscess wound with gauze for 24-48 hours to
absorb the pus and discharge.

If it is a deeper abscess, the doctor may insert a drainage tube after cleaning out the wound. Once the
tube is in place, the surgeon closes the incision with simple stitches, and applies a sterile dressing.
Drainage is maintained for several days to help prevent the abscess from reforming.

Medical management

The goal of pharmacotherapy is to reduce morbidity and to prevent complications.

Antibiotics

Treatment involves management of predisposing conditions, antibiotic therapy, and close observation.

IV. DISCHARGE PLANNING

 MEDICATION

Instruct patient about take home drugs as prescribed by the Doctor. Teach the patient about the desired effect and
adverse reactions of the drug. Note the use and time of taking up medicine. It will also be helpful to instruct also
the relatives most especially because our client is a minor.

 Co-Amoxiclav 625 m.g. BID, taken every 8am and 8pm for infection.

EXERCISE

Advice patient to do exercise to improve immunity and to have the body’s normal functioning. Exercises will
significantly help the client in the prevention occurrence of illnesses and infections.

TREATMENT

Encourage patient to have a lifestyle modification to reduce symptoms and the underlying cause. Inform client that
some activities may expose her to pollutants that may irritate her eyes. We can suggest use of eye drops for eye
irritation and accordingly prevention of it.

HEALTH TEACHING

Stress to the patient the therapeutic management in eye care. Keeping the eyes clean may prevent incidence of
irritations that may lead to infections. Some tips that can give additional knowledge in giving care to the eyes such
as:

1. Lighting: Light source should be positioned behind your child while reading. Avoid direct glare by using
shielded light.
2. UV light: Too much exposure to bright sunlight is harmful and can cause damage. Wide brimmed hats and
UV filtering sunglasses provide adequate protection.
3. Instruct patient to avoid rubbing or having a contact within the eyes to prevent further infection.

OUT PATIENT

Encourage patient to attend follow up check to evaluate and reassess her present condition. It is important to at
least have a monthly eye check to ophthalmologist because infection or infirmities may possibly intensify by time.

o September 30, 2010, 10:00am, CMC out-patient Department.

o Dr. Jenny Aldana-Pucan

DIET

Eating a lot of Vitamins A, E, C, and some Zinc and Selenium can help prevent many diseases including those that
affect the eyes. A healthy diet with emphasis on green leafy vegetables, drumstick, carrots, beetroot, fresh fruits
including mango and papaya are particularly rich in Vitamin A.

ASSIGNMENT
MICHAEL CARA JEMIMA MIA M. CORTINA

Introduction  Physical assessment

 Background of the Study PRISCILLA CHANTAL M. CORRAL

 Significance of the Study
Clinical Discussion
 Objective
 General  Anatomy and physiology
 Specific  Pathophysiology
 Theoretical Framework  Schematic diagram of disease

JULIAN CARLO CATIPON MANUEL CIFRA JR.

Nursing Health History  Medical & Surgical Treatment /
Management
 Patient’s Profile
 History of Present Illness
ALAN JAY CLAR
 Past Medical History
 Family History  Nursing Care plan
 Social and Environmental History
 Immunization record KATELYN CUARESMA
 Developmental Milestone
 Drug Study
KENNETH BUNDANG & MARY JOY
CANO JOAN ANGELIQUE CORDOBA
 Discharge planning
 Gordon’s Pattern of Functioning