PROGRAMME PLACE

: :

B.Sc (N), II YEAR college of nursing, Madurai medical college, madurai-20.

SUBJECT TOPIC SUBMITTED TO

: : :

Medical Surgical II Diarginal keratitis Mrs.S.Gnana Prabha B.Sc (N), Nursing tutor, Mrs.J.Jeya Lakshmi B.Sc (N), Nursing tutor, Madurai medical college, madurai-20.

SUBMITTED BY

K.Nithya Kalyani B.Sc (N), II YEAR.

DATE MARKS ORIENTED

: :

24.6.2011

Signature of the faculty

Signature of the principle

INTRODUCTION: Imagine in a camera, the lens is the part which helps in the capture of viviol picture. If there is any problem with the lens the capturing of images are affected. Likewise our eye plays an important role in vision. If there is any ulcer in the cornea, it is known as MARIGINAL KERATITIS. I have selected this carestudy out of my interest to know about the treatment reginen and nursing care for MARIGINAL KERATITIS patient.

OBJECTIVES  To promote good relationship between the nurse & patient.  To develop a care plan for patient suffering from marginal keratitis & provide better care to the patient.  To improve the health condition of the patient.  To dicuss the incidence, pathophysicology, clinical features of marginal keratitis.  To know about the complicated & treatment about the marginal keratitis.

Patients profile: Name Age/sex Occupation Income Address : : : : : Mr.Chellaiah 55/female Cool 900/- per month s/o Alagar, 69TT Muthuramalinga nagar, 3rd ward, pudhur, Madurai 9. Ward Unit I.P.No Admitted on Diagnosis : : : : : 164 I unit 036286 11.4.2011 at 12.00 pm Mariginal keratitis

Chief complaints: He is clefective vision in the last eye, associated with pain & watering discharge & photo phobia since 2 weeks. Post history: He had trauma of the left eye. 2 years back. No h/o DM, HT.

Present history: The patient has pain, visual defects in lesteye, watering discharge presetent this eye. Family history:

- Death

Male

- Female - Death H&A - Health&alive -

No consangumous marrige. No H/O DM, HT among their family members. Personal History: The patient takes mixed diet, no smoking, no alcoholic, & tobacco chewing. He wears spectacle for past 6 months for reading purpose.

Environmental history: The patient lires in his own house, well water supply & electric supply, closed drainage system, well ventilillated. Socio economic status: The patient possess low socio economic status. Spiritual history: The patient has faith to lord muruga goes to the temple weekly once.

Physical examination General appearance: Thin body built, black in color. Head: Gray color hair, No dandruff, No pediculosis. Eyes: Eye lids are normal in both eyes Conjuctive normal in both eyes. Clear cornea in right eyes. Pheriphery thining of cornea in left eye. Pupil reactive to light in both eyes. Normal lens. Vision
RE 6/8

Height : 160cm Weight : 58 kg

with pin hole 6/24 with pin hole 6/36

LE 6/24

Duct patients in both eye Water dischrge present. Ears: Normal hearing pattern, No cerumen collection. No discharge from Present. Nose: No septal eleviation, No dischrge, patient nostril. Mouth: Pale tongue, No odour, dry lips. Dental carries present. Neck: All range of motions are possible. Throat: No lymphnode enlargement, No thyroid enlargement.

Chest: Mosit genitalia Genitalia: symmetrical chest wall movement, Normal breathing pattern. Abdomen: No hepatomegaly & spleenomegaly. Upper & lowet extremity: All range of motions are possible.

Systemic assessment Central nervous system: The patient was oriented about time, place & person. Respiratory system: Normal vesicular breathing sound heard. Symmertical chest wall movement respiratory rate in24 breath 1 minute. Cardiovascular ayatem: S1, s2 heared, No murmur, pulse rate is 84 beats/ minutes. Gastrointestinal system: Normal bowel sounds heared. No scar present. No organomegally. Genitourinary system: Moist clean genitalia. Skeletal system: All range of motions are possible. Integumantry system: Intact skin, no rash. VITAL SIGNS: Temprature : 98.40 F

Pulse Respiration

: 84 beats/minutes : 24 breaths/ miutes

Blood pressure : 120/90 mm hg O2 saturation : 100%

Investigations Investigation Blood Sugar Urea Creatinine Normal value 80-120 mg/dl 15-40 mg/dl 7-1.5 mg/dl Patient value 64 mg/dl 24 mg/dl 1.2 mg/dl Inference Normal Normal Normal

Rheumatoid factor: Negative

Medications
Name of Dose drug T.Paracetamal 500 mg T.BCT 3 mg Route Frequent Oral Tds Action NSAID Antipyretic Vitamin supplement Remarks Nurse role Administer medication properlly Abserve any allergic reactions

Oral

od

Ciprofioxic drops

3drops Eye Tds drops

Antibiotic

No allergic reactions Abserve any allergic reactions Abserve any allergic reactions Monitor vital signs

Tetracycline drops

3drops

Qid

Include tears

Rantac

300mg Oral

Bd

H2 blocker

ANATOMY AND PHYSIOLOGY OF CORNEA  Cornea is a clear transperent & elliptical stucture with a smooth shining curface.  The average diameter is 11-12 mm, horizontal, 12mm vertical 11mm.  The thickness of the contral part is 0.52mm & the peripheral part is 0.67mm.  The central one third is known as the optical zone refractive index of cornea is 1.37  The dioptic power of the cornea is approximately +43 to +45D.

STRUCTURE: The cornea consists of five layers namely . 1. The opithelium: Stratified squamous type of epi-thelium consists of three cell types namely the basal columnar cells, two or three layer of wing cells & surface cells. It is commonly replaced with in the days when damaged. 2. Bow mans membrane: It is made up of collagen fibrils. It does not regenrate when damaged. This result in the formation of permanent corneal opcity.

3. Substantia properia or stoma: It fprms 90% of corneal thickness. It consists of keratocytes regularly as ranged collagen fibrils & ground substance. 4. Descements membrane: It is thin but strong homogenous elastic membranes which can megenerators. The endothellium: It is single layer of flattened hexagonal cells. The cell density is about 3000 cells mm2 at birth which decreases with advancing age. Corneal decompensation occurs with when more than 75% cells are damaged. It is measured by specular microscopy. Functions of the retina: The retina is the photosensitive part of the eye. The light senstive nerve cells are the rods & cones & their distribution in the retina. Light rays cause chemical changes in photosensitive pigments in these cells & they generate nerve impulses which are conducted to the occuptional lobes of the cerebrum via of the optic nerves. The rods are more senstive than the cones. They are stimulated by low intesity or dim light (eg) by the dim light in a darkened room. The cones are senstive to bright light & color. The different wavelength of visible light stimulate photosensitirity pigment present in

the cones, resulting in a perception of different colours. In bright light the light rays are focused on the macula lutea. The rods are more common numerous forwards the periphery of the retina. Visual purple is a photosenstive pigment present only in the rods. It is bleached by bright light & is quickly regenerated provided an adequate supply of vitaminA is available.

Dark adaption: When exposed to bright llight, the rhodospin with in the senstive rods is clegraded comletely. This is not siginificant untill the individual moves into a darkened area where the light intensity is insufficient to stimulates the cones, & temporary

Subjective data: The patient verbalises that he has pain in the lost eye Nursing Diagnosis: Nursing Goal :

Objective data: The patient looks like dull, irritate and fatigue

Occurlar pain related to inflammation of the cornea The pain will be minimized Implementation Established rapport with the patient Rationals Wins the confidence and co-operation of the patient The pain will be minimized Evaluation

Plan of action Establish rapport with the patient

Assess the level of pain

Assessed the level of pain by pain scale

To know the pain level

Provide comfortable bed and position Provide dressing to the eyes

Provided comfortable bed and position Provided dressing by irrigating the eye by using eye patch

Promote comfort

Avoid entry of infection

Plan of action Administer medication as prescribed by the physician Watch for signs of infection such as fever, drainage warmth and redness Reassess the patient

Implementation Administered medication as prescribed by the physician Watched for signs of infection

Rationals Relieve pain and avoid infection To avoid further

Evaluation

such as fever, drainage, increasing complication pain and warmth Reassessed the patient To know the effectiveness of nursing care

Subjective data: The patient may verbalizes that he is not able to visualise properly Nursing Diagnosis: Nursing Goal :

Objective data: The patient struggless to find object and has difficult in handling the objects

Disturbed sensary perception related to dimmed vision Improve the sensory perception Implementation Assessed the general condition Rationals To know the base line data The patient reports no fall or injury as evidenced by confidential improvement in patient environment Evaluation

Plan of action Assess the general condition

Check the visual activity

Assessed the visual activity

To know the visual activity

Provide bed rest to the patient Schedule the activities of the patient

Provided bed rest by restricting the activities of the patient Scheduled the activities of the patient by avoiding unnecessary activities

Avoid injury to the patient Provide safety to the patient

Plan of action Assist with activity and care

Implementation

Rationals

Evaluation

Assisted with acitivity and care by Ensures safety and assisting the patient in performing reassurance to the self care activities patient Avoid injury

Maintain safe environment to the patient

Maintaining safe environment to the patient by avoiding sharp instrument

Subjective data: The patient may verbalizes that

Objective data: The patient has watery discharge

he is unaware about how to provide care to the eye form eyes, dull vision Nursing Diagnosis: Nursing Goal : Deficient eye care related to watery dischare from the eye To improve the self care Implementation Provided dressing to the patient eye Provided eye shield Taught the patient about eye hygiene Adviced to the patient about the follow up care Improve the awareness of the disease Prevent injury Prevents infections Rationals Prevent infection The patient answers questions regarding eye care and hygiene evidenced by Evaluation

Plan of action Provide dressing to the patient Provide eye shield Teach the patient about eye hygiene Advice the patient about follow up care

Plan of action

Implementation

Rationals Prevent recurrence

Evaluation the self care of the patient

Advice to the patient to avoid Adviced to the patient to avoid pollution environment Advice to the patient to wear glasses polluted environment Adviced to the patient to wear glasses

Prevent infection

Advice to the patient to check Adviced to the patient to check periodically his eye periodically his eye

Improve the health

Subjective data: The patient verbalizes that he have eye discharge, pain and irritation Nursing Diagnosis: Nursing Goal :

Objective data: He looks like very irritated, dull and discharge from eye

Risk for infection related to hospitalization Infection will be prevent Implementation Established rapport to the patient and care giver Assessed the general condition of the patient Monitored vital signs temp:98.40F, pulse: 78/min, resp:20breath, BP:120/80mmHg Rationals To wins the confidence of the client To know the baseline data about the client To know about the vital signs Evaluation

Plan of action Establish rapport to the patient and care giver Assess the general condition of the patient Monitor vital signs

Educate to the patient to wash their hands thorought soap with water

Educated to the patient to wash their hands thoroughly soap with water

To prevent cross infection

Plan of action Educate the patient to wear eye shield Advice to the patient to take medications properly Teach the patient to follow routine personal hygiene

Implementation Educated the patient to wear eye shield Adviced to the patient to take medications properly Taught the patient to follow routine personal hygiene

Rationals To prevent micro organisms spread To prevent infection

Evaluation

To improve the health status

Subjective data: The patient verbalizes that he have no idea about the care for an eye and other measures Nursing Diagnosis: Nursing Goal :

Objective data: He looks like very disturbed and doubtfullness

It will improve the knowledge of the patient Implementation Rationals Evaluation

Plan of action Establish rapport to the client Assess the general condition of the patient Ask the questions to the patients Educate about the operative techniques and indications Advice to the patient ask questions and clarifies the doubts with me Reassess the client

Established rapport to the client To wins the confidence of the client Assessed the general condition of the patient Asked the questions to the patient Educated about the operative techniques and indications Adviced to the patient ask questions and clarified the doubts with me Reassessed the client To know the baseline data about the client To know the knowledge level of the patient To improve the knowledge of the patient To know the knowledge about the treatment To know the effectiveness of nursing care The patient knowledge will improved