REPORT INTRODUCTION

CONJUNGTIVITIS

Name : Bayu Harjunanto

NPM : 1814201310004

Semester : 4 (Four)

Public health center : Puskesman Pekauman

Group : 1 (one)

PRENERS PRACTICE I
BILINGUAL NURSING STUDY PROGRAM
FACULTY OF NURSING AND HEALTH SCIENCE
MUHAMMADIYAH UNIVERSITY OF BANJARMASIN
2019-2020
REPORT OF CONJUNGTIVITIS INTRODUCTION
1. Definition
Conjunctivitis is inflammation of the conjunctiva and is characterized by swelling and
exudate. In conjunctivitis the eyes appear red, so they are often called red eyes (Suzzane,
2001: 1991).
Conjunctivitis is inflammation of the conjunctiva or red eye or pink eye. (Elizabeth,
Corwin: 2001).
Conjunctivitis is inflammation of the conjunctiva (the outer layer of the eye and the inner
layer of the eyelid) caused by microorganisms (viruses, bacteria, fungi), allergies, and
irritation of chemicals. (Mansjoer, Arif et al: 2001).

2. Etiology
Conjunctivitis can be caused by various things, such as:
a) Infection by viruses or bacteria.
b) Allergic reactions to dust, pollen, animal dander.
c) Irritation by wind, dust, smoke and other air pollution; ultraviolet light from electric
welding or sun reflected by snow.
d) Contact lens wear, especially in the long term, can also cause conjunctivitis
(anonymous, 2009). Sometimes conjunctivitis can last for months or years. This type of
conjunctivitis can be caused by:
 Entropion or ectropion.
 Tear canal abnormalities.
 Chemical sensitivity. Exposure by irritants.
 Infection by certain bacteria (especially chlamydia) (medicastore, 2009).

The frequency of appearance in children increases when the child experiences other
allergic symptoms such as fever. Triggers for allergic conjunctivitis include grass,
pollen, animals and dust (Effendi, 2008).
Other substances that can irritate the eye and cause conjunctivitis are chemicals
(such as chlorine and soap) and air pollutants (such as smoke and fumigation liquids)
(Effendi, 2008).
3. Classification
a) Allergic Conjunctivitis
Allergic conjunctivitis is one of the most common external eye diseases. This form of
conjunctivitis may be seasonal or certain seasons and usually has to do with sensitivity to
pollen, animal protein, feathers, dust, certain food ingredients, insect bites , drugs.
Allergic conjunctivitis may also occur after contact with toxic chemicals such as hair
spray, makeup, smoke, or cigarette smoke. Asthma, itching due to plant allergies and
eczema, is also associated with allergic conjunctivitis.
b) Bacterial Conjunctivitis
Bacterial conjunctivitis is also called "Pink Eye". This form is easily transmitted
infectious conjunctivitis, which is usually caused by staphylococcus aureus. It may also
occur after recovery from haemophylus influenza or neon gonorhe.

c) Hyperacute Bacterial Conjunctivitis

Neisseria gonnorrhoeae can cause severe hyperacute bacterial conjunctivitis and
threaten vision.

d) Viral Conjunctivitis
This type of conjunctivitis is a result of infection with human adenovirus (the most
common is epidermic keratoconjunctivitis) or from systemic viral diseases such as
mumps and mononucleus. It is usually accompanied by follicular formation so it is also
called follicular conjunctivitis. The other eye is usually infected within 24-48 hours.

e) Blenorrhea conjunctivitis
Purulent conjunctivitis (suppurating in infants and gonorrhea conjunctivitis).
Neonatal gonorrhea is a conjunctivitis found in newborns.

4. Pathophysiology
The conjunctiva because of its location is exposed to many microorganisms and other
disturbing environmental factors. Several mechanisms protect the surface of the eye from
external substances. In the tear film, the aqueous element dilutes the infectious material, the
mucus captures debris and the pumping action of the palpebra constantly sweeping away the
 tear duct and tears contain antimicrobial substances including lysozyme. The presence of a
destructive agent, causing injury to the conjunctival epithelium followed by epithelial
edema, cell death and exfoliation, epithelial hypertrophy or granuloma. There may also be
edema of the conjunctival stroma (chemosis) and stromal lymphoid layer hypertrophy
(formation of follicles). Inflammatory cells migrate from the conjunctival stroma through the
epithelium to the surface. These cells then join fibrin and mucus from goblet cells,
Inflammation of the conjunctiva causes dilation of the posterior conjunctival vessels,
causing hyperemia which is most evident in the fornix and decreases toward the limbus. In
conjunctival hyperemia is usually found swelling and hypertrophy of the papillae which is
often accompanied by foreign body sensations and the sensation of scratches, heat, or
itching. This sensation stimulates tear secretion. Mild transudation also arises from
hyperemia and increases the amount of tears. If the client complains of pain in the iris or
silier body means the cornea is affected (Source: http // dhetective-dhetective.blogspot).

5. Clinical Manifestations
Subjective symptoms include itching, cramping (scratching) or feeling a foreign object.
The cause of this complaint is conjunctival edema, formation of papillary hypertrophy, and
follicles which results in a feeling of foreign bodies in the eye. Objective symptoms include
conjunctival hyperemia, epiphora (excessive tears), pseudoptosis (upper eyelids as they
close), a kind of membrane or pseudomembrane due to fibrin coagulation.
The manifestations according to their classification are as follows:
1. Allergic Conjunctivitis
 Severe to mild edema in conjunctivitis
 Feel like burning
 Vascular injections in conjunctivitis
 Tears often come out on their own
 Itching is the most severe form of conjunctivitis

2. Bacterial Conjunctivitis
 Blood vessel dilation
 Medium conjunctival edema
  Tears keep coming out
 The existence of secret or dirt on the eyes
 Minor damage to the corneal epithelium may be found

3. Viral Conjunctivitis
 Photophobia
 Feel like there is a foreign object in the eye
 Lots of tears
 Prorbital Pain
 If the cornea is infected there can be turbidity in the cornea
 Redness of the conjunctiva
 Found a little exudate

4. Hyperacute Bacterial Conjunctivitis

 Eye infection shows massive purulent secret
 Red eye
 Irritation
 Palpation pain
 Usually there is chemosis
 Swollen eyes and painful preauricular adenopathy

5. Blenorrhea conjunctivitis
Signs of blenorrhea are as follows:
 Transmitted from mothers suffering from GO disease
 Causes the main cause of ophthalmia neinatorm
 Gives a thick, dense secret purulent secret
 Visible after birth or incubation period between 12 hours to 5 days
 Subconjunctitary bleeding and chemotherapy

6. Management
 If conjunctivitis is caused by microorganisms, patients must be taught how to avoid
contamination of healthy eyes or other people's eyes. Nurses can instruct patients not to rub
the affected eye and then touch healthy eyes, wash their hands after each time they touch the
affected eye, and use a separate cloth, towel and handkerchief to clean the affected eye.
Special care must be carried out by personal health care to avoid the spread of conjunctivitis
between patients. Specific treatment depends on the identification of the cause.
Conjunctivitis due to bacteria can be treated with sulfonamide (sulfacetamide 15%) or
antibiotics (Gentamycine 0.3%; chlorampenicol 0.5%). Fungal conjunctivitis is very rare
whereas conjunctivitis due to viral treatment is primarily intended to prevent secondary
infections, allergic conjunctivitis is treated with antihistamines (antazidine 0.5%, rapazoline
0.05%) or corticosteroids (eg dexametazone 0.1%). Handling begins with patient education
to improve eyelid hygiene. Cleaning the lids 2 to 3 times a day with artificial tears and
ointments can refresh and reduce symptoms in mild cases.
In more severe cases, topical steroids or antibiotic-steroid combinations are needed.
Cycloplegics are only needed if iritis is suspected. In many cases of Prednisolone acetate
(Pred forte), one drop, QID is quite effective, without any contraindications. If the etiology
is suspected to be a Staphylococcus or acne rosacea reaction, oral Tetracycline 250 mg or
erythromycin 250 mg QID PO, along with topical antibiotic ointment such as bacitracin or
erythromycin before going to sleep. Topical metronidazole (Metrogel) given on TID skin is
also effective. Because tetracycline can damage teeth in children, so it is contraindicated for
ages under 10 years. In this case, doxycycline is replaced with 100 mg TID or erythromycin
250 mg QID PO. Therapy is continued for 2 to 4 weeks. In suspected cases, chest X-ray
examination to rule out tuberculosis (Alamsyah, 2007) .2.10 Prognosis The eye can be
affected by various conditions. Some of them are primary while others are secondary due to
abnormalities in other organ systems, most of these conditions can be prevented if detected
early and can be controlled so that the vision can be maintained. When immediately
addressed, this conjunctivitis will not be dangerous. However, if inflammation of the eye
disease is not immediately treated / treated it can cause damage to the eye / disorder and
cause complications such as glaucoma, cataracts and retinal detachment (Barbara C. Long,
1996). most of these conditions can be prevented if detected early and can be controlled so
that vision can be maintained. When immediately treated, this conjunctivitis will not be
 dangerous. However, if inflammation of the eye disease is not immediately treated / treated
it can cause damage to the eye / disorder and cause complications such as glaucoma,
cataracts and retinal detachment (Barbara C. Long, 1996). most of these conditions can be
prevented if detected early and can be controlled so that vision can be maintained. When
immediately treated, this conjunctivitis will not be dangerous. However, if inflammation of
the eye disease is not immediately treated / treated it can cause damage to the eye / disorder
and cause complications such as glaucoma, cataracts and retinal detachment (Barbara C.
Long, 1996).

Bacterial Conjunctivitis

Before there are microbiological results, a single antibiotic can be given, such as gentamicin,
chloramphenicol, folimiksin for 3-5 days. then if it does not give good results, stop and wait for
the results of the inspection. If no bacteria are found in direct preparations, eye drops are given
along with broad spectrum antibiotics ointment every hour for sleep or eye ointment 4-5 times a
day.

Hyperacute Bacterial Conjunctivitis

 Patients usually need hospital care for topical and systemic therapy. Secret is cleaned
with a cotton swab moistened with clean water or with physiological salt every ¼ hour.
 Then given penicillin ointment every ¼ hour.

- Treatment is usually treated in a hospital and isolated, medica menstosa:

 Penicillin eye drops can be given as a penicillin G solution of 10,000-20,000 / ml every 1

minute to 30 minutes.
 Then the ointment is given every 5 minutes for 30 minutes. Followed by giving penicillin
every 1 hour for 3 days.
 Systemic antibiotics are given according to gonococcal treatment.
 The treatment was stopped if the microscopic examination made every day produced 3
times consecutive negative.

Allergic Conjunctivitis

Nursing management is in the form of cold compresses and avoids the causes of disease triggers.
Doctors usually give antihistamines or vasoconstrictor agents and administering astringents,
sodium chromolin, low-dose topical steroids. Pain can be reduced by removing crusts in the
eyelids by rubbing gently with saline (gram physiology). The use of celluloid protectors in sick
eyes is not recommended because it will provide a good environment for microorganisms.
Viral Conjunctivitis

Some patients experience improvement in symptoms after topical antihistamine / decongestant

administration. Warm or cold compresses can help improve symptoms.

Management of blenorrhea conjunctivitis

In the form of topical penicillin the eyes are cleaned of secret. Prevention is a safer way to clean
the baby's eyes immediately after birth by giving chloramphenicol ointment. Doctor's treatment
is usually adjusted to the diagnosis. Treatment of blenorrhea conjunctivitis:

1. Penicillin topical drops or ointments as often as possible. These drops can be given every
half hour in the first 6 hours followed by every hour until there are signs of improvement.
2. Injections to infants are given 50,000 U / KgBB for 7 days, because if not then the
administration of drugs will not be effective.

Sometimes it needs to be given together with tetracycline which is a common chlamydia

infection.
7. Pathway

A. Anatomy and Physiology of the Eye

The eye is one of the important organs in the human body. The eye can be divided into
three layers. The outermost layer is the cornea and sclera, each of which has a different
function. The cornea functions as a protective eye from infection and structural damage
and refracts light into the lens and retina. Sclera is a coat or eye protection in order to
maintain its shape when there is pressure from internal or external. The sclera is covered
by a transparent membrane called the conjunctiva. The cornea and sclera are connected
by the limbus. (Willoughby CE, 2010).
The second layer consists of iris, ciliary body and choroid. The iris functions in
the regulation of pupil accommodation so that incoming light can be conveyed to the
retina properly. The ciliary body functions in producing aqueous humor and is located
between the iris and the choroid (Borges, AS, 2013).
Choroid functions in supplying oxygen and nutrients to the outside and inside the
retina. Another function of the choroid is absorbing light, thermoregulation by removing
heat from the eye, and also regulating intraocular pressure by controlling vasomotor
blood flow (Nickla, DL, 2010).
 6 The deepest layer of the eye is the retina. The retina is the part of the eye that is
sensitive to light, containing cone cells and stem cells. When stem cells and cone cells are
stimulated, signals will be transmitted through nerve cells in the retina itself, to the optic
nerve fibers and interpreted by the cerebral cortex (Guyton, 2013).

B. Eye histology
The eyeball consists of three layers. The first layer is the sclera which is a buffer
network. The inside of the sclera is adjacent to the choroid where in the layer there are
various types of connective tissue and tissue support between cells including the presence
of melanocytes and macrophages. On the anterior part there is a thin transparent layer of
the conjunctiva that serves to continue the light entering the eye. The second layer is the
vascular layer. The vascular layer lies deeper beneath the sclera (uvea) which has three
layers in order from the outermost are the choroid, the ciliary body and the iris.

1. DIAGNOSIS
1) Pain associated with inflammation is characterized by a burning sensation in the eye
2) Disorders of comfort associated with edema and conjunctival irritation are
characterized by increased exudation, lacrimation photophobia and pain.
3) Perceptual sensory disorders are associated with corneal ulcers characterized by
purulent secretions.
4) Impaired self-concept (decreased body image) associated with changes in the eyelid
(swelling / edema)
5) High risk of disease transmission to other eyes or to other people related to the client's
limited knowledge about the disease.
6) Lack of knowledge is related to the lack of information about the prognostic
condition and treatment of the disease process

B. NURSING PLAN

Day / Goals or
N
Date / Dx Kep Criteria Nursing Plan Rational
o
Time Results
1 Pain b/d After nursing 1. Assess the level 1. To determine the
inflammation care is of pain client's pain level and
d /d expectedthe experienced by determine the next
 heartburn client's pain the client. intervention
is resolved 2. Teach clients 2. To minimize client
by kriteria of the method of pain
results : distraction
during pain,
 Pain is
such as deep
reduced or
and regular
controlled.
breathing. 3. Is a way of fulfilling a
3. Create a sense of comfort to the
comfortable, client by reducing
safe and calm stressors in the form of
sleeping noise.
environment. 4. Relieve pain, because
it blocks nerve
4. Collaboration delivering pain.
with the medical
team in
providing
analgesics.

2 Disorders of After nursing 1. Compress the 1. Release the sticky

comfort b/ d care is palpebral edge exudate at the edge of
edema and expectedThe (eyes closed) the palpebral.
irritation client feels with saline
conjunctiva d comfortable solution for
/ d increased with kriteria about 3 minutes
exudation, of results : 2. Wipe the
lacrimation exudate gently 2. Cleanse the palpebral
 Take
photophobia with a cotton from exudate without
action to
and pain. wool soaked in causing pain and
reduce
copy and each minimize the spread of
pain /
waster is only microorganisms.
 photophob used once 3. Closed eyes are the
ia / 3. Tell the client best medium for the
exudas. not to close his growth of
 Indicates sick eyes. microorganisms.
improvem 4. In fotofobi clients,
ent in 4. Encourage dark glasses can
complaints clients to use reduce light entering
. (dark) glasses. the eye so that
sensitivity to light
decreases. In allergic
conjunctivitis, glasses
can reduce exposure to
allergens / prevent
environmental
irritation.
5. Reducing allergic or
irritant exposure.
5. Advise female
allergic
conjunctivitis
clients to avoid /
reduce the use
of tatarias until
all the
symptoms of
conjunctivitis
disappear. Help
the client
identify other
sources of
allergens.
 Emphasize the
importance of
protective
eyewear for
clients who
6. Reducing the risk of
work with
misuse of eye
irritant
medications
chemicals.
6. Assess client's
ability to use
eye medication
and teach clients
how to use eye
drops or eye
ointments.
7. Accelerate healing in
7. Collaboration in
infective conjunctivitis
giving:
and prevent secondary
Antibiotics
infections in viral
conjunctivitis. Eye
drops are given during
the day and eye
ointments are given at
night to reduce the
stickiness of the
eyelids in the morning.
8. Reducing pain such as
periorbital pain in viral
8. Collaboration in conjunctivitis.
administration:
Mild analgesics
such as 9. Reducing blood vessel
 acetaminophen dilatation in allergic
9. Collaboration in conjunctivitis.
administration:
Vasoconstrictor
s such as
nafazolin.
3 Perceptual After being 1. Verify the 1. Affect patients' future
sensory given nursing degree / type of expectations and
disorders b/ d care, it is vision loss intervention choices
corneal ulcer expected to 2. Encourage the 2. While early
d / d the be seenn feeling of loss intervention prevents
presence of when it of vision blindness, patients face
purulent returns to the possibility /
secretions. normal with 3. Show the experience of partial /
kriteria of administration total vision loss.
results : of eye drops, for 3. Prevents further vision
example
 Recognize
counting
sensory
droplets,
disturbanc
following the
es and
schedule, not
compensat
dosing wrong
e for
4. Take action to
change 4. Reduces safety
help patients
 Identifyin hazards due to changes
deal with
g / in visual field / loss of
limited vision.
correcting vision and pupil
potential accommodation to
hazards in environmental light.
the
environme
nt
4 Impaired After being 1. Encourage the 1. Helping patients to
self-concept given nursing expression of initiate change and
(decreased care, it is feelings and reduce embarrassment.
body image) expected not accept what
b/d any to spoilin they say.
changes in self-concept 2. Give an 2. Increases security,
the eyelids disorder with environment encourages
(swelling / kriteria of that can accept verbalization.
edema) results : the situation
himself 3. Patients' perceptions
 Demonstra
3. Discuss the of changes in self-
ting
inflammation of image may occur
adaptive
the self-image suddenly or later.
responses
and the effects
to changes
of the disease.
in self-
concept.
 Expressin
g
awareness
about
change
and
developme
nt toward
acceptance
.
5 High risk of After being 1. Tell the client to 1. Minimize the risk of
writingeffect given nursing prevent spreading infection.
of diseases of care, it is exchanging
other eyes / expected not gloves, towels
of others b/d to be and pillows with
limited client completedso other families.
knowledge the spread of Clients should
about the infection use a tissue, not
disease. with kriteria a handkerchief
of results : and this tissue
must be
 Have
discarded after
adequate
one use only
knowledge
2. Remind client
about
not to rub the
prevention
eyes that are
measures
sick / careless 2. Avoid the spread of
for
contact with infection in other eyes
transmissio
eyes and in others.
n
3. Tell the client
 Take
about proper
precautiona
hand washing
ry
techniques. 3. The hygiene principle
measures to
Encourage needs to be
transmit the
clients to wash emphasized on the
disease.
hands before client to prevent germ
 There is no replication so that the
and after
transmissio spread of infection can
treatment, use
n of disease be prevented.
clean
to other
handkerchiefs /
eyes, or
towels. Tell the
other
client to use eye
people.
drops / ointment
properly
without
touching the tip
 of the bottle on
the client's eye /
eyelashes.
4. Clean the tool
used to check
the client

4. Prevents cross
infection in other
clients.
6 Lack of After nursing 1. Assess the 1. As a basis for
knowledge care is patient's level of determining
b/d lack of expected to knowledge intervention.
information be fulfilled about the 2. Patients get clarity
about the inclient disease. about the disease.
prognostic formation is 2. Explain to the
condition and fulfilled with patient about
treatment of kriteria of conjunctivitis
the disease results : (understanding, 3. The patient gets
process causes, and clarity about care at
 The client
complications). home after returning
declares
3. Explain to the from the hospital.
understand
patient about 4. So that the patient's
ing of the
treatment of the eyes are not dirty
condition,
disease.
prognosis
4. Encourage eye
and
care at home
testing.
with eye 5. Functioning as a
 Can
cleaning every vitamin for the eyes
identify
 the day.
relationshi 5. Encourage the
p of signs / patient to 6. So that patients easily
symptoms consume fruit remember when the
with the and nutritious right time control.
disease meals.
process. 6. Provide a
written record
of time to re-
control after
illness.

BIBLIOGRAPHY

Smeltzer, Suzzane C. 2001. Medical Surgical Nursing Textbook. Jakarta: EGC

Tamsuri, Anas. 2010. Textbook for Eyes and Vision Disorders Client. Jakarta: EGC

Ilyas, Sidarta et al. 2002. Eye Disease Association of Indonesian Ophthalmologist

Association. Jakarta: CV. Sagung Seto

Capernito-Moyet, Lynda Juall. 2006. Nursing Diagnosis Pocket Book. Jakarta: EGC.

Marrilyn, Doenges. 1999. Nursing Care Plans. Jakarta: EGC.

Mansjoer, Arif. 2000. Capita Selekta Medical Volume 2 Ed. III. Jakarta: Aeuscualpius
media.
Academic counselors Clinical Advisor

(Esme Anggeriyane, Ns., M.Kep) (Marlina S.Kep., Ns)