Lyceum of The Philipines University Batangas

Capitol Site, Batangas City

CORNEAL LACERATION

PREPARED BY:
JOHN KELVIN R. MALABANAN
BSN III-5
 I. INTRODUCTION

Corneal laceration is common ocular injuries in

with epithelial cells are lost. Laceration can be caused by
scratches from objects of a foreign body, or over worn contact
lenses. The patient presents with sudden onset of pain, which
is often intense, photophobia, foreign body such as a
mascara brush, twig or fingernail. They also may be a result
sensation, and tearing. Visual acuity may be normal or
decreased depending on the site of the lesion.
 Mortality from corneal lacerations is rare. However,
morbidity from corneal lacerations is significant. Corneal lacerations or
subsequent secondary infection (endophthalmitis) can result in complete or
partial loss of vision, loss of the eye, or systemic infection.

In this case study, we eagerly enough to know and

understand better the corneal laceration. It is better for us to be educated
because it is common among the children as well as the prevention and
management whenever corneal laceration occur.
 II. OBJECTIVES
General Objectives

This study aims that the nursing student will be able

to enhance and gain knowledge as well as the skills and
attitude through effective utilization of nursing process
and appropriate nursing action including the effect to
every individual, its manifestation and prevention and
necessary treatment of patient with corneal laceration.
 Specific Objective

At the end of the study, the nurse will be able to:

1. State the patient profile, past health history, family history,

personal and social health history, psychologic history as
well as history of present illness.
2. Assess the body parts of the patient to identify the
condition and abnormalities of each part.
3. Analyze and interpret the laboratory exam of the patient
to know the condition related to disease.
4. Understand the anatomical parts and functions of the
affected part of the disease.
5. Explain and identify the cause, the disease process and
its manifestation.

6. Utilize the nursing process in rendering care based on the

patient’s needs and concerns

7. Enumerate and discuss the drugs that have been

administered to manage the patient’s condition.

8. Lastly, state a prognosis to the patient.

NAME:III.
Child PATIENT
X
AGE: 8 yrs. old
PROFILE
SEX: Male
DATE OF BIRTH: May 1, 2001
CIVIL STATUS: Single
ADDRESS:Bagong Pook San Vicente Lipa City
NATIONALITY: Filipino
RELIGION: Roman Catholic
DATE OF ADMISSION: Dec 4, 2008
ATTENDING PHYSICIAN: Dr. Allegre
CHIEF COMPLAIN: Corneal Laceration OD
ADMITTING DIAGNOSIS: Corneal Laceration OD
 IV. CLINICAL APPRAISAL

A. PAST HEALTH HISTORY

According to Mrs. Z child X mother,
that child z is completed to her childhood
immunization. She has no allergies to any
drugs. Child X doesn’t have any injury or
accident in the past. And it is the first time
that child X was confined in the hospital.

B. FAMILY HISTORY
Mrs. Z is 28 yrs. old and child X father
is 29 yrs. old. Chills X grandmother is 56 yrs,
old and her grand father is 58 yrs. old parents
of Mrs. Z.
PERSONAL HISTORY
Child X is a playful child. He is sleeping more
than 8 hours. According to Mrs.Z child X is like to play
most of the time. And she has no any diet. She likes to
eat sweet foods. Childs X eat what he wants.

SOCIAL HISTORY
Child X is living in a safe and peaceful place.
There are no any problems to their area. Child X is able to
mingle or socialize with their neighbour especially to her
playmates.

PSYCHOLOGICAL HISTORY
The major stressor of child X is when Mrs. Z
preparing her to getting to sleep. There is no specific
psychological problem does Child X have.
HISTORY OF PRESENT ILLNESS
Dec 2, 2008 when the accident happened.
Child X and her brother was playing that time and
accidentally that the spine of the flower comes into
his eyes. at that time Mrs. Z is working.. Mrs. Z
observed that the right eye of child X has injury. She
tests if the right eye has a vision by covering the left
eye but the right eye doesn’t react. After that they go
to EENT but it’s already closed. Dec 4, 2008 when
child Z is admitted in the BRH. According to Mrs. Z
child X felt pain that time and she was crying. Child
Z was diagnosed having corneal laceration.
 V. PHYSICAL ASSESSMENT
AREA METHOD FINDING ANALYSIS
ASSESED

Skin >Inspection -Smooth, soft and -Normal. It is the

flexible. normal texture of
the skin of the
children.
-Moisture varies -Normal.
with activity, body
and environmental
temperature
humidity and skin
folds and the
axillae.
 AREA METHOD FINDING ANALYSIS
ASSESED
>Palpation -Temperature of the skin -Normal
is warmth.

Hair >Inspection -Absence of redness or -Normal

>Palpation scallyness in the scalp.

-Thin and very short with -Normal

normal hair distribution.

-Absence of lice. -Normal

Nails >Inspection -Pink color of fingernails. -Normal.

 AREA METHOD FINDING ANALYSIS
ASSESED
Head >Inspection -Absence of abrasion. -Normal
-Absence of seborrhea. -Normal
-Symmetrical. -Normal
Eyes >Inspection
:eye brow -Symmetrically aligned. -Normal
-With normal hair -Normal
distribution.
-Equal movement. -Normal
:Eye lashes >Inspection -Normal distribution. -Normal
:Conjunctiva >Inspection -Pink and moist palpebral -Normal
conjunctiva.
:Cornea >Inspection -Presence of scratch in -Abnormal.
the epithelium. Scratch is
due to the
 AREA METHOD FINDING ANALYSIS
ASSESED

effect of
accidentally
poking the
eye with nail
cutter.
:Pupillary >Inspection -No vision (right eye). -Abnormal.
reaction >Inspection -Not constricting and Blindness
not dilating (right eye). caused by
corneal
Ear >Inspection -Symmetrically laceration.
>Palpation aligned. -Normal.
-Firm, smooth, free -Normal.
from lesion and pain.
 AREA METHOD FINDING ANALYSIS
ASSESED
Nose >Inspection -Symmetrical. -Normal.
-Midline of the face -Normal.
without swelling, lesion
and masses.
Mouth -Normal. It is
:Lips >Inspection -Pink, firm moist normal
without lesion and hydration of
inflammation. lips of
:Teeth >Inspection children.
-Properly aligned and -Normal.
shiny, presence of 6
: Tongue >Inspection teeth.
:Gums >Inspection -Tongue at the midline. -Normal
-Gums are pink, moist, -Normal.
smooth and firm.
 AREA METHOD FINDING ANALYSIS
ASSESED
:Tonsil >Inspection -Tonsils are -Normal.
present.
Neck >Inspection -No enlargement of -Normal
>Palpation thyroid gland. -Normal.
-Lymph node is not Palpable
palpable. nodes may
result from
variety of
disease.
Chest and >Inspection -Respiration rate of -Normal. 15-25
Lungs 21 breaths per bpm is the
minute. normal RR of 3
-Thorax rises and yrs. old.
fall. -Normal
 AREA METHOD FINDING ANALYSIS
ASSESED
Heart >Auscultati -87 breaths per -Normal. 75-100
on minute. breaths per
minute is the
cardiac rate of 3
yrs. old.
Abdomen >Inspection -Rounded and
bilaterally -Normal.
symmetrical.
>Palpation -Tenderness and -Normal.
warmth skin
Upper and >Inspection temperature.
lower >Palpation -No edema. -Normal.
extremities -Strong muscle -Normal.
strength.

.
 AREA METHOD FINDING ANALYSIS
ASSESED

Genitalia >Inspection -Absence of swelling. -Normal.

-Absence of discharges -Normal

SUMMARY OF PHYSICAL ASSESSMENT

Child Z the subject of the study is diagnosed with corneal

laceration. Physical appearance of the patient was assessed
through inspection, palpation, percussion and auscultation. This
will serve as a baseline guide to recognized the sign and
symptoms of the disease.
as I assessed child Z’s for General survey I noted no vision
(blind) on her right eye because of her corneal laceration that
affect her vision.
 VI.DIAGNOSTIC AND LAB
TEST
EXAMINATION
RESULT
RESULT NORMAL
VALUE
ANALYSIS

WBC 13.50 0.38-0.47 Abnormal.

Elevated WBC
count indicates
stress such as
long lasting
emotional
RBC 4.5 4.2-5.4 upset.
Normal.
 TEST RESULT NORMAL ANALYSIS
EXAMINATION VALUE
HEMOGLOBIN 116.5 120-140 Abnormal.
Decrease
hemoglobin
level indicates
anemia but
usually the
client is not
considered
anemia until
the level is less
HEMATOCRIT 0.39 0.38-0.47 than 10.5/dl.

Normal.
 TEST RESULT NORMAL ANALYSIS
EXAMINATION VALUE
MCH 25.86 27-31 Abnormal.
Decrease in
the MCH
indicates
microcytic
MCV 81 80-96 anemia.
Normal.
RDW 12 11.5-14.5
PLATELET 427 150-400 Normal.
Abnormal.
Elevated
platelet
indicates
trauma such as
injury.
 VII. ANATOMY AND
most anterior portion PHYSIOLOGY
CORNEA- A transparent, avascular, domelike structure, forms the
of the eyeball and is the main refracting
surface of the eye. It is composed of five layers: epithelium,
bowman’s membrane, stoma, descemet’s membrane and
endothelium. Cornea is the anterior sixth of the eye that permits
light to enter the eye. As part of the focusing system the fibrous
tunic, it also bends, or refracts, the entering light. The blood
supply to the cornea is derived from the limbal vessels, the
nutritional elements passing through the avascular cornea from
the limbus, although some oxygen is derived from the fifth cranial
nerve. The superficial corneal layers contain about 70 sensory
nerve fibers,which accounts for the severe pain that result from
seemingly minor irritative phenomena.
EPITHELIAL CELL- has 5-6 layers, Are capable of rapid
replication and completely replaced every 7 days.

BOWMANS MEMBRANE- The second layer moving in toward the

eye, serves as the smooth adhesion layer for the basement
membrane of the epithelial cells. A clear accellular layer which is a
modified portion of thev superficial stroma.This layer is not
crucial for clarity or visual function since removal of
the Bowman layer during photorefractive keratectomy
does not negatively affect vision.
ENDOTHILEUM CELL- The innermost layer of the cornea is the
endothelial cell layer, a monolayer of polarized cells. They are
Arranged with their apical portion toward the aqueous humor in
the.anterior chamber. The endothelial cells are responsible for
maintaining the desiccation of the stroma by actively removing
water.

DESCEMET’S MEMBRANE- Is the specialized basement

membrane of the endothelial cells positioned between the stroma
and the endothelial cell layer. Any condition that causes
inflammation of the cornea or the anterior chamber
can cause Descemet membrane folds.
CORNEAL STROMAL- Consist of lamellas and accounts for
about 90% of the corneal thickness. Each lamellar fiber is is
transparent , 1um thick and 15 um wide, and as long as the
diameter of the cornea.The stromal lamellas are parallel to the
corneal surface but do interwine Each contain a flattened cell
nucleus.Anterior chamber- Filled with a continually replenished
supply of clearAqueous humor, which nourishes the cornea.

AQUEOUS HUMOR- Is produced by the ciliary body, and its

production is relat to the intraocular pressure 9IOD). Normal IOP
is 10-20mmHg.
CORNEAL LACERATION CORNEA
VIII. PATHOPHYSIOLOGY
 Modifiable Non Modifiable

Hazrdous Environment Age

Caused of metallic object Impacting with sufficient force

Direct trauma to the cornea

Sign and Symptoms

Ocular trauma, pain, photophobic, anterior chamber
is shallow, bubbles with thin anterior chamber reduce with
visual acuity.

Corneal Laceration
 SUMMARY OF PATHOPHYSIOLOGY

A corneal laceration results from direct trauma to

the cornea, typically from metallic object impacting with sufficient
force, there may be either a full thickness laceration or a partial
thickness laceration. A full thickness is termed a penetrating
injury. In full thickness laceration there will be a flat chamber.
Seidel’s sign will be present; as fluorescein is added, you will
see the aqeous oozing out from the wound amidst the
fluorescein there may alsobe bubbles in the anterior chamber.
Damage to the iris may result in an irregular shaped, unreactive
iris. Additional pressure on the globe may result in extrusion of
uveal tissue through the wound.
ASSESSMENT NURSING SCIENTIFIC PLANNING
IX. NURSING
DIAGNOSIS CARE PLAN
EXPLANATION
O> The patient Risk for infection Unlike most tissues After the 2
undergone related to post in the body, the hours of
corneal repair. operative incision. cornea contains no nursing
blood vessels to intervention the
nourish or protect it client’s risk for
against inspection. infection will be
.(General Ophthalmology, 8th lessened.
edition, D. Vaughan, T.
asburg.)
INTERVENTION RATIONALE EVALUATION
> Wash hands with >Reduces risk of cross contamination The client’s risk
antibacterial soap because gloves may have for infection
before/ after each unnoticeable defects, get torn or lessened.
care activity. damaged during use. Some
pathogens may survive on hands for
31 hr. after exposure. Note:
methicillin- resistant staphylococcus
aureus (MRSA) is most commonly
transmitted via direct contact with
health care workers who fail to wash
hands between patient contacts.
(Nursing Care Plan 6th edition, Marilyn E. Doenges et.
al; pg.634)
 INTERVENTION RATIONALE EVALUATION
> Inspect wounds/ site >May provide clue to portal of entry,
of invasive devices type of primary infecting organism as
daily, paying particular well as early identification of
attention to parenteral secondary infection. Note: high
nutrition lines. nutrition (TPN) provides excellent
Document sign of medium for bacterial growth. (Nursing Care
local inflammation/ Plan 6th edition, Marilyn E. Doenges et. al; pg.634)
infection changes in
character of wound
drainage. >Pressure like pain over area of
cellulitis may indicate development of
> Investigate reports necrotizing fascutis due to group
of pain out of Abeta-hemplytic streptococci (GABS),
proposition to visible necessiating prompt intervention.
signs. (Nursing Care Plan 6th edition, Marilyn E. Doenges et.
al; pg.634)
 INTERVENTION RATIONALE EVALUATION

>Maintain sterile technique >Prevents introduction of

when changing dressings. bacteria reducing risk of
nasocomial infection. (Nursing
Care Plan 6th edition, Marilyn E. Doenges
et. al; pg.634)

> Wear gloves/ gowns when

changing caring for open > Prevents spread of
wounds/ anticipating direct infection/ cross –
contact with secretions or contamination.
(Nursing Care Plan 6th edition, Marilyn E.
excretions Doenges et. al; pg.634)
 INTERVENTION RATIONALE EVALUATION

>Dispose of soiled dressing/ > Reduces contamination/

material in double bag. soiled of area; limit spread of
airborn organism.

>Assest with prepare for > Facilitates removal of

incision and drainage of patient material / necrotic
wound, irrigation, application tissue healing and promotes
of warm/ moist in soaks, as healing. (Nursing Care Plan 6th edition,
indicated Marilyn E. Doenges et. al; pg.634)
ASSESSMENT NURSING SCIENTIFIC PLANNING
DIAGNOSIS EXPLANATION
S> “Madalas ang Acute pain Unpleasant sensory After the 2 hours
mata niya kapag related to and emotional of nursing
pinapatakan ng tissue trauma experience arising intervention the
gamot” as secondary to from actual or client’s pain will
verbalized by the post operative potential tissue be lessened to a
mother. procedure. damage or described tolerable level.
O>restless in terms of such
>irritable damage. .(General
>kept eyes closed. Ophthalmology, 8th edition, D.
Vaughan, T. asburg.pg86)
>guarding behaviour
>scale 8/10
 INTERVENTION RATIONALE EVALUATION
>Vital sign taken and >Provide information The client’s pain
recorded. about the effectiveness decreased to a tolerable
of care.(Delmanr’s Pediatric level.
Nursing Care Plans, 3rd edition,
Luxner)

> To identify behaviour

that may indicate pain
>Asked other who know when client is unable to
client well. verbalize.(Nurse’s Pocket
Guide, 11th edition, Marilynn E.
Doenges, pg 500)
 INTERVENTION RATIONALE EVALUATION
.>Provide comfort >To promote
measure, quite nonpharmacological pain
environment and calm management.(Nurse’s Pocket Guide,
activities. 11th edition, Marilynn E. Doenges, pg 501)

>Obtained client’s >To rule out worsening of

assessment of pain to underlying condition/
include location, development of complication.
characteristics, (Nurse’s Pocket Guide, 11th edition, Marilynn
E. Doenges, pg 500)
onset/duration,
frequency, quality
intensity and
precipitating/aggravating
factors. Reassaa each
time pain occurs/ is
 INTERVENTION
reperted. Note and
investigate changes from
previous report.
>Observed non verbal cuts/
pain behaviours and other
objective. Defining
characteristics, as noted
especially in person who
cannot communicate verbally.
>Note when pain occurs.
RATIONALE EVALUATION
>Observation may/ may not
be congruent with verbal
reports or may be only
indicator present when client
is unable to verbalize.(Nurse’s
Pocket Guide, 11th edition, Marilynn E.
Doenges, pg 500)
>To medicate
prophylactically, as
appropriate.(Nurse’s Pocket Guide,
11th edition, Marilynn E. Doenges, pg
501)
 INTERVENTION RATIONALE EVALUATION
>Advised the mother to >To distract attention and
provide diversional reduce tension.(Nurse’s Pocket Guide,
activities by giving toys. 11th edition, Marilynn E. Doenges, pg 501)

>Administered >To maintain “acceptable” level

analgesics, as indicated, of pain. Notify physician if
to maximum dosage as regimen is inadequate to pain
needed. control goal.(Nurse’s Pocket Guide, 11th
edition, Marilynn E. Doenges, pg 502)

>Evaluate/document
client’s response to >Increasing/ decreasing dosage,
analgesic and assist in stepped program helps in self
transitioning/altering management of pain.(Nurse’s Pocket
drug regimen based on Guide, 11th edition, Marilynn E. Doenges, pg
individual needs. 502)
ASSESSMENT NURSING SCIENTIFIC PLANNING
DIAGNOSIS EXPLANATION
S>Madalas ay Anxiety related An emotional state After the shift the
umiiyak ang aking to unfamiliar characterized by client will be able
anak marahil dahil environment. feeling of to adapt in the
hindi sya apprehension, hospital.
komportable ditto discomfort,
sa hospital”as restlessness, or
verbalized by the worry.
mother. (Medical–surgical
nursing,vol.1,11th
O>crying edition,Smeltzer, pg.112)
>upset
>irritable
>difficulty in
sleeping
 INTERVENTION RATIONALE EVALUATION
>Advised the mother >To distract attention The client was able to
to provide and reduce tension. adapt to the hospital
divertional activities (Nurse’s Pocket Guide, 11th as evidenced by
edition, Marilynn E. Doenges, pg
by giving toys. 501) verbalization of:
“Hindi na umiiyak ang
>Determined the aking anak,
client’s sleep and >To determined those maaliwalas na ang
activity pattern. that might be helpful in kanyang mukha at
Monitor vital signs current circumstances. komportable na sa
(Nurse’s Pocket Guide, 11th
Review coping skills edition, Marilynn E. Doenges, pg hospital.
used in past. 91)
 INTERVENTION RATIONALE EVALUATION

>Review symptoms to > Knowledge of expectations

be reported to physician can avoid undue concern for
e.g., increase in insignificant reasons or delay
frequency/ duration of in treatment of important
attacks, change in symptoms .(Nurse’s Pocket Guide, 11th
response medication. edition, Marilynn E. Doenges, pg 502)
 NAME OF X. DRUG STUDY
CLASSIFICATION
INDICATION ADVERSE
DRUG AND MECHANISM REACTION
OF ACTION
GENERIC Opthalmic anti- >Relief from ocular >CNS:
NAME: inflammatory. itching caused by Headache.EENT
seasonal allergic : Transient
Ketorolac Thought to inhibit conjunctivitis stinging and
tromethamine the action of burning on neal
cyclooxygenase, an >Post-operative edema, corneal
DOSAGE: enzyme inflammation in infiltrates, iritis,
8mg patients who ocular
 NAME OF CLASSIFICATION INDICATION ADVERSE
DRUG AND MECHANISM REACTION
OF ACTION
ROUTE responsibility for have had , superficial ocular
:IV prostaglandin cataract infections. edema
synthesis. extraction. and ocular
FREQUENCY: Prostaglandins inflammation, ocular
Q1 medicate the >Reduce ocular irritation, ocular
inflammatory pain, burning pain, superficial
response and also and stinging keratitis, superficial
cause miosis. after corneal ocular infections.
refractive
surgery.
 CONTRAINDICATION NURSING MONITORING
RESPONSIBILITY PARAMETERS
>Contraindicated in patients >Store drug away >May increase ALT and
hypersensitive to from heat in a dark, AST levels. >May
components of drug and in tightly closed increase bleeding time.
those wearing soft contact container and protect
lenses. from freezing.
NAME OF DRUG CLASSIFICATION INDICATION ADVERSE
AND REACTION
MECHANISM OF
ACTION
GENERIC NAME: Nonopioid > Mild pain. HEMATOLOGIC:
Paracetamol analgesic Hemolytic anemia,
and antipyretics. leukopenia,
DOSAGE: neutropenia,
220mg Thought to pancytopenia.
produce analgesia HEPATIC: jaundice
ROUTE: by blocking pain METABOLIC:
Oral impulses by Hypoglycemia
inhibiting SKIN: Rash uticaria.
FREQUENCY: synthesis of
Q4 prostaglandin
NAME OF CLASSIFICATION AND INDICATION ADVERSE
DRUG MECHANISM OF ACTION REACTION

in the CNS or of other

substance
that sensitize pain receptors
to stimulation . The drug may
relieve fever through central
action in the hypothalamic
heat regulating center.
 CONTRAINDICATION
>contraindicated in patient
hypersensitive to drug.
NURSING MONITORING
RESPONSIBILITY PARAMETERS
>ALERT: Many OTC >May decrease glucose
and prescription and haemoglobin levels
products contain and hematocrit.
acetaminophen: be
aware of this when >May decrease
calculating total daily neutrophil WBC< RBC
dose. and platelets counts.
>Use liquid form for >May cause false
children and patients positive test result for
who have difficulty urinary
5+hydrocyindoleatic acid.
CONTRAINDICATION NURSING MONITORING
RESPONSIBILITY PARAMETERS
swallowing. glucose level in
>In children don’t home monitoring
exceed five doses in system
24 hrs.
>May falsely
decrease glucose
level in home
monitoring system
 NAME OF CLASSIFICATION INDICATION ADVERSE
DRUG AND REACTION
MECHANISM OF
ACTION
GENERIC Tetracycline > used to treat DENTAL: Discolorin
NAME: infections of the and inadequate
Oxytetracycline respiratory and calcification of primary
urinary tracts, teeth of fetus if used
DOSAGE: skin, ear, eye by pregnant women,
1 drop Tetracycline are and discolouring and
bacteriostatic but Gonorrhoea inadequate
ROUTE: maybe calcification of
Eye bactericidal permanent teeth if
against certain used
FREQUENCY: organisms. They
Q2 find reversibly
NAME OF CLASSIFICATION INDICATION ADVERSE
DRUG AND MECHANISM REACTION
OF ACTION
30s and 50s during dental
ribosomal subunits, development.
which inhibits DERMATOLOGI
bacterial protein Photoxic reaction,
synthesis. rash, exfoliative
dermatitis.
GI: Fatty liver failure,
anorexia, nausea,
vomiting, diarrhea,
glossitis, dysphagia,
enterocolitis,
 NAME OF CLASSIFICATION INDICATION ADVERSE
DRUG AND MECHANISM REACTION
OF ACTION
GENERIC Ophthalmic anti- >External CNS: Headache.
NAME: infectives. ocular infection EENT: Conjunctival
Gatifloxacin caused by irritation, increased
suspectible lacremation, keratitis,
DOSAGE: organisms. papillary conjunctivitis,
1 drop Inhibits DNA gyrase chemosis, conjunctival
and topoisomerase, Hemorrhage,
ROUTE: preventing cell discharge, dry eyes,
Eye replication and eye irritation, eyelid
division. edema, pain, red
Frequency: eyes, reduced visual
Q2 acuity.
GI: Taste disturbance
 NURSING RESPONSIBILITY MONITORING
CONTRAINDICATION PARAMETERS
>Contraindicated in >Don’t inject >May increase
patient by solution sub ALT,
hypersensitive to drug conjunctivally or AST and LDH
or other quinolones. into the anterior levels.
chamber of the
Eye.

>Systemic drug may cause serious

hypersensitivity reaction. If allergic
reaction occur, stop and treat
symptoms.

>Monitor patient for super infection.

 NAME OF CLASSIFICATION INDICATION ADVERSE
DRUG AND MECHANISM REACTION
OF ACTION
GENERIC Ophthalmic anti- >External ocular EENT: blured vision
NAME: inflammatory. injection by with ointment burning
Trobromycin susceptible or stinging on
DOSAGE: bacteria. instillation,
7 drops Thought to inhibit conjunctival
protein synthesis, erythema, increased
ROUTE: usually lacremation, lid
Eyes bactericidal. itching or swelling.

FREQUENCY:
Q4
 CONTRAINDICATION NURSING MONITORING
RESPONSIBILITY PARAMETERS
>Contraindicated in patients >When two different None reported.
hypersensitive to drug or ophthalmic solution
other amino glycosides. are used, allow at
least minutes between
instillations.

>Alert: Tobromycin
ophthalmic solution
isn’t for injection.
CONTRAINDICATION NURSING MONITORING
RESPONSIBILITY PARAMETERS
>If topical ocular
tobramycin in is given
with systemic
tobramycin, carefully
monitor level.

>Prolonged used may

result in overgrowth of
non susceptible
organisms including
fungi.
 XI. PROGNOSIS
Prognosis is good. Patient become stabilize. The
lab result return to normal values. She gain normal
strength. She was discharge last December 13,
2008.
XII. DISCHARGE PLANNING
M- Advised to continue regular intake of medication
prescribed by the physician
E - Such as multi vit.-500ml OD instructed the patient
the modification of home environment to facilitate the
challenge of living with an illness.
T - Reminded the mother of patient to give the
medication the right time.
H - Advised the mother of patient to assist in
maintaining personal hygiene and emphasize the
importance of good hygiene such as bathing, mouth
care and many hygienic practices.
 O Instructed the mother of patient to have a
-
follow up check up after a months.

D Instructed the relatives to provide nutritious

-
food.
S- Emphasized to the family members the
importance of having a positive attitude and continuing
support to keep the recovery of the patient by giving
positive reinforcement to the progress made by the
patient provided spiritually guidance through giving the
patient opportunities to experience prayer.
 ACKNOWLEDGEMENT
First of all I want to thank almighty God who is always
there to support and guide in our daily living.
To my family who always at my side and support me
in all my problems.
To Batangas Regional Hospital who trust us and
permitted me to handled my patient.
To Dra.Iturralde our clinical instructor who guide us in
rendering care to our patient and being approachable
when we need them.
 Also to my group mates who always there to
make our duty enjoyable, when I need an accompany
and answer all my calls.
THANK YOU. . .
Medical –surgical nursing, vol.1, 11th edition, Smeltzer.
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General Ophthalmology, 8th edition, D. Vaughan,
T.asburg.
Laboratory and Diagnostic tests with nursing
implecations 7th edition, Joyce
Lefever kee.
Essentials of Anatomy and Physiology, 6th edition,
Seeley Stephens.
Nursing Care Plan 6th edition, Marilyn E. Doenges et. al;
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Venable RN, MS, FNP.
Nursing 2008 Drug handbook, 28th edition, Wolters
kluwer et, al;