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Nursing Process – Inflammation And Infection Of The Eye

ASSESMENT

Assessment of symptoms for any eye problem includes asking the client for subjective data using the WHAT’S UP acronym:

Where is it? What part of the eye is affected? Eyelid, conjunctiva, cornea?

How does it feel? Pressure? Itchy? Painful? No pain? Irritated? Spasm?

Aggravating and alleviating factors. Worse when rubbing eyes, blinking? Photosensitivity?

Timing. Was there exposure to a pathogen? Previous infection or irritation? Length of time symptoms have persisted?

Severity. Is there visual impairment? Does pain affect ADL?

Useful data for associated symptoms. Immunosuppression drugs ? Do other members of the family or peer group have symptoms? Are decongestant eyedrops used? Is there exudate? Are the eyelids stick together on awakening? Does client wear contact lenses, soft contact lenses overnight, disposable contact lenses? Does client have dry eyes? Infection with tuberculosis, syphilis, HIV? What is typical eye hygiene?

Perception by the client of the problem. What does client think is wrong?

Objective assessment data collected by the nurse include the condition of conjunctiva, the condition of eyelids and eyelashes, the presence of exudate, whether tearing is occurring, any visible abscess on palpebral border, a palpable abscess in eyelid, opacity of the cornea, and visual acuity testing comparing unaffected and affected eyes.

NURSING DIAGNOSIS

The major nursing diagnoses for inflammation and infection of the eye include but are not limited to the following:

  • Pain related to inflammation or infection of the eye or surrounding tissues.
  • Sensory-perceptual alteration (visual) related to blepharospasm, photophobia, diminished visual acuity (corneal opacity, eye patching), visual distortions (exudate, ophthalmic ointment).
  • Risk for injury related to visual impairment.
  • Risk for infection related to poor eye hygiene .
  • Knowledge deficit related to disease process, prevention and treatment.

PLANNING

The client and family are included in the planning phase. Planning focuses on helping clients return to their preillness state and preventing any further eye disorders. Client goals include the following:

  • States pain is decreased or acceptable on a scale of 1 (low) to 10 (severe).
  • Vision returns to preillness state.
  • Does not become injured as a result of impairment measures.
  • Does not develop infection.
  • Explains disease process, prevention and treatment measures.
  • Demonstrates treatment regimen correctly, such as administration of eyedrops.

NURSING INTERVENTIONS

Nursing care focuses on relieving the client’s pain, promoting safety, maintaining eye function, educating the client about the disorder, application of medication if ordered, eye hygiene, and preventive eye care.

The client should be assessed for pain using objective and subjective cues. Use of dark glasses, rubbing the eye, squinting, and avoiding light are nonverbal indicators of pain that should also be assessed. Eye pain is generally treated with topical anesthetic drops or ointments, antibiotics, and anti-inflammatory agents. Warm or cool packs may also assist in soothing the eye. Patching of the effected eye also helps reduce pain by decreasing the movement of the eye across the eyelid. For severe pain, analgesics may also be prescribed. The nurse and client should also explore methods of pain reduction such as guide imagery, relaxation techniques, music or distraction.

Visual impairment of any type raises safety concerns for the client. The nurse must promote safety by assessing any visual impairment that may be present. Inflamed eyes often do not focus well and may have exudate, tearing, or ointment present, which interfere with vision. Clients with one eye patched should be advised that depth perception is altered and they should not drive. They must be taught to be cautious and careful when ambulating and reaching for things.

Interventions to maintain eye function must be implemented. If the client is to rest the eye, reading and television should be discouraged because they require use of the eyes. Quiet activity, which can be carried out with the eyes closed, is best. Listening to music, radio, or an audio-recorded book may provide distraction and rest for the eye. Contact lenses should be avoided when the eye or surrounding structure is inflamed. When the eye has healed and infection is gone, contact wear can usually be resume. Contact lenses must be sterilized before use to prevent re-infection of the eye. Soft contact lenses that cannot be sterilized need to be discarded.

The nurse is responsible for educating the client in prevention, care of the affected eye, medication administration, safety issues, and outcomes. Clients should demonstrate the administration of ointments or drops after teaching has occurred. The client and family are taught how to prevent spreading the infection if it is contagious. The nurse also teaches the client how to maintain good eye hygiene or prevent further complications.

EVALUATION

The goals for the client are met if the following occur:

  • Pain is reduced to a lower acceptable rating.
  • Vision improves or returns to preillness level.
  • Injury does not occur as a result of visual impairment.
  • Infection does not occur as a result of poor eye hygiene or contact lens wear.
  • Explains disease process, prevention, or treatment regimen accurately.
  • Prescribed treatment is stated or demonstrated correctly (e.g., administering eyedrops or ointments)