Konjunctivitis
A Defenition
A Defenition
An inflammation of the conjunctiva caused by bacteria, viruses, fungi, clamida, allergies or irritation by chemicals.
B Pathophysiology.Conjunctiva in touch with the outside possibility of conjunctival infection with micro-organisms are very large. Conjunctiva defense mainly because of the tear film on the surface of the conjunctiva which serves dissolve impurities and toxic substances then circulate through the lacrimal duct into the inferior meatus nasi. Tear films containing beta lysine, lysozyne, Ig A, Ig G which serves to inhibit the growth of germs. If there is a pathogenic germs can penetrate the defenses causing conjunctival infection called conjunctivitis.
C DIVISION / CLASSIFICATION BY Clinic.1. Catarrhal conjunctivitis.
Catarrhal conjunctivitis Akut.ÄMukopurulenta also called conjunctivitis, acute conjunctivitis simplex, "pink eyes".Cause:Koch Weeks, stafilokok aureus, streptokok viridan, pneukok, and others.
Clinical signs:On lid edema, conjunctival rough red lid, like velvet because there is edema and infiltration. Conjunctiva bulbi many conjunctival injection, chemosis can be found pseudomembranous on pneumococcal infection.
Catarrhal conjunctivitis Sub Akut.Ä
Cause:As a follow-up of acute conjunctivitis or by haemophilus influenza virus.
Clinical signs:Lid edema. Palpebral conjunctival hyperemia was so infiltrative. Conjunctiva bulbi positive conjunctival injection, there was no secret blepharospasm and liquid.
Cataracts Chronic conjunctivitis.As a follow-up of acute catarrhal conjunctivitis caused by bacteria or koch weeks, stafilokok aureus, morax Axenfeld, E. Colli or caused too naso lacrimal duct obstruction.
Clinical signs:Lid was swollen, bleparitis lid border with all its consequences. Palpebral conjunctiva slightly red, slippery, sometimes hypertropis like velvet. Conjunctiva bulbi mild conjunctival injection.
2. Purulent conjunctivitis.Can be Caused:Gonorrhoe and Nongonorrhoe due pneumokok, streptokok, meningokok, stafilokok, etc..
Clinical signs:Acute conjunctivitis, accompanied by purulent secretions.Definition:Hyperacute conjunctivitis with purulent secretions caused by Neisseria Gonorrhoika.
Pathophysiology:Conjunctiva to the hyperacute inflammatory process caused by Neisseria Gonorrhoika, ie not in the form kokkus bacteria, gram ngatif which are often the cause urethritis, and vaginitis in men or in women bartolinitis. This infection can occur due to the direct contact between Neisseria Gonorrhoika the conjunctiva.
Top 3 distinguished Stadium, Namely:
Stadium infiltrates.Lasts for 1-3 days. Where lid swelling, hyperemia, tense, bleparospasme. Palpebral conjunctival hyperemia, swelling, there may be pseudomembranous infiltrates thereon. In the conjunctiva bulbi are great conjunctival injection, kemotik, secretions sereus sometimes beradarah.
Suppurative or purulent stage.Lasts for 2-3 weeks. Symptoms are not so great anymore. Lid was swollen, hyperemia, but not so tense. Bleparospasme still there. Secretions mixed blood, come out continuously when the lid is opened the typical going out with a sudden discharge (gushing squirt) should therefore be careful when you open the lid, do not let the inspectors eyes.
Convalescent stage
(Healing) Hypertropi Papil.Lasts 2-3 weeks. Symptoms is not so mighty anymore. Little lid swelling, conjunctival hyperemia lid, no infiltrates. Bulbi conjunctival injection, conjunctival injection was real, not kemotik, secretions much reduced.Symptoms / Clinical Presentation:Gonoblenore disease may occur suddenly. The incubation period can occur a few hours to 3 days.The main complaint: red eyes, swollen with secretions such as pus is sometimes mixed with blood.Laboratory examination:Conjunctival scrapings or sap purulent eye painted with gram stain and examined under a microscope. Polymorphonuclear cells obtained in large quantities once. Gram-negative cocci in pairs such as coffee beans are scattered outside and inside the cell.
Diagnosis:The diagnosis is based on clinical examination and laboratory tests.Treatment:
Gonoblenore Without Complications In Cornea.Topical:Tetracycline eye ointment or bacitracin HCl 1% given at least 4 times a day in neonates and given at least every 2 hours in adult patients, followed up to 5 times a day until the resolution. Before giving the eye ointment, eye must be cleaned first.Systemic:In adults given penicillin G 4.8 million IU in a single dose intra-muscular coupled with Probenecid 1 g by mouth, or Ampisillin 3.5 grams in a single dose by mouth. In neonates and children given penicillin injection at a dose of 50.0000 - 100.0000 IU / kg bw.
Gonoblenore With Complications In Cornea.Topical:Can be started with bacitracin eye ointment every hour or Sulbenisillin eye drops, besides penicillin was given also the conjunctiva.Systemic:Systemic treatment is given as in gonoblenore without corneal ulcers.3. Flikten conjunctivitis.Is limited inflammation of the conjunctiva with the formation of one or more than one minor bumps, reddish-called flikten.Cause: allergy too Tuberkulo protein, in tuberculosis.o Bacterial infections: Koch weeks, pneumococcal, stafilokok, streptokok.o Virus: herpes simplex.o Toxins from molluscum contagiosum found on the border of the lid.o the candida albicans fungus.o Worms: ascaris, tripanosomiasis.o Focal Infection: teeth, nose, ears, throat and urogenital tract.
Conjunctivitis 2 kinds:
Flikten conjunctivitis.No clear sign of inflammation, confined to a place flikten, there are hardly any discharge.
Kum Flikten conjunctivitis.Clear sign of inflammation, discharge mukos, mucopurulent, usually due to secondary infection in conjunctivitis flikten.Complaint:Lacrimation, photophobia, bleparospasme. Therefore basically allergic, then quickly recovered but quickly relapsed back, as long as the cause is still present in the body.
4. Conjunctivitis Membrane / Membrane Pseudo.Period characterized by a white or yellowish, even palpebral conjunctiva covering the conjunctiva bulbi.Obtained at:• Diphtheria primary or secondary of the nasopharynx.• beta-hemolytic streptococci are exogenous or endogenous.• Steven Johnson Syndrome.
Clinical symptoms:Lid swelling. Palpebral conjunctiva: hyperemia with a membrane on top. Conjunctiva bulbi: conjunctival injection (+), there may be a membrane. Sometimes there is corneal ulcers. Pseudomembrane conjunctivitis are common to all who are hyperacute conjunctivitis or purulent conjunctivitis such as gonorrhea, due gonokok, epidemic keratoconjunctivitis, inclusion conjunctivitis.
5. Vernal conjunctivitis.Named psring catarh as are found in the spring in an area that has four seasons.Complaint eyes very itchy, especially in the open field was scorching hot. Often indicates an allergy to pollen and grasses.
6. Nontrakoma Folikularis conjunctivitis.Subdivided into:
Folikularis acute conjunctivitis, caused by viruses belong to this group are:o Inclusion conjunctivitis.o epidemika keratoconjunctivitis.o Fever faringokonjungtiva.o herpetika keratoconjunctivitis.o Conjunctivitis new castle.o Konjungtivits acute hemorrhagic.
Conjunctiva
folikularis chronicle.
Conjunctiva folikularis toksika / allergic.
Folikulosis.
7. Conjunctivitis Trachoma Folikularis.Causes of viruses in the PLT (Psittacosis Lympogranuloma Tracoma)
D EXAMINATION LABORATORY.Direct examination of scrapings or sap eyes after such material is made preparations painted with gram or Giemsa staining can be found polymorphonuclear inflammatory cells. On allergic conjunctivitis caused by Giemsa staining will get eosinophil cells.
E DIAGNOSIS.Diagnosis based on clinical examination and laboratory tests. At pemeriksasan to the clinic in conjunctival hyperemia, and eye secretions or sap conjunctival edema.F TREATMENT.Specific treatment depends on identifying the cause. Conjunctivitis caused by bacteria can be treated with sulfonamides (sulfacetamide 15%) or antibiotics (Gentamycine 0.3%; chlorampenicol 0.5%). Conjunctivitis is rare fungal conjunctivitis due to virus treatment while primarily intended to prevent secondary infections, allergic conjunctivitis due to be treated with antihistamines (antazidine 0.5%, 0.05% rapazoline) or corticosteroids (eg dexametazone 0.1%).
Nursing careTO CLIENTS WITH conjunctivitis
A. Bios.Date of interview, date of MRS, No.. RMK. Name, age, sex, race / ethnicity, religion, education, occupation, perkawinana status, address, person in charge.
B. HEALTH HISTORY.1. Health History Now.
Main complaints:Pain, ngeres (like there is sand in the eyes), itching, burning and redness around the eyes, and eye secretions epipora, many out especially on conjunctiva, purulent / Gonoblenorroe.
Nature of the complaint:Continuous complaints; thing that can aggravate complaints, pain spreading to the inflamed area where, when complaints arise during the night, sleep complaints arise naturally.
Accompanying the Complaint:Is blurred vision, especially in the case Gonoblenorroe.
2. Past Medical History.The client had suffered from the same disease, eye trauma, allergy medications, history of eye surgery.
3. Family Health History.In the family there are people with infectious diseases (conjunctivitis).
C. PHYSICAL EXAMINATION.Data Focus:Objective: VOD VOS and less than 6/6.Red eye, conjunctival edema, epipora, secretions lot out, especially in purulent conjunctivitis (Gonoblenorroe).Subjective: Pain, ngeres taste (like there is sand in the eyes), itching, burning.
D. Nursing Diagnosis.1. Changes comfort (pain) associated with inflammation of the conjunctiva, characterized by:
Clients say discomfort (pain) is felt.
Look on his face / face client looks in pain (pain expression).Expected outcomes:Pain is reduced or controlled.Intervention:
Assess the level of pain experienced by the client.
Teach clients for pain distraction methods, such as breathing deeply and regularly.
Give a warm compress on the eye pain.
Create a comfortable sleep environment, safe and quiet.
Collaboration with the medical team in the delivery of analgesics.Rationalization:o With the explanation of the clients are expected to understand.o Useful in subsequent interventions.o It is a way of fulfilling a sense of comfort to clients by reducing stressors in the form of noise.o Eliminate the pain, because the pain blocking nerve conduction.Evaluation:
Demonstrate knowledge of assessment of pain control.
Experience and demonstrate periods of uninterrupted sleep.
Show feelings of relaxation.
2. Anxiety related to lack of knowledge about the disease process, characterized by:
Clients say about anxiety.
Clients look anxious and restless.Outcomes:Clients say the understanding of disease processes and quiet.Intervention:
Assess the level of anxiety / anxiety.
Give an explanation of the disease process.
Give moral support to clients in the form of prayer.Rationalization:o Helpful in determining intervention.o Improve understanding of the client's disease processo Provide a sense of calm to clients.
Evaluation:
Demonstrate assessment of adaptive management to reduce anxiety.
Pemahamaan demonstrate disease processes.
3. Risk of spread of infection associated with inflammatory processes.Outcomes:Spread of infection does not occur.Intervention:
Clean the eyelid from the inside to the outside (k / p do irrigation).
Give appropriate antibiotic dose and age.
Maintain septic and aseptic measures.Rationalization:o By cleaning the eye and eye irrigation, the eyes become clean.o Antibiotics are expected to spread the infection does not occur.o It is expected that transmission does not occur either from patient to nurse or nurse to patient.Evaluation:
There are no early signs of the disease spreading.
4. Self-concept disturbances (decreased body image) associated with the change of the eyelids (swelling / edema).Intervention:
Assess the client's level of acceptance.
Encourage clients to discuss the situation.
Note any deviant behavior.
Describe the changes that occur.
Give the client the opportunity to determine the action taken decisions.Evaluation:
Demonstrate adaptive changes in response to the self-concept.
Express awareness of the changes and developments in the direction of acceptance.
5. High risk of injury associated with limited vision.Outcomes:Injury does not occur.Intervention:
Limit activities such as moving the head suddenly, eye scratching, bending.
Orient the patient to the environment, bring the necessary equipment to his patients.
Set the environment around the patient, keep the things that can cause an accident.
Supervise / accompany the patient while doing the activity.Rationalization:o Reduce the risk of falls (injury).o Prevent injury, increase independence.o Minimize the risk of injury, providing a secure feeling for the patient.o Controlling the activities of patients and reduce safety hazards.
Evaluation:
Expressed understanding of the factors involved in the possibility of injury.
Shows changes in behavior, lifestyle to reduce risk factors and protect yourself from injury.
Changing environment as indicated to improve security.
SOURCE
1. Wijana, Nana. , 1990. Science of eye disease. Prints V. Jakarta.
2. Guidelines for Diagnosis and Therapy, Lab / UPF Sciences Ophthalmology. RSU Sutomo. , 1994. Surabaya.
3. Carpenito, Lynda Juall. 2000. Handbook of Nursing Diagnosis. Edition 8. Publisher: EGC, Jakarta.
