Orbital Cellulitis

Presented by:
Doula, Farha P.
Vargas, Teresa Carmela S.
Introduction
• Orbital cellulitis is a major infections of the ocular adnexal
and orbital tissues. Orbital cellulitis is an infection of the
soft tissues of the orbit posterior to the orbital septum.

• Orbital cellulitis usually begins deep to the orbital septum.

Both are more common among children; preseptal cellulitis
is far more common than orbital cellulitis.

• Orbital cellulitis is most often caused by extension of

infection from adjacent sinuses, especially the ethmoid
sinus (75 to 90%); it is less commonly caused by direct
infection accompanying local trauma (eg, insect or animal
bite, penetrating eyelid injuries) or contiguous spread of
infection from the face or teeth or by hematogenous
spread.
• Pathogens vary by etiology and patient age.
• Streptococcus pneumoniae is the most frequent pathogen
associated with sinus infection, whereas Staphylococcus
aureus and S. pyogenes predominate when infection arises
from local trauma. Haemophilus influenzae type b, once a
common cause, is now less common because of widespread
vaccination. Fungi are uncommon pathogens, causing
orbital cellulitis in diabetic or immunosuppressed patients.
Infection in children < 9 yr is typically with a single aerobic
organism; with increasing age, particularly age > 15 yr,
infection is more typically polymicrobial with mixed
aerobic and anaerobic (Bacteroides, Peptostreptococcus)
infections.
Demographic Data
• Name: L.L
• Age: 1 Month old
• Gender: Male
• Birthday: Dec. 11, 2014
• Birthplace: Tarlac
• Nationality: Filipino
• Religion: Roman Catholic
• Mothers Name: A.L
• Occupation: Housewife
• Age: 26
• Father Name: L.L
• Occupation: OFW
• Age: 36
• Chief Complaint: “Namamaga yung mata ng anak ko for 11
days”.

• Past Health History: At 3 weeks client had coughs and colds

with yellowish nasal discharge and fever of 38oC.

• Birth History: Patient was born full term to 25 year old G3P3,
delivered via NSD at home assisted by a midwife. Patient
weighed 6 pounds. At birth, patient had cry with activity.
Mother had regular check-up since 2 months AOG. Birth
weight was 6 lbs.

• Pregnancy, Labor and delivery: Mother had regular prenatal

check-up since 2 months of pregnancy.
Perinatal History:
• Dietary (Feeding History): Patient was mixed fed since birth
4oz of bottle every 3 hours. Patient is being fed with Bona.
Patient has Tiki-tiki and Ceelin for multivitamins.

• Immunization History: 1 dose of BCG and 1 dose of Hepatitis

B given at health center.
Family Health
History:
Genogram
LEGENDS:
MALE

FEMALE

PATIENT
Gordon’s Functional
Health Pattern
Health Perception – Health
Management Pattern
• Before hospitalization “nung hindi pa siya na hospital, three
weeks palang siya may ubo at sipon na siya, tapos after three
days, meron pa din ubo at sipo pero nakita naming na
namamaga yung mata niya kaya pinacheck up naming siya sa
clinic sa Tarlac, tapos sabi ng doctor baka daw may pigsa sa
loob ng mata or baka may tumor.” as verbalized by the
mother.
• During hospitalization, “medyo nawawala na yung maga niya
sa mata” as verbalized by the mother.
• Analysis: Risk for infection related to environmental
pathogens.
Nutritional – Metabolic
Pattern
• Before hospitalization, “apat na bote ng gatas ang naiinom
niya sa isang araw at minsan dumedede pa siya sa akin, hindi
naman siya mahirap painumin ng gatas” as verbalized by the
mother.
• During hospitalization, “ganun pa rin naman siya kumain, wala
naman problema sa pagiinum niya ng gatas mixed parin” as
verbalized by the mother. HT: 57 cm WT: 4.9 kg BMI: 15.08
kg/m2. Skin is warm to touch, smooth with good skin turgor
and no jaundice noted. Abdomen is globular in shape,
umbilicus is protruding, normal and active bowel sounds, no
masses and tenderness noted.
• Analysis: Impaired tissue integrity related to inflammation.
Elimination Pattern
• Before hospitalization “naka diaper lang siya sa bahay,
nakakaihi naman siya kulay dilaw at nakakadumi din siya every
morning, kulay golden brown at nakakatatlong diaper siya sa
isang araw.” As verbalized by the mother.

• During hospitalization “ngayon apat na araw na siyang hindi

nakakadumi” as verbalized by the mother. Fluid intake: 4 oz. of
Milk Urine output: 130 g, o bowel elimination.

• Analysis: Constipation related to eating pattern.

Sleep – Rest Pattern
• Before hospitalization “natutulog siya ng mga bandang 10 ng
gabi tapos magigising siya ng 8 am kanina ko siya pag
matutulog, hindi naman siyang patulungin, depende rin kami”
as verbalized by the mother.

• During hospitalization “maaga na siyang natutulog mga 6 pm

tapos ng gigising nalang pag may pumapasok na doctor at
kung nakadumi or kung gutom siya.” As verbalized by the
mother.
• Analysis: Disturbed sleep pattern related to inturuptions.
Activity – Exercise Pattern
• Before hospitalization “hindi naman siya nakakalaro kasi one
month pa lang siya, hindi siya mahirap paliguan, araw-araw ko
siyang pinapaligo.” As verbalized by the mother.

• During hospitalization “ganun din hindi siya nakakalaro” as

verbalized by the mother. Heart rate is 131 bpm with regular
rhythm no murmurs noted. Thorax is smooth rounded and
symmetrical, respiratory rate is 44 bpm, no adventitious
sounds, equal chest expansion. No cyanosis on the extremities
and no edema noted.

• Analysis: Readiness for enhanced organized infant behavior.

Cognitive – Perceptual
Pattern
Patient is a 1 month old infant.
Self- Perception – Self –
Concept Pattern
• Patient is a 1 month old infant.
Role – Relationship Pattern
• Before hospitalization “tawag namin sa kanya Andre. Meron
kaming alagang hayop, 2 aso, 1 pusa 5 kambing at 2 baboy.
Meron siyang kapatid na dalawa isang babae at isang lalaki” as
verbalized by the mother.

• During hospitalization – “ang kasama naming ngayon ditto ay

yung mother-in-law ko. Pinupuntahan din siya ng mga tito niya
ditto sa hospital.”

• Analysis: Readiness for enhanced family processes.

Sexuality- Reproductive
Pattern
• Patient is a 1 month old infant.
Coping – Stress Tolerance
Pattern
• Patient is a 1 month old infant.
Value – Belief Pattern
• Before hospitalization “Catholic kami kaya sinasama naming
siya sa church” as verbalized by the mother

• During hospitalization “Ngayon nagdadasal din kami para

gumaling na siya” as verbalized by the mother.

• Analysis: Readiness for enhanced religiosity.

Physical
Assessment
 SYSTEM FINDINGS ANALYSIS

Head Head is unsymmetrical, Risk for infection related to

right side is inflamed, no presence of pathogens.
masses and no lesions
palpated. Hair is evenly
distributed no masses
palpated.
Neck Trachea in the midline, no Normal findings.
visible lymph nodes, upon
palpation no masses
palpated.

Skin Skin is warm to touch, Normal findings.

smooth with good skin
turgor and no jaundice
noted.
 SYSTEM FINDINGS ANALYSIS

Eyes Right eyelid is inflamed Orbital Cellulitis

with no discharge.

Ears No discharge and lesions on Normal findings.

the ears.

Nose and Sinuses Nose in the midline of the Normal findings.

face, no discharge and
tenderness.
 SYSTEM FINDINGS ANALYSIS

Thorax and Lungs Thorax is smooth rounded Normal findings.

and symmetrical, respiratory
rate is 44 bpm, no
adventitious sounds, equal
chest expansion.

Breast Brest is symmetrical with Normal findings.

no discharge and masses
noted.

Heart Heart rate is 131 bpm with Normal findings.

regular rhythm no murmurs
noted.
 SYSTEM FINDINGS ANALYSIS

Abdomen Abdomen is globular in Normal findings.

shape, umbilicus is
protruding, normal and
active bowel sounds, no
masses and tenderness
noted.

Extremities No cyanosis on the Normal findings.

extremities and no edema
noted.
Laboratory Data
 TEST REFERENCE RESULTS DESCRIPTION ANALYSIS

Hemoglobin Mass C 140-160 110 Low

Can lead to anemia
Hematocrit 40-54 32 Low
RBC 4.5-5.0 3.4 Low Indicates trauma
MCHC 32-37 34 Normal
MCH 27.5-33.2 32.0 Normal
MCV 80-94 93 Normal
RDW 11-15 15.9
WBC 5-10 21.7 High Indicates infection

Differential Count

Neutrophils 40-75 62 Normal

Lymphocytes 20-45 36 Normal
Monocytes 2-6 2 Normal
Platelet 150-440 856
MEV 7.5-11.5 8.3 Normal
RBC Morphology Normochromic Normal celli
Normocytic
 CT SCAN RESULTS
• Clinical information: Swelling / enlargement of the right eye
• Findings:
• Examination shows a hypodense multiseptated/multicystic mass
with mild peripheral enhancement centered in the inferior extraconal
portion of the right orbit measuring approximately 41.4 x 27.4 x 32.1
mm in its widest cranio-caudal, transverse and antero-posterior
dimensions. Laterally is extends to the extra orbital portion of right
orbital wall. Inferiorly it transverses the floor of the orbit, right
infraorbital rim, anterior wall of the right maxillary sinus including
the alveolar process of the right maxilla extending to the oral cavity. It
also extends to the right ethmoif sinuses. The lateral portion of the
mass displaces the right lateral rectus medially with no demonstrable
plane of cleavage. The medial aspect of the mass displaces the right
media; rectus muscle laterally with no evidence of tumoral
infiltration. This lesion also causes proptosis of the right globe.
• The globes, optic nerve and superior orbital vein and the rest of the
extraocular muscles and osseous structure appear intact bilaterally.
• The rest of the visualized paranasal sinuses and brain parenchyma
show no evidence of disease.
Anatomy and
Physiology
THE EYE
• The eye is surrounded by the orbital bones and is
cushioned by pads of fat within the orbital socket. Extra
ocular muscles help move the eye in different directions.
Nerve signals that contain visual information are
transmitted through the optic nerve to the brain. It’s
structure are classified into two: External and Internal
• EXTERNAL STRUCTURES OF THE EYE. The external
structures are the orbital cavity, extrinsic ocular muscles,
eyelids, conjunctiva, and lacrimal apparatus.
• Orbital Cavity
• The orbital cavity is cone-shaped, containing the posterior
4/5 of the eyeball. Its walls are formed by the cranial and
facial bones. The bones forming the orbital cavity are thin
and fragile. The bone at the rim of the orbit is thicker to
protect the eye from injury.
• Extrinsic Ocular Muscles
• Six extrinsic muscles connect the eyeball to the orbital
cavity and provide rotary movement and support.
• Recti Muscles – rotate the eyeball in the directions
indicated by their names.
• Oblique muscles – Superior Oblique rotate the eyeball
medially so that we are able to look downward and
laterally. Inferior oblique muscles turn the eyeball upward
and laterally and rotate the eye laterally.
• Eyelids -They are movable curtains located anterior to the
eyeball. They protect the eyes from dust, intense light, and
impact. The connective tissue which gives shape to the eye is
known as tarsus. It contains sebaceous glands known as
meibomain glands which secrete an oily fluid to prevent the lids
from sticking together.
• Conjunctiva –jConjunctiva is a thin, transparent layer of tissues
covering the front eye, including the sclera and the inside of the
eyelids. It keeps the bacteria and foreign material from getting
behind the eye. Contains Visible blood vessels that are visible
against the white background of the sclera
• Cornea - Is a transparent, clear layer at the front and center of
the eye. The cornea is so clear that one may even realize it is
there. It is just located just in front of the iris. It’s main purpose is
to help focus light as it enters the eye.
• Sclera - A tough, leather-like tissue, also extends around the eye.
Just like an eggshell surrounds an egg and gives an egg its shape,
the sclera surrounds the eye and gives the eye its shape. The
extraocular muscles that are attached to the sclera, these muscles
pull on the sclera causing the eye to look left or right, up or down,
and diagonally.
• Iris and Pupil
• The iris is the colored part of the eye, controls the amount
of light that enters the eye.It is a ring shaped tissue with a
central opening which is called the pupil. The iris has a ring
of muscle fibers around the pupil, which when they
contract, causes the pupil to constrict. This occurs in bright
light. A second set of muscle fiber radiate outward from the
pupil. When these muscles contract, the pupil dilates. This
occurs under reduced illumination or darkness.
• Lens
• Lens is a clear, flexible structure that is located just behind
the iris and the pupil. A ring of muscular tissue, called the
ciliary body, surrounds the lens and is connected to the
lens bu fine fibers. Together the lens and the ciliary body
help control fine focusing of light as it passes through the
eye. The lens together with the cornea, functions to focus
light onto the retina.
• Lacrimal Apparatus This consists of four structures,
namely:
• Lacrimal gland – located in the depression of the frontal bone
at the upper and the outer angle of the orbit. This gland
secretes a lacrimal fluid which flows over, washes and
lubricates the surface of the eye, and protects it from infection
and irritation.
• Lacrimal ducts – openings known as punctae, positioned at
the inner canthus of the eye. When we cry, tears flow out from
this duct.
• Lacrimal sac – located at the inner angle of the eyelids in a
groove at the junction of the lacrimal bone with the frontal
process of the maxilla. It is an enlargement of the nasolacrimal
duct.
• Nasolacrimal duct – passes through a bony canal formed by
bones of the face and opens into the lower portion of the nasal
cavity.
Pathophysiology
Drug Analysis
 Drug Classification Indication Contraindicatio Mechanism of Side Nursing
n Action effects/Adve Responsibilities
rse Effects
Ampicillin Anti -infective Treatment of Hypersensitivity Binds to bacterial  Rashes  Assess patient
Sulbactum skin structure, to penicillins or cell, wall, resulting  Urticiari for infection
250mg skin infection, sulbactum. in cell death; a (vital signs,
Q6 soft tissue spectrum is broader  Seizures wound
infection, than that of appearance,
sinusitis. penicillin. sputum, urine,
Additional of stool and
sulbactam increase WBCs).
resistance to beta-  Observe
lactamase, enzymes patient for
produced by signs and
bacteria that may symptoms of
inactivate anaphylaxis
ampicillin. (rash, pruritus,
laryngeal
edema,
wheezing).
Discontinue
the drug and
notify the
physician.
 Advise patient
to report signs
of
superinfection
 Drug Classificati Indication Contraindic Mechanism of Side Nursing
on ation Action effects/Ad Responsibilitie
verse s
Effects
Ibuprofe Antipyretics Treatment of Hypersensitivi Inhibits  Ambly  Assess
n nonsteroidal inflammatory ty (cross prostaglandin opia patient for
Q6 anti- disorders. sensitivity synthesis.  Blurred skin test.
inflammator may exit with vision  Assess for
y. other  Tinnitu signs and
NSAIDS, s symptoms of
including GI bleeding.
aspirin).  Advise
parents or
caregivers
not to
administer
Ibuprofen to
children who
may be
dehydrated
(can occur
with
vomiting,
diarrhea, or
 Drug Classific Indication Contraindi Mechanism of Side Nursing
ation cation Action effects/Ad Responsibilitie
verse s
Effects
Tobramycin Anti - Treatment of Hypersensitiv Inhibitis protein  Ototoxi  Assess for
1 gtts infectives serious gram ity to synthesis in city infection
TID negative aminoglycosi bacteria at level (vesibul  Monitor
bacillary des; products of 30S ribosome. ar and intake and
infection and containing cochear output and
infection benzyl ) daily weight.
caused by alcohol  Assess for
staphylococci should be superinfectio
when avoided in n
penicillins or neonates.  Keep patient
other less well
toxic drugs are hydrated.
contraindicate
d,
 Drug Classific Indication Contraindi Mechanism Side Nursing
ation cation of Action effects/Adver Responsibilitie
se Effects s

Muconase Nasal Liquefies & Mucolytic  Transient  To make that

2 pray s Decongesta loosens crusted sneezing the patient’s
QID nt, Anti- or accumulated  This product head is slightly
allergy mucus. Helps may contain elevated to
restore moisture inactive prevent
to dry or ingredients, aspiration.
congested nasal which can  Make sure that
passages. Relief cause the medicine is
of nasal allergic
congestion due reactions or
to dry, irritated, other
crusty or problems.
inflamed nasal
passages, low
humidity, heat,
environmental
factors & air
travel.
 Drug Classific Indication Contraindi Mechanism of Side Nursing
ation cation Action effects/Ad Responsibilitie
verse s
Effects
Lipolin Eye Substitute for Remove Protects and  Blurred  To make sure
1 cm strip lubricant tear fluid for contact lens serves as vision that the
TID use in cases of prior to moisturizer for or medicine is
inadequate administratio the eye stinging applied as
tear n. May cause , instructed to
production & transient irritatio avoid
for blurring of n& developing
symptomatic vision in itching. corneal ulcer.
treatment of large doses.
dry eye May affect
conditions for driving or
all tear film operating
phases. machinery.
Pregnancy
and lactation.
Nursing Care Plan
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
O> Right eye inflamed Impaired tissue After 8 hours of  Assess patient  To note for any After 8 hours of
without discharge. integrity related to nursing intervention general condition. abnormalities nursing intervention
infection. patient will obtain and deformities patient obtained
optimal well-being. present. optimal well being.
 Assess skin and  For comparative
tissue baseline.
impairments.

 Monitor sites of  Systemic

skin impairments inspection can
for color changes, identify
redness, swelling, impending
or other signs of problems.
infection.

 Do not position  To protect the

the client in site patient from
of impairment. advance effect of
mechanical force
such as pressure,
friction and
shears.

 Assess the  Inadequate

patient’s nutrition intake
nutritional status. places individual
at risk for skin
breakdown and
its compromise
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
O> Right side of the Risk for infection After 8 hours of  Assess patient  To note for any After 8 hours of
eye is inflamed at the related to nursing intervention general abnormalities nursing intervention
11th day of environmental the patient will be free condition. and deformities patient was free from
hospitalization. pathogens. from any signs of present. any signs of infection.
infection.  Note the risk  For occurrence
factors. of infection.

 Monitor client’s  To reduce cross

visitor and contamination.
caregivers for
respiratory
illness, offer
masks and
tissues to visitors
who are
coughing or
sneezing.

 Provide health  To reduce

teaching about transmission of
hand washing to microorganisms.
significant
others.

 Administer  To determine
medications. effectiveness of
the therapy or
presence of side
effects.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
O > right eye is Risk for After 8 hours  Assessed the  To note for After 8 hours of
patient’s any nursing intervention,
inflamed infection of nursing abnormalitie the client’s mother
related to intervention, physical status
s and was able to verbalize
prolonged the client’s deformities on how the risk of
present. infection of the client
hospitalization mother will was lessened.
be able to  To prevent
verbalize on  Maintained infection
from
how the risk hygiene over
spreading
of infection of the infected
the client will part  To prevent
infection
be lessen.
 Monitor sites of from
spreading
other infections
 To control
the infectious
process

 Assisted in giving  To check of

medications recurrence of
systemic
infection
 Monitored the vital
signs