Alamia, Hasan II

Arado, Dersly Lane Q.

Francisco, Lyka Nicole
Orbital Trauma: Case Study
A 13-year-old male presented to his primary care physician with headache and nausea one day after sustaining right frontal and orbital blunt trauma during a
skateboarding accident. The patient fell and impacted his face on concrete. The patient reported initially experiencing blurry vision that resolved; otherwise, a
review of systems was negative except for the presenting complaints. Physical exam revealed facial swelling and ecchymosis in the right frontal and orbital region.
Neurologic and ophthalmologic examinations were within normal limits. Vision and ocular movements were normal and intact.

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

Subjective: Acute pain related to After 8 hours of nursing care, the After 8 hours of nursing
“Masakit po yung injury to the orbital patient will: care, the patient reported:
parte ng mukha ko soft tissue
malapit sa may ● verbalize relief of pain ● Evaluate pain using 1-10 scale ● Relieves pain and ● Decreased pain felt
mata,” as verbalized and maintain immobilization of prevents bone with with a scale of
by the patient affected part by means of bed displacement and 3/10
rest extension of tissue injury
Objective: (Brunner & Suddarth’s
● Facial swelling MedSurg, 12th ed.)
and ecchymosis
in the right ● Apply ice and elevate head of ● Cold compress reduces ● Diminished swelling
frontal and bed to decrease swelling swelling and elevation around the orbital
orbital region promotes venous return area
● Pain scale of and decreases edema
7/10 (nurseslabs.com,
● Extraocular Fracture NCP)
movements
(EOMs): painful ● Teach the patient to avoid ● Nose blowing generate ● Verbalized
and limited blowing nose significant intranasal willingness to adhere
upward and pressure that may with the health
lateral gaze contribute to pain felt teaching

● demonstrate ability to
participate in activities with
minimal complaints of
discomfort
● Administer medications as
indicated: narcotic and
nonnarcotic analgesics,
anti-inflammatory drugs
● Explain every procedure to the
patient before proceeding
● Medicate before performing
any activities
● Identify activities appropriate
for patient age, physical
abilities, and personal
preferences
around the orbital area
(QJM: An International
Journal of Medicine,
Volume 110, Issue 1)
● These medications are
used to reduce pain and
control swelling from
injury (nurseslabs.com,
Fracture NCP)
● This allows patient to
prepare mentally for
activity and to participate
in controlling the level of
discomfort
(nurseslabs.com,
Fracture NCP)
● Comfort and relief from
pain enhances
cooperation during
activities
(nurseslabs.com,
Fracture NCP)
● Activities that are
appropriate for a patient's
age, physical abilities,
and personal preferences
have greater therapeutic
effect (Brunner &
Suddarth’s MedSurg,
12th ed.)
● Explicit verbalization
of pain relief and
comfort
● Patient cooperated
with the care
procedure with
minimal complaints
of discomfort
● Patient is
cooperative during
activities and with
only minimal
complaints of
discomfort
● Patient manifested
enhanced coping
abilities in the
management of
acute pain as
evidenced by
focused attention
and sense of control
during the activities
 Drug Classification Mechanism of Indication Contraindication Adverse Effect Nursing Responsibilities
Action

Generic Name: NSAID Ibuprofen may Ibuprofen contains Ibuprofen is CNS: Headache, Tell the patient to take with
Ibuprofen inhibit the active ingredient contraindicated in dizziness, nervousness, meals or milk to reduce
prostaglandin ibuprofen, which patients hypersensitive aseptic meningitis. adverse GI reactions.
Brand Name: synthesis, to belongs to a group of to drug and in those with
Advil produce medicines called angioedema, syndrome CV: Peripheral edema, Note: Drug is available at OTC.
anti-inflammatory , non-steroidal of nasal polyps, or fluid retention, edema. Instruct patients not to exceed
Dosage: analgesic, and antiinflammatory bronchospastic reaction 1.2 g daily, not to give to
400 mg (>12 years, antipyretic effects. drugs (NSAIDs). It to aspirin or other EENT: Tinnitus children younger than age 12,
95 lbs and over) works by blocking the NSAIDs. and not to take for extended
action of a substance GI: Epigastric distress, periods ( longer than 3 days for
Route: Oral in the body called Contraindicated in nausea, occult blood fever or longer than 10 days for
cyclooxygenase. pregnant women. loss, peptic ulceration, pain) without consulting a
Frequency: Cyclooxygenase is diarrhea, constipation, prescriber.
q 4-6 hours, p.r.n. involved in the Use cautiously in abdominal pain,
production of various patients with GI bloating, GI fullness, Tell patients that the full
chemicals in the body, disorders, history of dyspepsia, flatulence, therapeutic effect for arthritis
some of which are peptic ulcer disease, heartburn, decreased may be delayed for 2 to 4
known as cardiac appetite. weeks. Although pain relief
prostaglandins. decompensation, occurs at low dosage levels,
Prostaglandins are hypertension, asthma, GU: Acute renal failure, inflammation doesn’t improve at
produced in response or intrinsic coagulation azotemia, cystitis, dosages less than 400 mg q.i.d.
to injury or certain defects. hematuria.
diseases and would Teach patients to watch for and
otherwise go on to HEMATOLOGIC: report to prescriber immediately
cause pain, swelling Prolonged bleeding signs and symptoms of GI
and inflammation. time, anemia, bleeding, including blood in
neutropenia, vomit, urine, or stool or coffee
Ibuprofen is therefore pancytopenia, ground vomit, and black, tarry
used to relieve pain thrombocytopenia, stool.
and inflammation. All aplastic anemia,
the medicines in this leucopenia, Warn patients to avoid
group (NSAIDs) agranulocytosis. hazardous activities that require
 reduce inflammation mental alertness until effects on
caused by the body's METABOLIC: CNS are known.
own immune system, Hypoglycemia,
and are effective pain hyperkalemia Advise patients to wear
killers. Ibuprofen can sunscreen to avoid
be used to relieve RESPIRATORY hypersensitivity to sunlight.
pain such as Bronchospasm
muscular aches and
pains, period pains, SKIN
headache, backache, Pruritus, rash, urticaria,
rheumatic pain and stevens, Johnson
neuralgia. It can also syndrome.
reduce feverishness
and the symptoms of
colds and flu.
Source: Hannah, K (2019). Ibuprofen Drug Study. Retrieved March 23, 2021 from https://idoc.pub/documents/ibuprofen-drug-study-mwl1y90d25lj
 Drug Classification Mechanism of Indication Contraindication Adverse Effect Nursing Responsibilities
Action

Generic Name: Corticosteroids Prednisone Prednisone is Prednisone is CV: fluid retention, ● The nurse must not
prednisone tablets, decreases indicated as an contraindicated to the edema, and administer the medication if
usp inflammation via
anti-inflammatory or following: hypertension signs of systemic infection is
suppression of the immunosuppressive ● patients with Electrolytes: ↑Na, ↓K+, present;
Brand Name: migration of
drug for allergic, hypersensitivity ↑Ca, ↑BG ● Teach the patient proper
Prednisone polymorphonuclear dermatologic, to prednisone handwashing techniques
leukocytes andgastrointestinal, or to any CNS: mood swings ● Daily assessment of body
Dosage: reversing increasedhematologic, components of and euphoria in high temperature at 5-6pm could
1 mg, 2.5 mg, 5 mg, capillary ophthalmologic, the formulation. doses be useful to detect the first
10 mg, 20 mg, 50 permeability. nervous system, ● in systemic signs of infection, as pyrexia
mg (Dosage for renal, respiratory, fungal GI: Nausea/Vomiting, is most easily detected at
children is usually It also suppresses rheumatologic, infections GI bleed this time of day
based on weight) the immune system infectious, endocrine, ● Contact doctor on exposure
by reducing the or neoplastic MS: bone resorption to chickenpox or measles
Route: Oral activity and the conditions as well as ● Even when instructed by the
volume of the in organ transplant. Skin: acne, paper thin, physician about the dosing, it
Frequency: immune system. bruises, infections, and is important to keep in mind
Once daily delayed healing that when using more than
10 days, the dose must be
Weight gain slowly tapered
● The drug may increase blood
Adrenal suppression glucose levels, the nurse,
therefore should pay close
Increased risk for attention to the blood
infection and infections glucose level of the patient.
can be masked ● Encourage patient to eat
foods high in calcium; low-fat
Long-term use may dairy products suggested
result in Cushing’s ● Monitor full blood count
syndrome ●
Source: Griffiths, Thomas & Jordan, Sue. (2002). Corticosteroids: implications for nursing practice. Nursing standard (Royal College of Nursing (Great Britain) :
1987). 17. 43-53; quiz 54. 10.7748/ns2002.12.17.12.43.c3312.