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ABSTRACT
The study shows the analysis of the disease condition and health status of
a 6 year old male from Capitol University Medical Center at the medical
ward station 3. This study aims to draw a conclusion and find appropriate
nursing interventions to improve patient condition and thus, facilitates
promotion of optimal wellness. The author of this study focuses on the
management of Facial /Periorbital cellulitis .
The researcher is interested on this health problem for it entails a
thorough study and assessment for it to be fully understood. The
researcher also wants to know the appropriate care that she has to
provide for a patient having this situation. The study and results are just
based on the actual rendering of care to the patient which lasted for three
days including a thorough assessment of the patients past and present
hospitalization and health problem.

ACKNOWLEDGEMENT
I would like to take this opportunity to express my gratitude and deep
regard to my guide and mentor, Mr. Leo Hamed Fabre RN,MAN, our
Clinical Instructor, for his exemplary guidance, monitoring and constant
encouragement throughout the rotation duty and especially this case
study. The help, guidance and education given by him shall carry me a
long way in the journey of my life on which I am about to embark.
I am also very thankful to our God Almighty, to my parents, and friends for
their constant encouragement. Without them, this assignment would not
be possible.

INTRODUCTION

When you are a nurse you know that every day you will touch a life
or a life will touch yours. Anonymous
We, as health care practitioners, called to the responsibility of
promoting health through providing strategic care to patients and to
actively involve of the development of the nursing profession. In addition
to the conventional nursing duties of observing, assessing and recording
symptoms and treatments, they also provide emotional support to patients
and their families. In each patient we care, we tend to provide quality of
care as if we are taking our own family member and at the end of the day
we are bound to touch a persons life or their life will touch ours.
The chosen patient has a case of Facial Periorbital cellulitis

What is a Cellulitis? Is a common, potentially serious bacterial skin

infection. Cellulitis appears as a swollen, red area of skin that feels hot
and tender. It can spread rapidly to other parts of the body. Cellulitis isn't
usually spread from person to person.
Skin on lower legs is most commonly affected, though cellulitis can occur
anywhere on your body or face. Cellulitis might affect only your skin's
surface. Or it might also affect tissues underlying your skin and can
spread to your lymph nodes and bloodstream.
Left untreated, the spreading infection can rapidly turn life-threatening. It's
important to seek immediate medical attention if cellulitis symptoms occur.
Periorbital cellulitis, also known as preseptal cellulitis. Is an inflammation
and infection of the eyelid and portions of skin around the eye, anterior to
the orbital septum. It may be caused by breaks in the skin around the eye,
and subsequent spread to the eyelid; infection of the sinuses around the
nose (sinusitis) or from spread of an infection elsewhere through the
blood.

NURSING PROCESS

The researcher used the nursing process for appropriate nursing

interventions. During Assessment, collecting patient health datas through
physical assessment, patients chart and by asking the patient and
significant other necessary questions, this help the researcher clearly
identify specific patient problem. Nursing diagnoses, analyzing
assessment datas and determine priority nursing diagnosis. Planning,
developing plan of care and prescribe intervention to attain expected
outcomes. Implementation, initiating the intervention identified in the plan
of care and integrates evidence with clinical expertise and patients unique
needs. Evaluation, evaluating attainment of patients outcome.
Scope and Limitations of the Study
The researcher has chosen this particular case to associate and
incorporate the concept of a nurse.
This case study focuses on medical condition of Patient Cabanday
MC French Laurence, a 6 year-old Male, who was admitted last July 02,
2015 at around 2:35 pm at Capitol University Medical Center- Medical
ward. This covers the patients medical history, present condition, disease
process, diagnostic tests, prognosis and evaluation. Data were collected
via physical assessment, observations, and interviews with the patient.
However, this study is limited to the time when the patient was
assigned, seen and assessed by the researcher last July 07,2015 and to
the information the researcher was able to obtain from the patient and
significant others.

SIGNIFICANCE OF THE STUDY

Nursing Education
This study can be a useful learning guide in nursing education as this can
be used by students as a reference for future studies regarding Heart
failure and related cases. This case study will enable the students to learn

how to assess patients with any complications and be able to provide

appropriate nursing care and management.
Furthermore, the students will learn about the nursing interventions and
have an idea of the rationale behind its actions. They can apply this
intervention in the real setting when they encounter the same or similar
condition. In this way, they are acquiring more knowledge about the
complication that they can use to further develop their skills as student
nurses and future nurses. It may open a new door, in the practice of
getting quality care. This study might also inspire other individuals to come
up with their own research about this complication or any similar
conditions.
Nursing Practice
This case study can be used as a tool in nursing practice because it
provides nursing interventions for patients with Heart failure. This study
can give a good introduction to the complication so that an established
nursing action can be quickly utilized. And through discovering and
rediscovering, and trial after trial of innovative interventions and facilitation
of this condition, a more advanced using management may be developed.
Through this study, important information regarding this complication has
been gathered which will be helpful on the researcher to have an in-depth
understanding on the said condition.
Nursing Research
This case can be used as a baseline data for further research of the
current management of patients with Heart failure. There might be some
information in this study that can be of good use for future research. It is
important to do research every now and then to gain new information,
better interventions and techniques to provide to the patients. Aside from
being beneficial as a simple academic informative material, this study
might serve as a guide for orienting people about the substance of the
condition, and how this affects the person. Therefore through this study,
the researcher should have introduced the condition, treatment (for
information), and management.

OBJECTIVES OF THE STUDY

General Objective
After 16 hours hospital exposure at Capitol University Medical
center @ medical ward, the researcher aims to develop the cognitive,
affective and psychomotor skills effectively in dealing with periorbital
cellulitis patient. The researcher also aims to show and demonstrate how

the nursing process was utilized in the care of a Periorbital cellulitis by

presenting a thorough assessment, identifying nursing diagnoses,
prioritizing nursing care plans, implementing nursing interventions and
honestly evaluating their outcomes.
Specific Objectives
This study aims to:
Describe the patients condition properly.
To gain knowledge about the disease process, pre-disposing
factors, clinical manifestation and the disease management.
To gain skills and appropriate attitudes needed to function as a
student-nurse in the caring patient in the hospital.
To be able to use the nursing process as framework for care of the
patient.
To develop and establish therapeutic nurse-patient relationship, as
well as to the significant others effectively.
Render proper nursing interventions to the patient effectively.
Promote wellness through health teachings to the patient and
significant others who are unfamiliar with Facial Cellulitis.

PATIENTS PROFILE
Nursing Health History
BIOGRAPHICAL DATA

Patient is a 6 year old Filipino male, and born on September 6,

2008 and presently residing at Tagoloan, Misamis Oriental. He is a
Member of Aglipay religion. He was admitted in Capitol Univirsity Medical
Center on July 2, 2015 around 2:35 pm.
CHIEF COMPLAINT
Patient was brought to Capitol University Medical Center July 2,
2015 due to Facial swelling.
HISTORY OF PRESENT ILLNESS
4 days prior to admission, patient experience to have low grade
fever and swelling, erythema on the left nares. Self-medicated by his
mother with paracetamol syrup.
3 days prior to admission, symptoms persisted associated with
circumoral swelling. Sought consult with a private doctor, advised
admission however patients mother refused and given with cloxacillin.
On July 2, 2015, Afternoon patients swelling in the face spread to the Left
eye sought admission.

PAST HISTORY
Patient family history has no known Hypertension on his mother side and
no known diabetes in both sides families. No previous admissions
Patients General Appearance
During assessment patient appeared conscious, coherent, and
awake. Pale, weak in appearance.
FUNCTIONAL HEALTH PATTERN
NUTRITIONAL AND METABOLIC PATTERN
The patient eats everything before he was been admitted. He
drinks 5-7 glasses a day. After diagnosed with Facial periorbital he was
been in hypoallergenic diet.
ELIMINATION PATTERN
According to the patient he usually defecated for at least once a
day with yellowish brown in color, soft formed with no discomfort. During
his illness he defecated once a day.
He urinated with an average of 350ml each day, clear urine.

ACTIVITY -EXERCISE PATTERN

For his leisure activity he plays with his friends in their house.
SLEEP-REST PATTERN

Pre-hospitalization: Patient usually sleeps at night around 9:00 pm

to 6:00 am. He has no history of sleep disturbances and his place was so
conducive for sleeping which makes him well-rested at night.
During hospitalization: Patient is having a hard time sleeping.
COGNITIVE-PERCEPTUAL PATTERN
Patient is conscious and oriented.
ROLE-RELATIONSHIP PATTERN
Patient Lives with his family. He knows his family members and can easily
familiarize the people around him.
COPING-STRESS TOLERANCE PATTERN
The patient is sometimes stressed with the pain he feels. To manage this
his mother is there to give medication self-medicated.
VALUES/BELIEF PATTERN
Patient is a member of Aglipay and he put his faithful in GOD that
he will be somehow help through his faith.
PHYSICAL ASSESSMENT
Vital Signs
Day 1 of Assessment (July 5, 2015)
The Patients temperature is 36.3C, Pulse rate is 94 bpm, Respiratory
rate is 23 cpm, and Blood Pressure of110/70mmHg.
Day 2 of Assessment (July 6, 2015)
The Patients temperature is 36.5C, Pulse rate 90 bpm, Respiratory rate
is 25 cpm, and Blood Pressure of 110/80 mmHg.
Day 3 of Assessment (July 7, 2015)
The Patients temperature is 36.3C, Pulse rate 95 bpm, Respiratory rate
is 26 cpm, and Blood Pressure of 110/80 mmHg.
Head
Head is normocephalic, with symmetrical facial movements. Hair is fine in
distribution with no dandruffs nor wounds and scars noted.
Eye
With anicteric sclerae and pale palpebral conjunctiva.
Nose
Septum was in midline with pinkish mucosa. Both patent with no
obstruction masses and lesions noted. With no discharges noted. Gross
smell normal and no tenderness noted.
Ears
External pinnae are symmetrical in alignment, with no tenderness and
lesions noted. No discharges noted and no hearing difficulties.
Mouth
His lip was dry and pallor in color. Mucosa is moist, tongue is in midline
and pale gums.
Neck

Trachea is in midline upon palpation. Thyroids were non-palpable. No

tenderness noted upon palpation of the cervical lymph nodes.
Pharynx
Uvula is in midline. Tonsils and posterior pharynx are not inflamed.
Abdomen
Upon auscultation of the abdomen, hypooactive bowel sounds of less than
5-30 clicks per minute.
Upon palpation, abdomen is soft and non-tender. And +fluid wave
Cardiovascular
The point of maximal impulse was located at 5 th intercostal space at
midclavicular line.
Respiratory
Upon inspection, respiratory rate was 24 cycles per minute, with deep
inspiration and shallow expiration.
Upon Palpation, trachea is in midline.
Extremities
Faint pulses and cold extremities.

ANATOMY AND PHYSIOLOGY

He has wound at the

left side of the nostril

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Facial swelling

PATHOPHYSIOLOGY

PREDISPOSING
FACTORS
-

PRESIPITATING
FACTOR

Male

Cellulitis
Entry of pathogen through
impaired skin integrity:
commonly S. Aureus and S.
Pneumoniae

Viral agent

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Tissues of the skin are

colonized
Infection

Inflammation

Vasodilation
Increased blood flow

Redness

warmth

swelling of lymph nodes

Erythematous inside the Left nares

(+) neck lymph nodes

DIAGNOSTIC TESTS AND LABORATORY RESULTS

Hematology Report
A complete blood count is used to determine the number of
leukocytes, erythrocytes, and platelets; a white blood cell differential count
to indicate the relative percentages of the different leukocytes; coagulation
studies such as prothrombin time (PT), partial thromboplastin time (PTT),
and bleeding time; and morphology to differentiate various anemias and
blood dyscrasias.
Lab result: 07/02/15
TEST

Time: 03:51:38PM
RESULT

UNIT

REFERENCE

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WHITE BLOOD CELLS

19,500

Cell/mm3

5,000-10,000

5.2

10^6/Ul

4.2 5.4

HEMOGLOBIN

14.60

g/dL

12.0 - 16.0

HEMATOCRIT

40.50

37.0 - 47.0

MCV

87.4

fL

82.0 98.0

MCH

27.80

Pg

27.0 31.0

MCHC

31.5

g/dL

31.5 35.0

RDW-CV

12.7

12.0 - 17.0

PDW

10.50

fL

9.0 -16.0

MPV

09.80

fL

8.0 12.0

Lymphocyte (%)

20

17.4 48.2

Neutrophil (%)

52

43.4 76.2

Monocyte (%)

4.5 10.5

Eosinophils (%)

1.0 3.0

0.20

0.0 2.0

1.0 3.0

Cell/mm3

144,000-372,000

RED BLOOD CELLS

DIFFERENTIAL COUNT

Basophils (%)
Bands/Stabs (%)
PLATELET

527,000

INTERPRETATIONS:
1 WBC High white blood cells indicates infection.

Medical Management
Generic Name: cetirizine hydrochloride
Brand Name: -Reactine (CAN)
-Zytec
Classification: Antihistamine
Pregnancy Category B
Dosage: 5-10 mg Adult
6-11yrs 5 or 10mg

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Route: p.o.
Frequency: q8 3times a day
Mechanism of Action: Potent histamine (H1) receptor antagonist; inhibits
histamine release and eosinophil chemotaxis during inflammation, leading
to reduced swelling and decreased inflammatory response
Indication: Management of seasonal and perennial allergic rhinitis
Treatment of chronic, idiopathic urticaria
Treatment of year-round allergic rhinitis and
chronic idiopathic urticaria in infants > 6 mo

Contraindication: Contraindicated with allergy to any antihistamines,

hydroxyzine.
Use cautiously with narrow-angle glaucoma, stenosing peptic
ulcer, symptomatic prostatic hypertrophy, asthmatic attack,
bladder neck obstruction, pyloroduodenal obstruction (avoid use
or use with caution as condition may be exacerbated by drug
effects); lactation.

Adverse effect: CNS: Somnolence, sedation

CV: Palpitation, edema
GI: Nausea, diarrhea, abdominal pain, constipation
Respiratory: Bronchospasm, pharyngitis
Other: Fever, photosensitivity,
rash, myalgia, arthralgia, angioedema

Nursing Responsibilities: Give without regard to meals.

Provide syrup form or chewable tablets for pediatric use if
needed.
Arrange for use of humidifier if thickening of secretions, nasal
dryness become bothersome; encourage adequate intake of
fluids.
Provide skin care for urticaria.
Generic Name: clindamycin
Brand Name: Cleocin, Cleocin Suppository, Dalacin C
Classification: -Lincosamide Antibiotic
Dosage: 200mg
Route: IVTT
Frequency: q8 3times a day

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Mechanism of Action: Inhibits protein synthesis in susceptible bacteria,

causing cell death.
Indication: Systemic administration: Serious infections caused by
susceptible strains of anaerobes, streptococci,
staphylococci, pneumococci; reserve use for penicillin-allergic patients or
when penicillin is inappropriate; less toxic antibiotics (erythromycin) should
be considered
Parenteral: Treatment of septicemia caused by staphylococci,
streptococci; acute hematogenous osteomyelitis; adjunct to surgical
treatment of chronic bone and joint infections due to susceptible
organisms; do not use to treat meningitis; does not cross the bloodbrain
barrier.
Topical dermatologic solution: Treatment of acne vulgaris

Contraindication: Contraindicated with allergy to clindamycin, history of

asthma or other allergies, tartrazine (in 75- and 150-mg capsules); hepatic
or renal dysfunction; lactation.
Use cautiously in newborns and infants due to benzyl alcohol content;
associated with gasping syndrome.

Adverse effect: CNS: Fatigue, headache

Dermatologic: Contact dermatitis, dryness, gramnegative folliculitis
GI: Pseudomembranous colitis, diarrhea, bloody diarrhea;
abdominal pain, sore throat
GU: Urinary frequency

Nursing Responsibilities: Keep solution away from eyes, mouth and

abraded skin or mucous membranes; alcohol base will cause stinging.
Shake well before use.
Keep cool tap water available to bathe eye, mucous membranes, abraded
skin inadvertently contacted by drug solution.

Nursing Management:
Assessment Data
Subjective: Gangulngol akong samad as verbalized by the patient.

Objective Data:
facial grimace (+)
Irritability

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Restlessness
Nursing Diagnosis:
Acute pain related to disruption of the skin
Goals and Objectives:
Goal:
After effective nursing interventions, the clientss pain will decrease
from 5/10 to 2/10.
Objectives:
After 1 hour of nursing interventions, the client will be able to:
1. Perform non-pharmacological management for pain.
2. Demonstrate increased comfortability.

Nursing Interventions and Rationale:

- administer pain medication as ordered by the doctor to relief pain.
- encouraged to support the affected area upon movement to lessen
the pain.
- advised non-pharmacological management like focus imaging and
other activities to divert
attention from pain.
- performed wound cleaning and dressing to diminish the irritability of
the patient.
- provided clean environment to lessen the risk for worsening of the
wound.
- encouraged adequate rest to aid and put on a normal body result.
Evaluation:
After 1 hour of nursing intervention, the pain felt by the client wass
decreased from 5/10 to 2/10.

Assessment Data
Subjective: Iya gakaluton pirme iya samad as verbalized by his mother.
Objective Data:
Nursing Diagnosis:
Risk for infection related to breakage of superficial skin
Goals and Objective:

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After 8 hours of nursing intervention, the patient will gain knowledge in

infection control.
Nursing Interventions and Rationale:
- encouraged patient to avoid touching the woundto prevent
contamination and prevent infections.
- encouraged intake of protein and calorie-rich food, this maintains
optimum nutritional status.
- encouraged to maintain good hygiene, this reduces the risk of having
infection.
- teach the mother to wash hands of her child especially before and
after meals and before and after administering self care, hand washing
reduces the risks for infection.
- discuss the mother the following signs of infections: redness,
swelling, pain, fever and purulent drainage in the site to impart the mother
when the wound become infected and when to sought medical care.
Evaluation:
After 8 hours of intevention, the mother of the patient gained
knowledge in infection control as evidenced by discussing the wound care.

Assessment Data
Subjective: Dili na sya sakit as verbalized by the patient
Objective Data:
Ambulatory
Normal vital signs
Nursing Diagnosis:

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Readiness for enhanced home maintenance management

related to improving health status
Goals and Objectives:
After 2 hours of nursing intervention, the patients mother will
verbalize the understanding of importance of continued heealth
maintenance and supervision

Nursing Interventions and Rationale:

- assessed patients vital signs to monitor changes in patients
health status.
- allowed patient to rest and stay in bed, as children his age are
usually highly active physically especially as his condition improves.
- discussed with mother discharge needs and home care,
continued monitoring necessarry to prevent possible development of
complications.
- emphasized importance of home adults supervision, supervision
is necessary to direct childrens curiosity in the proper direction.

Evaluation:
Goal met.
As evidenced by patients mother verbalized and understood
discharge needs of the patient.

DISCHARGE PLAN/ HEALTH TEACHINGS

Medications
Should be taken regularly as prescribed, on exact dosage, time, &
frequency, making sure that the purpose of medications is fully

disclosed by the health care provider.

Encourage the client to report or inform the physician if any of these
side effects occur. Inform and explain to the client in simple terms

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that other drugs, such as over the counter drugs that he is taking,
will probably have other effects with the medication given.
Moreover, emphasize the right timing or taking or the right time
intervals of these drugs to maximize its effects and avoid further
complications.

Provide information for better understanding regarding therapeutic

regimen.
Rationale: To be able to provide a list of take home medications for
patient X. This would also help his in the on-time and proper
compliance of maintenance medications.
Exercise
The patient is permitted to resume his former activities and
responsibilities completely once recovered from illness. Until then,
bed rest is recommended.

Treatment

After discharge is expected for patients and watcher with Septic

Shock to fully participate in continuous treatment.

Discuss to the patient the complication of the condition.
Rationale: To be able to suggest alternative measures if medical
treatment is not effective. This may also lead to the development of a
new problem or if not, a threat to health.
Health teachings

Regarding the importance of proper hygiene and hand washing,

food and water.

Preparation, intake of adequate vitamins especially vitamin C-rich
foods to strengthen the immune response and increasing of oral
fluid intake should be conveyed.

OPD
Encourage patient and family members to consider regular checkups as ordered by the physician to ensure the continuing
management and treatment.
Diet

Inform family if there is specific diet ordered by the physician.

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Rationale: To be able to present information regarding the types of foods

patient X must include this on his diet. Diet is one of the most vital parts
on patients recovery. This will help in reminding the patient on what food
they shall eat or avoid. For the patients condition, he must be reminded
so as to help alleviate his condition.

RELATED LEARNING EXPERIENCE

Related learning experience subject is one of the most important

subject in the field of Nursing. It is because in this subject, we are able to
gain knowledge and skills in the real hospital setting. Thus, it is in this
subject matter that we will be able to perform all the procedures that we
acquired from school up to the real situation. Furthermore, it serves as our
foundation and training ground towards becoming a proficient nurse.
My exposure at Capitol University Medical Center, Intensive care
unit was the most astonishing and in fact the most unforgettable moment
that I will never forget for my entire nursing profession. I was amazed by
the learning experience. Our clinical instructor Mr. Hamed Leo B. Fabre,
RN, MN who served as a teacher who guided and assisted us on what Im
going to do prior to the care of my patient.

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Having been exposed to the hospital area was not that easy
because we were dealing with the lives of the patients. It is in this rotation
that I felt that I was now moving on towards a more challenging event in
my career. My skills have enhanced due to our day to day duties, I was
introduced to new skills and procedures and how to use and perform
them. I learned how to become responsible and effective nurse when it
comes to giving quality care to patients.
The experience I had was fruitful because I was able to acquire
new knowledge and skills that I need and it was very beneficial in my part
because my capabilities have reach its peak level.

BIBLIOGRAPHY
A Books

Doenges, Marilynn E., Moorhouse, Mary Frances. Murr, Alice C.

(2006). Nurses PocketGuide. Philadelphia, Pennsylvania.

Delgin, Judith H., Vallerand, April H. (2007). Davis Drug Guide for
Nurses Tenth Edition. 1915 Arch Street Philadelphia, PA 19103.

Marieb, Elain. (2006). Essentials of Human Anatomy and

Physiology.8th Edition. Pearson Education.Jurong, Singapore.

B Internet

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http://en.wikipedia.org/wiki/Hemothorax
http://emedicine.medscape.com/article/2047916-overview
http://www.nlm.nih.gov/medlineplus/ency/article/000126.htm
http://www.teleflex.com/en/usa/ucd/thoracic_system_pathology.php
http://www.sciencedirect.com/science/article/pii/S02725231040
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