ABSCESS

I. Objectives

General Goal: To know the major cause/causes of this condition, how it is acquired, and
the major manifestations of this disease.

Specific Objectives:
The student should be able to:
1. To know the common cause(s) of this disease.
2. To identify the means by means this disease can be acquired
3. To know the major manifestations of this disease.
4. To know ways on how to prevent the transmission of this disease.

II. INTRODUCTION

A. Background of the Study

Abscesses occur when an area of tissue becomes infected and the body's immune
system tries to fight it. White blood cells move through the walls of the blood vessels into
the area of the infection and collect within the damaged tissue. During this process, pus
forms. Pus is the build up of fluid, living and dead white blood cells, dead tissue, and
bacteria or other foreign substances.
Abscesses can form in almost every part of the body and may be
caused by infectious organisms, parasites, and foreign substances.
Abscesses in the skin can be easily seen, and are red, raised, and
painful. Abscesses in other areas of the body may not be obvious, but
if they may cause significant organ damage.
This case study will help the student nurse in understanding the disease process of
the patient. This will also help the student nurse in identifying the primary needs of the
patient with an abscess by identifying the needs and health problems of the patient and
formulating an individualized nursing care plan. Effective management of the problem
identified will help the patient recover faster and maintain a holistic sense of wellness
even while in the hospital.

B. Definition of the Case

An abscess is a common infection characterized by a localized accumulation of

polymorphonuclear leukocytes with tissue necrosis involving the dermis and
subcutaneous tissue. It is also a collection of pus (dead neutrophils) that has accumulated
in the cavity formed by the tissue on the basis of an infectious process (usually caused by
bacteria and parasites) or other foreign materials (e.g. splinters, bullet wounds, or
injecting needles). It is a defense reaction of the tissue to prevent the spread of infectious
materials to other parts of the body.
An abscess is typically painful and it appears as a swollen area that is warm to
touch. The skin surrounding an abscess typically appears pink or red.
C. General Signs and Symptoms

General signs and symptoms of an abscess includes:

• Redness (rubor)
• Heat (callor)
• Swelling (tumor)
• Pain (callor)
• Loss of function

D. Etiology

The primary causes of abscess includes:

• Inflammatory response to an infectious process; invasion of bacteria or
parasite such as streptococci or staphylococci
• Foreign substance within the body (a needle or a splinter)
• Obstructed oil or sweat glands
• Inflammation of hair follicles
• Minor breaks or punctures in the skin

E. Incidence

Skin abscesses are fairly common. They occur when an infection causes pus and
infected material to collect in the skin. During the last decade, the incidence of the skin
and soft tissue infections has risen dramatically in the Philippines and skin abscesses
caused by methicillin-resistant staphylococcus aureus are largely accountable for this
increase.

III. PATIENT’S PROFILE

A. Biographic Data

Name: xxx
Age: 6 ½ months
Gender: male
Nationality: Filipino
Marital Status: single
Occupation: N/A
Religious Orientation: Roman Catholic
Educational Attainment: N/A
Date of Admission: August 5, 2009
Attending Physician: Dra. Abana
Diagnosis: Abscess, thigh Left
B. Chief Complaint:

Abscess, fever

C. History of Present Illness

1 week PTA, the patient has erythematous swelling on his left thigh associated
with fever, hence, they consulted a family doctor and was given meds.
3 days PTA, the patient have the above condition associated with cough, again
sought the help of the family doctor and meds were given.
Persistence of swelling associated with pustular discharge hence consulted again
the family doctor then advised for admission.

D. Past Health History

According to the SO, the patient has never been hospitalized before. He also has
no known allergies and negative for asthma. The patient hasn’t yet completed his
immunization vaccines (measles and oral polio vaccine)

E. Family History of Illness

F. Physical Assessment

• Flaring nares upon respiration

• With supple neck
• Eyes slightly swollen
• With warm skin
 • With good skin turgor
• (-) cyanosis
• Afebrile: T= 36.5°C
• With adventitious breath sounds (whezzes) heard on both upper lobes upon
auscultation
• (+) non-productive cough
• Erythematous swelling with pustular drainage, ulcer, on left thigh

G. Vital Signs: From Admission Up to Discharge

August 5, 2009

8pm 12 4am
Temperature 37.4 38.8 37.2
Pulse rate 130 132 140
Respiratory rate 46 44 50

August 6, 2009

8pm 12 4am
Temperature 38 37.3 37.5
Pulse rate 116 137 129
Respiratory rate 62 56 60

August 6, 2009

8pm 12 4am
Temperature 37.7 -. -
Pulse rate 139 - -
Respiratory rate 60 - -

H. Course in the Ward (Doctor’s Progress Notes)

August 5, 2009
 admitted to ROC under the servce of Dra. Abana having the chief complaint of
fever and abscess
 inserted with IVF of D50.3NaCl 1L x 40 µgtts/min
 labs ordered and done: CBC, U/A
 medications given:
Paracetamol oral drops 0.9mL q4 PRN for fever
Fucidin cream over skin lesion 3x a day
Sulbactam-ampicillin 750mg/vial 160mg IV q6
 IVF to follow: D5IMB 1L x 27 µgtts/min

August 6, 2009
  continue meds as ordered by the physician

IV. ANATOMY AND PHYSIOLOGY

A. Integumentary System

The integumenatry system is the organ system that protects the body from damge,
comprising the skin and its appendages. It is the largest organ system.

Functions of the integumentary system:

1. Protects the body against invasion by infectious organisms.

2. Protects the body from dehydration.
3. Protects the body against abrupt changes in temperature.
4. Helps excrete waste materials through perspiration.
5. Acts as receptor for touch, pressure, pain, heat and cold.
6. Generate vitamin D through the exposure to UV rays.
7. Stores, fat, glucose and Vitamin D.

The 3 layers of the skin includes:

a. Epidermis
- top layer of the skin made up of epithelial cells. Main job is protection,
absorption of nutrients and homeostasis.

b. Dermis
- dense connective tissue that makes up the dermis contains fibroblasts, fat cells
and macrophages.

c. Hypodermis
- layer of tissue directly underneath the dermis. Functions include insulation,
storage of energy and aiding in the anchoring of the skin. It also cushions the underlying
body for extra protection against trauma.

B. Lymphatic System

The lymphatic system is composed of the tissues and the organs that produce,
store and carry WBC that fight infections and other disease. This system includes the
bone marrow, spleen, thymus, lymph nodes and lymphatic vessels that branch into all
tissues of the body.

Functions of the lymphatic system includes:

1. Filtering out organisms that cause disease.

2. Produces certain WBC’s and generate antibodies
 3. Distribution of fluids and nutrients in the body
4. Fat absorption in the digestive tract

Lymph is a milky body fluid a type of WBC, called “lymphocytes”, along with
proteins and fats. Lymph seeps outside the blood vessels in spaces of the body tissue and
is stored in the lymphatic system to flow back into the bloodstream. Through the flow of
blood in and out of the arteries, and into the veins, and through the lymph nodes and into
the lymph, the body is able to eliminate the products of cellular breakdown and bacterial
invasion. Two very large areas are of significance to this system:

1. Right lymphatic duct – drains lymph fluid from the upper right quarter of the
body above the diaphragm and down the midline.
2. Thoracic duct – a structure, roughly 16 inches long located in the mediastenum of
the pleural cavity which drains the rest of the body.

It is through the action of this system, including the spleen and the thymus, the
lymph nodes and the lymph ducts that our body is able to fight infection and ward off
infection from foreign invaders. The lymphatic vessels are present wherever there are
blood vessels and transport excess fluid to the end of vessels without the assistance of
any “pumping” action. There are 100 tiny, oval structures (called lymph nodes) in the
body. These are mainly in the neck, groin and armpits, but are scattered along the lymph
vessels. They act as barriers to infection by filtering out and destroying toxins and germs.
The largest body of lymphoid tissue in the human body is the spleen.
V. PATHOPHYSIOLOGY

Break in the skin Pain Pain Injury

Invasion of bacteria in the

site (staphylococci and
streptococci)

Body releases toxins

Histamine, plasmins, kinins,

Vascular response serotonin, and prostaglandins Redness and Heat
are released and activated

Histamine, kinins, and

prostaglandins causes increase Swelling and loss of
Fluid exudation
in cellular permeability. function

Cellular exudation WBC collects to the site

Formation of a
thick, yellowish pus
Leukocyte breakdown the dead from broken down
tissue and absorb the bacteria by tissues, dead
bacteria and
means of a phagocytosis. leukocytes, and
extracellular fluid.

ABSCESS FORMATION

Nearby healthy cells form a capsule of

tissue around the pus and develop a cell
wall that delimits the abscess from
nearby healthy tissues.

Fibroblasts produce Resolution of

Healing collagen fibers and tissue inflammation and
regeneration. formation of scar tissue
VI. LABORATORY AND DIAGNOSIS EXAMINATION

SPECIFICATION NORMAL RESULTS INTERPRETATION

RANGE
Urinalysis:
• Pus cells 0-2/HPF 5-8HPF Presence of infection
• RBC 0-2/HPF 0-3/HPF Slight hematuria; a sign of
bleeding in the genitourinary tract
as a result of systemic bleeding
disorders, various kidney diseases,
bacterial infections, parasitic
infections, obstructions in the
urinary tract, scurvy, subacute
bacterial endocarditis, traumatic
injuries, and tumors.
Hematology:
a. hematocrit 0.37-0.45 0.35 Anemia
b. WBC 5-10x10^/L 12.9 Presence of infection
c. segmenters 0.55-0.65 0.78 Presence of bacteria
d. lymphocytes 0.25-0.35 0.20 Low body immunity

VII. DISCHARGE PLANNING METHOD

M Continue medication regimen as ordered by the physician strictly following the right
medicine, right dose, and time as prescribed.
E  Provide environment that is conducive to health and wellness.
 Minimize clutter around the house to prevent accidents and injuries and maintain
cleanliness to minimize the potentials of harboring microorganisms.
 Allow the child to play but with strict supervision since playing a form of play to
the child.
T Regimen of antibiotics should be followed as scheduled even after the signs and
symptoms of the condition are gone to ensure the potency and effectivity of the drug.
H  Stress the importance of a good personal hygiene and its contribution to health
and wellbeing. Teach the client the proper hand washing technique.
 Teach the clients that pressing an abscess in an attempt to drain it is not good. This
can push the infected material into the deeper tissues.
 Teach the client not to stick needle or any other sharp instruments into the abscess
because it may injure an underlying blood vessel or cause the infection to spread.
O  Carefully follow any instructions that the doctor provides.
 Be sure to keep all follow-up appointments.
 Report any fever or increased pain or redness to the doctor immediately.
D  Emphasize the importance of offering baby breastmilk instead of formula milk
 May also add solid foods little by little like mashed potatoes.
REVIEW OF THEORETICAL FRAMEWORKS
THEORY
Environmental Theory External life conditions
(Florence Nightingale) affect life and the
individual’s development.
Interpersonal Relations in To develop an interpersonal
Nursing interaction between patient
(Hildegard Peplau) and the nurse.
14 Basic Needs 14 basic needs are provided
(Virginia Henderson) by assisting the client with
his needs that the client
would perform unaided if
they have necessary
strength, will or knowledge.
Four Conservation To use conversation
Principles activities aimed at optimal
(Myra Levine) use of patient’s resources.
 Maintained a safe
environment.
 Maintained a well-
ventilated environment.
 Maintained a clean and
noise-free environment.
 Provided diet
appropriate for the
condition of the patient.
 Established rapport with
the patient.
 Performed a good NPI.
 Encouraged mother to
breastfeed the patient.
 Encouraged
mobilization to facilitate
bowel movement.
 Suggested SO to
provide patient to have
adequate rest and sleep
for faster recovery.
Encouraged SO to
breastfeed infant to
strengthen the child’s
immunity.
 DRUG CLASSIFICATION INDICATION ACTUAL CONTRAINDICATION ADVERSE NURSING
NAME DOSAGE REACTION INTERVENTION

GN: Biogesic Analgesic and Relief of fever, 0.9mL q4h Anemia, cardiac pulmonary Allergic reactions Observe the 10 R’s
BN: antipyretics minor aches disease. Hepatic or sever renal ang GI of drug
Paracetamol and pain disease. disturbances administration.
drops

GN: Fucidic Topical Antibiotics Primary and Apply 3x a --- Hypersensitivity Observe the 10 R’s
Acid secondary day (rare) of drug
BN: Fucidin bacterial skin administration.
cream infections
caused by
staph., strep.,
methicillin-
resistant strains
and other
organisms
sensitive to
fucidic acid

GN: Antibiotics Treatment of 400mg IVP Hypersensitivity to ampicillin, Pain, rash, Observe the 10 R’s
Sulbactam succesptible (TID) sulbactam, penicillins, or any diarrhea, allergic of drug
BN: Unasyn bacterial component of the medication. reaction administration.
infections
involved in the
skin and skin
structure,
intraabdominal
infections,
gynecological
infections.