Cagayan de Oro College-PHINMA

College of Nursing

A Case Study of

Deep Neck Abscess

Submitted to:
Mr. Arsenio S. Poral, Jr., RN, MAN (c)
Submitted by:
Carmelli Mariae H. Calugay
February 20, 2015
I. INTRODUCTION
a. Overview
A neck abscess is a collection of pus from an infection in spaces between the structures of the
neck. As the amount of pus increases, the soft tissue spaces expand and push against the
structures in the neck, such as the throat, tongue, and, in extreme cases, the trachea (windpipe).
Neck abscesses are sometimes called cervical abscesses or deep neck infections.
There are several types of neck abscesses, including the following:
!

Retropharyngeal abscess. An abscess that forms behind the pharynx (back of the throat)
often following an upper respiratory infection. In children, the lymph nodes in this area can become
infected and break down, forming pus. Retropharyngeal abscesses are most common in young
children, because these lymph nodes atrophy (get smaller) by the time a child reaches puberty.

Peritonsillar abscess (quinsy abscess). An abscess that forms in the tissue walls beside

the tonsils (the lymph organs in the back of the throat). Peritonsillar abscesses are most common
in adolescents and young adults and are rarely seen in young children.
!

Submandibular abscess (Ludwig's angina). An abscess beneath the tissues in the floor
of the mouth. Pus collects under the tongue, pushing it upwards and toward the back of the throat,
which can cause breathing and swallowing problems. Ludwig's angina is not common in young
children but may occur in older adolescents, especially after a dental infection.
What causes a neck abscess?
A neck abscess occurs during or just after a bacterial or viral infection in the head or neck such as
a cold, tonsillitis, sinus infection, or otitis media (ear infection). As an infection worsens, it can
spread down into the deep tissue spaces in the neck or behind the throat. Pus collects and builds
up in these spaces forming a mass. Sometimes, a neck abscess occurs following an inflammation
or infection of a congenital (present at birth) neck mass such as a branchial cyst or thyroglossal
duct cyst.
What are the symptoms of a neck abscess?
The following are the most common symptoms of a neck abscess. However, each child may
experience symptoms differently. Symptoms may include:
- Fever
- Red, swollen, sore throat, sometimes just on one side
- Bulge in the back of the throat
- Tongue pushed back against throat
- Neck pain and/or stiffness
- Ear pain
- Body aches
- Chills
- Difficulty swallowing, talking, and/or breathing
The symptoms of a neck abscess may resemble other neck masses or medical problems. Always
consult a physician for a diagnosis.
How is a neck abscess diagnosed?
Generally, diagnosis is made by physical examination. In addition to a complete medical history
and physical examination, diagnostic procedures for a neck abscess may include the following:

!
!

Throat culture. A procedure that involves taking a swab of the back of the throat and
monitoring it in the laboratory to determine the type of organism causing an infection.
Blood tests. To measure the body's response to infection

Biopsy. A procedure in which tissue samples are removed (with a needle or during
surgery) from the body for examination under a microscope.

X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto film.

Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging

procedure that uses a combination of X-rays and computer technology to produce horizontal, or
axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the
body, including the bones, muscles, fat, and organs. CT scans are more detailed than general Xrays.
Treatment of a neck abscess
Specific treatment of a neck abscess will be determined by a physician based on:
o
o
o
o
o

Age, overall health, and medical history

Extent of the condition
Tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

Treatment may include:

Antibiotic medications (to treat the infection). Often, antibiotics must be given
intravenously (in the vein) and hospitalization may be required.
Drainage of the abscess using a needle. This procedure may require hospitalization.

b. Objective of the Study

The objective of this study is to be able to:
1. Acquire knowledge about the disease process.
2. Discuss thoroughly the disease process.
3. Formulate realistic and appropriate nursing care plans.
4. Identify and learn more about the treatment and modalities of the said disease.
5. Apply the nursing process and appreciate its significance in nursing practice.

c. Scope and Limitation of the Study

This study covers about facts related to patients condition. It includes the nature, causes,
signs and symptoms, pathophysiology, prognosis, treatment and the nursing interventions
appropriate for his condition. A nursing care plan is also provided which serves as a guide for the
interventions to be applied to the patient to aid in recovery and it will also serve as basis for the
evaluation of client care outcomes. Health teachings including referrals were also imparted to the
patient.
It is limited only to the case of our client. For the completion of this study, some information
was taken from significant others. The assessment and so with the interventions rendered to the
patient were also limited due to time constraint, with a total of 2 days, dated February 9 and 10 of
2015. Thus, weve supplemented our study with facts from various references.

d. Patients Profile
Name:

E.T.C.

Address:

Purok 3, Tablon, Cagayan de Oro City, Misamis Oriental

Sex:

Female

Age:

95 years old

Birth date:

December 26, 1920

Place of Birth:

Jimenez, Misamis Occidental

Occupation:

None

Civil status:

Widowed

Nationality:

Filipino

Religion:

Roman Catholic

Date of Admission:

February 7, 2015

Time of Admission:

10:00 pm

Chief Complaint:

Right Lateral Neck Mass

Admitting Diagnosis:

Deep Neck Abscess

Attending Physician:

Dr. Caayupan

e. Medical History
Patient E.T.C. was admitted at Northern Mindanao Medical Center in the year 2010 for the first time
because of pneumonia. With unknown hypertension and diabetes mellitus.

f. Social History
The patient is reasonably sociable. Shes easy to get along with, and has positive attitude towards
others.

g. Family History
There is no family history of hypertension and diabetes mellitus.

h. History of Present Illness

This is the case of patient E.T.C., who was admitted in Northern Mindanao Medical Center
at their ENT/Optha ward last February 7, 2015.
One week prior to admission, she had onset of erythema and pain at the right side of the
neck. No medications given. No consultation.

Three days prior to admission, patient noted to have increase mass size at the lateral
neck. This was associated with odynophagia. No consultation done.
One day prior to admission, the patient had increase in mass size of 8 x 10 cm, associated
with odynophagia, dysphagia, fever, and generalized body malaise. Resistance of symptoms
prompted consultation and subsequent admission.

i. Chief Complaint
The patient complains of having right lateral neck mass.

j. Diagnosis/Impression
She was then diagnosed to have deep neck abscess.

II. GROWTH AND DEVELOPMENT

Developmental theories of learning have to do with the additional learning tasks individuals
can accomplish as they mature mentally, emotionally, and physically. Although this maturation
actually progresses in slow, continuous fashion, it is often described as proceeding in stages.
Many names are associated with developmental research. The following people and their
stages of development are important in the field of development theory

FREUDS PSYCHOSEXUAL THEORY

Genital Stage: 13 yrs and above

Freuds advanced a theory of personality development that centered on the effects of the
sexual pleasure drive on the individual psyche. At particular points in the developmental process,
he claimed, a single body part is particularly sensitive to sexual, erotic stimulation.
Based on Sigmund Freuds Psychosexual Stages of development our client belongs to the
genital Stage. Characteristics of this stage are that energy of a person is directed toward full
sexual maturity and function and development of skills needed to cope with environment as well as
its demands. The patient is able to achieve independence and able to practice decision-making.
But this condition of the patient needs support from family in activities of daily living as well as
decision making to her present condition.

PIAGETS COGNITIVE DEVELOPMENT THEORY

Formal Operations Phase: 11- 15 and above
In this developmental theory, our patient belongs to FORMAL-OPERATIONAL wherein
logical reasoning processes are applied to abstract ideas as well as concrete objects. This is the
time when people are most capable of forming new concepts and shifting their thinking in order to
solve problems and general concepts are related to specific situations and alternatives are
considered.

III. ANATOMY AND PHYSIOLOGY

Neck Anatomy
The neck is the part of the body that separates the head from the torso. The Latin-derived term
cervical means "of the neck." The neck supports the weight of the head and is highly flexible,
allowing the head to turn and flex in different directions.
The midline in front of the neck has a prominence of the thyroid cartilage termed the laryngeal
prominence, or the so-called "Adam's apple."
Between the Adams apple and the chin, the hyoid bone can be felt; below the thyroid cartilage, a
further ring that can be felt in the midline is the cricoid cartilage. Between the cricoid cartilage and
the suprasternal notch, the trachea and isthmus of the thyroid gland can be felt.

The quadrangular area is on the side of the neck and is bounded superiorly by the lower border of
the body of the mandible and the mastoid process, inferiorly by the clavicle, anteriorly by a midline
in front of the neck, and posteriorly by the trapezius muscle.
The cervical spine is made of 7 cervical vertebrae deemed C1 to C7. The cervical portion of the
spine has a gentle forward curve called the cervical lordosis. Certain cervical vertebrae have
atypical features and differ from the general form of a typical vertebra.
The main arteries in the neck are the common carotids, and the main veins of the neck that return
the blood from the head and face are the external and internal jugular veins.
Quadrangular Area
A quadrangular area can be delineated on the side of the neck. This quadrangular area is
subdivided by an obliquely prominent sternocleidomastoid muscle into an anterior cervical triangle
and a posterior cervical triangle.
Anterior cervical triangle
The anterior cervical triangle is bounded by the midline anteriorly, mandible superiorly, and
sternocleidomastoid muscle inferolaterally. This triangle is subdivided into 4 smaller triangles by the
2 bellies of the digastric muscle superiorly and the superior belly of the omohyoid muscle inferiorly.
Submandibular triangle
The submandibular triangle is bounded by the mandible and 2 bellies of the digastric muscle. It
contains the submandibular salivary gland, hypoglossal nerve, mylohyoid muscle, and facial artery.
Carotid triangle
The carotid triangle is bounded by the sternocleidomastoid muscle, posterior belly of the digastric
muscle, and superior belly of the omohyoid muscle. It contains the carotid arteries and branches,
internal jugular vein, and vagus nerve.
Muscular or omotracheal triangle
The muscular or omotracheal triangle is bounded by the midline, hyoid bone, superior belly of the
omohyoid muscle, and sternocleidomastoid muscle. It includes the infrahyoid musculature and
thyroid glands with the parathyroid glands.
Submental triangle
The submental triangle is located beneath the chin, bounded by the mandible, hyoid, and anterior
belly of the digastric muscle.
Posterior cervical triangle
The posterior cervical triangle is bounded by the clavicle inferiorly, sternocleidomastoid muscle
anterosuperiorly, and trapezius muscle posteriorly. The inferior belly of the omohyoid divides this
triangle into an upper occipital triangle and a lower subclavian triangle.

Occipital triangle
The occipital triangle is bounded anteriorly by the sternocleidomastoid muscle, posteriorly by the
trapezius, and inferiorly by the omohyoid muscle. The contents include the accessory nerve,
supraclavicular nerves, and upper brachial plexus.
Subclavian triangle
The subclavian triangle is smaller than the occipital triangle and is bounded superiorly by the
inferior belly of the omohyoid muscle, inferiorly by the clavicle, and anteriorly by the
sternocleidomastoid muscle. The contents include the supraclavicular nerves, subclavian vessels,
brachial plexus, suprascapular vessels, transverse cervical vessels, external jugular vein, and
nerve to the subclavius muscle.
Osteology: The Cervical Spine
The cervical spine is made of 7 cervical vertebrae deemed C1 to C7. The cervical portion of the
spine has a gentle forward curve called the cervical lordosis. Certain cervical vertebrae have
atypical features and differ from the general form of a typical vertebra. C1 is also called the atlas
because it bears the head, "the globe." It has 2 concave superior facets that articulate with the
occipital condyles of the skull. This important articulation provides 50% of the flexion and extension
of the neck. C1 has no vertebral body and no spinous process.
C2, otherwise called the axis, has a conelike projection from the vertebral body that articulates
within the atlas. This atlantoaxial articulation is responsible for 50% of the rotation in the neck.
The C2 to C7 vertebrae have foramina in each of the transverse processes and bifid spinous
processes except for C7, which has a nonbifid and a prominent posterior spinous process that can
be felt distinctly at the base of the neck.
The vertebral artery travels in the foramina of the transverse processes. The spinal cord travels in
the spinal canal about 17 mm in diameter formed by the vertebral arches behind the body.
Myology
The muscles of the neck can be grouped according to their location. Those immediately in front
and behind the spine are the prevertebral, postvertebral, and lateral vertebral muscles and on the
side the neck are the lateral cervical muscles. In addition, a unique superficial muscle, the
platysma, exists.
Superficial muscle
The platysma muscles are paired broad muscles located on either side of the neck. The platysma
arises from a subcutaneous layer and fascia covering the pectoralis major and deltoid at the level
of the first or second rib and is inserted into the lower border of the mandible, the risorius, and the
platysma of the opposite side. It is supplied by the cervical branch of the facial nerve. The platysma

depresses the lower lip and forms ridges in the skin of the neck and upper chest when the jaws are
"clenched" denoting stress or anger. It also serves to draw down the lower lip and angle of the
mouth in the expression of melancholy.
Sternocleidomastoid
The sternocleidomastoid is the prominent muscle on the side of the neck. It arises from the
sternum and clavicle by 2 heads. The medial or sternal head arises from the upper part of the
anterior surface of the manubrium sterni and is directed upward, lateralward, and backward.
The lateral or clavicular head, which is flatter, arises from the superior border and anterior surface
of the medial third of the clavicle; it is directed almost vertically upward. The 2 heads are separated
from each other at their origins by a triangular interval, but they gradually blend, below the middle
of the neck, into a thick, rounded muscle. It is inserted by a strong tendon into the lateral surface of
the mastoid process, from its apex to its superior border, and by a thin aponeurosis into the lateral
half of the superior nuchal line of the occipital bone. It is supplied by the accessory nerve and
branches from the anterior rami of the second and third cervical nerves.
When only one side of the muscle acts, it draws the head toward the shoulder of the same side
and rotates the head toward the opposite side. Acting together from their sternoclavicular
attachments, the muscles flex the cervical part of the vertebral column. If the head is fixed, the 2
muscles assist in elevating the thorax in forced inspiration.
Trapezius
The trapezius arises from the spinous processes of the cervical and thoracic vertebrae and inserts
on the spine of the scapula and acromion; it is innervated by the spinal accessory nerve and
branches from the third and fourth cervical roots. Its upper fibers shrug the shoulder and aid in
suspension of the shoulder girdle (see the image below).

Anterior cervical muscles.

Anterior cervical muscles

Muscles in the front of the neck are the suprahyoid and infrahyoid muscles and the anterior

vertebral muscles (see the images below).

The suprahyoid muscles are the digastrics, stylohyoid, mylohyoid, and geniohyoid.
The infrahyoid muscles are the sternohyoid, sternothyroid, thyrohyoid, and omohyoid.

Muscles in the front of the neck.

The anterior vertebral muscles.

Suprahyoid muscles
The suprahyoid muscles perform 2 very important actions. During the act of swallowing they raise
the hyoid bone and, with it, the base of the tongue; when the hyoid bone is fixed by its depressors,
they depress the mandible. During the initial phase of swallowing, when the food is shifted from the
mouth into the pharynx, the hyoid bone and with it the tongue are carried upward and forward by
the anterior bellies of the digastrics, the mylohyoids, and geniohyoids.
In the next phase, when the food passes through the pharynx, the direct elevation of the hyoid
bone takes place by the combined action of all the muscles; after the food has passed, the hyoid
bone is carried upward and backward by the posterior bellies of the digastrics and the stylohyoids,
which assist in preventing the return of the food into the mouth.
The digastric muscle consists of 2 fleshy bellies united by an intermediate tendon. It lies below the
body of the mandible and extends, in a curved form, from the mastoid process to the symphysis
menti. The posterior belly, longer than the anterior, arises from the mastoid notch of the temporal
bone and passes downward and forward. The anterior belly arises from the inner side of the lower
border of the mandible, close to the symphysis, and passes downward and backward. The 2 bellies
end in an intermediate tendon that perforates the stylohyoideus muscle and is held in connection

with the side of the body and the greater cornu of the hyoid bone by a fibrous loop.
The stylohyoid muscle is a slender muscle lying in front of and above the posterior belly of the
digastric muscle. It arises from the back and lateral surface of the styloid process, near the base;
passing downward and forward, it is inserted into the body of the hyoid bone at its junction with the
greater horn and just above the omohyoid. It is perforated, near its insertion, by the tendon of the
digastric muscle.

The mylohyoid muscle is flat and triangular and is situated above the anterior belly of the
digastric, and it forms, with its fellow of the opposite side, a muscular floor for the oral
cavity. It arises from the whole length of the mylohyoid line of the mandible, extending from
the symphysis in front to the last molar tooth behind. The posterior fibers pass medialward
and slightly downward to be inserted into the body of the hyoid bone. The middle and
anterior fibers are inserted into a median fibrous raphe extending from the symphysis menti
to the hyoid bone, where they join at an angle with the fibers of the opposite muscle. This
median raphe is sometimes wanting; the fibers of the 2 muscles are then continuous.
The geniohyoid muscle is a narrow muscle, situated above the medial border of the
mylohyoideus. It arises from the inferior mental spine on the back of the symphysis menti
and runs backward and slightly downward to be inserted into the anterior surface of the
body of the hyoid bone; it lies in contact with its fellow of the opposite side.
The mylohyoid branch of the inferior alveolar nerve supplies the mylohyoid and anterior
belly of the digastric muscle. The facial nerve supplies the stylohyoid and posterior belly of
the digastric. C1 fibers that travel with the hypoglossal nerve supply the geniohyoid muscle.
Infrahyoid muscles
The sternohyoid muscle is a thin, narrow muscle, which arises from the posterior surface of
the medial end of the clavicle, posterior sternoclavicular ligament, and upper and posterior
part of the manubrium sterni. Passing upward and medialward, it is inserted, by short,
tendinous fibers, into the lower border of the body of the hyoid bone.
The infrahyoid muscles are supplied by branches from the first 3 cervical nerves via the
ansa cervicalis. These muscles depress the larynx and hyoid bone, after they have been
drawn up with the pharynx in the act of deglutition. The omohyoids not only depress the
hyoid bone but also carry it backward and to one or the other side.
The sternothyroid muscle is shorter, wider, and deeper than the sternohyoid. It arises from
the posterior surface of the manubrium sterni, below the fibers of the sternohyoid, and from
the edge of the cartilage of the first rib. It is inserted into the oblique line on the lamina of
the thyroid cartilage.
The thyrohyoid muscle is a small, quadrilateral muscle that arises from the oblique line on

the lamina of the thyroid cartilage and is inserted into the lower border of the greater horn of
the hyoid bone.
The omohyoid muscle consists of 2 fleshy bellies united by a central tendon. It arises from
the upper border of the scapula. From this origin, the inferior belly forms a flat, narrow
fasciculus, which inclines forward and slightly upward across the lower part of the neck,
being bound down to the clavicle by a fibrous expansion; it then passes behind the
sternocleidomastoid, becomes tendinous, and changes its direction, forming an obtuse
angle.
The omohyoid muscle ends in the superior belly, which passes almost vertically upward,
close to the lateral border of the sternohyoideus, to be inserted into the lower border of the
body of the hyoid bone, lateral to the insertion of the sternohyoid. The central tendon of this
muscle varies a great deal in length and form, and it is held in position by a process of the
deep cervical fascia, which sheaths it, and extends downward to be attached to the clavicle
and first rib; it is by this means that the angular form of the muscle is maintained.
Anterior vertebral muscles
The anterior vertebral muscles are the longus colli, longus capitis, rectus capitis anterior,
and rectus capitis lateralis.
The longus colli muscle is situated on the anterior surface of the vertebral column, between
the atlas and the third thoracic vertebra. It is broad in the middle, narrow and pointed at
either end, and consists of 3 portions: superior oblique, an inferior oblique, and a vertical.
The superior oblique portion arises from the anterior tubercles of the transverse processes
of the third, fourth, and fifth cervical vertebrae and, ascending obliquely with a medial
inclination, is inserted by a narrow tendon into the tubercle on the anterior arch of the atlas.
The inferior oblique portion, the smallest part of the muscle, arises from the front of the
bodies of the first 2 or 3 thoracic vertebrae and, ascending obliquely in a lateral direction, is
inserted into the anterior tubercles of the transverse processes of the fifth and sixth cervical
vertebrae The vertical portion arises , below, from the front of the bodies of the upper 3
thoracic and lower 3 cervical vertebrae and is inserted into the front of the bodies of the
second, third, and fourth cervical vertebrae.
The longus capitis is broad and thick above, narrow below, and arises by 4 tendinous slips,
from the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth
cervical vertebrae, and ascends, converging toward its fellow of the opposite side, to be
inserted into the inferior surface of the basilar part of the occipital bone.
The rectus capitis anterior is a short, flat muscle, situated immediately behind the upper
part of the longus capitis. It arises from the anterior surface of the lateral mass of the atlas
and from the root of its transverse process, and passing obliquely upward and medialward,

it is inserted into the inferior surface of the basilar part of the occipital bone immediately in
front of the foramen magnum.
The rectus capitis lateralis is a short, flat muscle, which arises from the upper surface of the
transverse process of the atlas and is inserted into the undersurface of the jugular process
of the occipital bone.
The rectus capitis anterior and the rectus capitis lateralis are supplied from the loop
between the first and second cervical nerves; the longus capitis, by branches from the first,
second, and third cervical; the longus colli, by branches from the second to the seventh
cervical nerves.
The longus capitis and rectus capitis anterior are the direct antagonists of the muscles at
the back of the neck, serving to restore the head to its natural position after it has been
drawn backward. These muscles also flex the head, and from their obliquity, rotate it, so as
to turn the face to one or the other side. The rectus lateralis, acting on one side, bends the
head laterally. The longus colli flexes and slightly rotates the cervical portion of the vertebral
column.

Lateral vertebral muscles

The lateral vertebral muscles are the scalenus anterior, scalenus medius, and scalenus
posterior.
Scalenus anterior lies at the side of the neck, behind the sternocleidomastoid. It arises from
the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical
vertebrae, and descending, almost vertically, is inserted by a narrow, flat tendon into the
scalene tubercle on the inner border of the first rib and into the ridge on the upper surface
of the rib in front of the subclavian groove.
Scalenus medius the largest and longest of the three scaleni, arises from the posterior
tubercles of the transverse processes of the lower 6 cervical vertebrae, and descending
along the side of the vertebral column, is inserted by a broad attachment into the upper
surface of the first rib, between the tubercle and the subclavian groove.
Scalenus posterior, the smallest and most deeply seated of the 3 scaleni, arises, by 2 or 3
separate tendons, from the posterior tubercles of the transverse processes of the lower 2 or
3 cervical vertebrae and is inserted by a thin tendon into the outer surface of the second rib,

behind the attachment of the serratus anterior. It is occasionally blended with the scalenus
medius.
The scaleni are supplied by branches from the second to the seventh cervical nerves.
When the scaleni act from above, they elevate the first and second ribs, and are, therefore,
inspiratory muscles. Acting from below, they bend the vertebral column to one or other side;
if the muscles of both sides act, the vertebral column is slightly flexed.
Suboccipital muscles
The suboccipital group comprises the rectus capitis posterior major, rectus capitis posterior minor,
obliquus capitis inferior, and obliquus capitis superior.
Rectus capitis posterior major (rectus capitis posticus major) arises by a pointed tendon from the
spinous process of the axis, and, becoming broader as it ascends, is inserted into the lateral part of
the inferior nuchal line of the occipital bone and the surface of the bone immediately below the line.
As the muscles of the 2 sides pass upward and lateralward, they leave between them a triangular
space, in which the recti capitis posteriores minores are seen.
Rectus capitis posterior minor (rectus capitis posticus minor) arises by a narrow pointed tendon
from the tubercle on the posterior arch of the atlas, and, widening as it ascends, is inserted into the
medial part of the inferior nuchal line of the occipital bone and the surface between it and the
foramen magnum.
Obliquus capitis inferior (obliquus inferior), the larger of the 2 oblique muscles, arises from the apex
of the spinous process of the axis and passes lateralward and slightly upward to be inserted into
the lower and back part of the transverse process of the atlas.
Obliquus capitis superior (obliquus superior), narrow below, wide and expanded above, arises by
tendinous fibers from the upper surface of the transverse process of the atlas, joining with the
insertion of the preceding. It passes upward and medialward and is inserted into the occipital bone,
between the superior and inferior nuchal lines, lateral to the semispinalis capitis.
The deep muscles of the back and the suboccipital muscles are supplied by the posterior primary
rami of the spinal nerves.
The 2 recti draw the head backward. The rectus capitis posterior major, owing to its obliquity,
rotates the skull, with the atlas, around the odontoid process, turning the face to the same side.
The obliquus capitis superior draws the head backward and to its own side. The obliquus inferior
rotates the atlas, and with it the skull, around the odontoid process, turning the face to the same
side.
Suboccipital triangle
Between the obliqui and the rectus capitis posterior major is the suboccipital triangle. It is bounded,
above and medially, by the rectus capitis posterior major; above and laterally by the obliquus
capitis superior; and below and laterally by the obliquus capitis inferior. It is covered by a layer of
dense fibro-fatty tissue, situated beneath the semispinalis capitis. The floor is formed by the

posterior atlanto-occipital membrane and the posterior arch of the atlas. The vertebral artery and
the first cervical or suboccipital nerve are in the groove on the upper surface of the posterior arch
of the atlas.
Arteries of the Neck
The main arteries in the neck are the common carotids arising differently, one on each side (see
the images below). On the right, the common carotid arises at the bifurcation of the brachiocephalic
trunk behind the sternoclavicular joint; on the left, it arises from the highest point on arch of the
aorta in the chest.

Dissection of the side of the neck showing the

major arteries.

The internal carotid and vertebral arteries.

Common carotid arteries

The common carotid arteries ascend in the neck and divide at the level of upper border of the
thyroid cartilage into 2 branches, the external and internal carotid arteries. The external carotid
artery supplies the exterior of the head; the face and the neck and the internal carotid artery
supplies the cranial and intraorbital contents.
The common carotid arteries lie on either side of the trachea. The common carotid artery, the
internal jugular vein, and the vagus nerve are enclosed in a fibrous sheath called the carotid
sheath, which is part of the deep cervical fascia. Within this sheath, the vein lies lateral to the artery
and nerve between and behind the vessels.
Descending in front of its sheath is the superior root of the ansa cervicalis, which accompanies the
hypoglossal nerve below the skull to the level of the greater horn of the hyoid bone. In the lower
part of the neck, the common carotid artery is covered by the sternocleidomastoid muscle. As it
ascends, only the medial border of this muscle covers it. It is crossed by the thyroid vessels at the
level of the thyroid gland.
Behind and medial to the carotid artery lie the sympathetic trunk, the longus colli and longus
capitis, and, directly posteriorly, the transverse processes of the cervical vertebrae, successively.
Medial to the artery are the esophagus, the trachea, and the thyroid gland. The recurrent laryngeal
nerve is interposed higher up between the trachea and esophagus. Lateral to the artery lies the
internal jugular vein. Within the angle of bifurcation of the common carotid artery is a reddish-brown
oval body, known as the carotid body.
External carotid artery
The external carotid artery begins at the level of the upper border of the thyroid cartilage, and
taking a slightly curved course, it passes upward and forward and then inclines backward to the
space behind the neck of the mandible, where it divides into the superficial temporal and maxillary
arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size
of the branches given off from it namely, the superior thyroid, lingual, facial, occipital, posterior
auricular, ascending pharyngeal, superficial temporal, and maxillary.
Internal carotid artery
The internal carotid artery begins at the bifurcation of the common carotid, at the level of the upper
border of the thyroid cartilage, and runs upward, in front of the transverse processes of the upper 3
cervical vertebrae, to the carotid canal in the petrous portion of the temporal bone. It lies behind the
sternocleidomastoid and lateral to the external carotid. It passes below the parotid gland and is
crossed by the hypoglossal nerve, the digastrics and stylohyoid muscles, and the occipital and
posterior auricular arteries.
Behind the artery lies the longus capitis, the superior cervical ganglion of the sympathetic trunk,
and the superior laryngeal nerve; lateral to it lie the internal jugular vein and vagus nerve. Medial to
it lie the pharynx, superior laryngeal nerve, and ascending pharyngeal artery. At the base of the
skull, the glossopharyngeal, vagus, accessory, and hypoglossal nerves lie between the artery and

the internal jugular vein. The cervical portion of the internal carotid gives off no branches.
Veins of the Neck
The main veins of the neck that return the blood from the head and face are the external and
internal jugular veins.

External jugular vein

The external jugular vein receives blood from the exterior of the cranium and the deep parts of the
face and is formed by the posterior division of the retromandibular vein joining with the posterior
auricular vein. It begins in the substance of the parotid gland, on a level with the angle of the
mandible, and runs down in the neck, in the direction of a line drawn from the angle of the
mandible to the middle of the clavicle at the posterior border of the sternocleidomastoid muscle. It
is separated from the sternocleidomastoid by the superficial layer or investing layer of the deep
cervical fascia and is covered by the platysma, the superficial fascia, and the integument.
This vein receives the occipital occasionally, the posterior external jugular, and, near its
termination, the transverse cervical, suprascapular, and anterior jugular veins; in the substance of
the parotid, a large branch of communication from the internal jugular may join it.
Internal jugular vein
The internal jugular vein collects the blood from the brain, from the superficial parts of the face, and
from the neck. It is directly continuous with the sigmoid sinus and begins in the posterior
compartment of the jugular foramen, at the base of the skull. It runs down the side of the neck in a
vertical direction, lying at first lateral to the internal carotid artery and then lateral to the common
carotid; at the root of the neck, it unites with the subclavian vein to form the brachiocephalic vein.
Behind it lies the internal carotid artery, and the vagus descends between and behind the vein and
the artery in the same sheath; the accessory runs obliquely backward, superficial or deep to the
vein.
This vein receives in its course the inferior petrosal sinus; the common facial, lingual, pharyngeal,
superior, and middle thyroid veins; and sometimes the occipital. The thoracic duct on the left side
and the right lymphatic duct on the right side open into the angle of union of the internal jugular and
subclavian veins.

NECK DEEP DISSECTION

IV. PATHOPHYSIOLOGY
a. Definition

In the past, infections of the deep neck abscess were associated

with high rates of morbidity and mortality. The overwhelming complication
rate of the past has been reduced with the advent of modern microbiology
and hematology, the development of sophisticated diagnostic tools (eg, CT,
MRI), the effectiveness of modern antibiotics, and the continued
development of medical intensive care protocols and surgical techniques.
Infections of the deep neck spaces present a challenging problem
for the following reasons:
Complex anatomy: The anatomy of the deep neck spaces is highly
complex and can make precise localization of infections in this region
difficult.

Deep location: The deep neck spaces are located deep within
the neck. This makes diagnosis of infections difficult because they
are often covered by a substantial amount of unaffected superficial
soft tissue. Deep neck infections may be difficult to palpate and
impossible to visualize externally.

Access: Superficial tissues must be crossed to gain surgical

access to the deep neck spaces, placing all of the intervening
neurovascular and soft tissue structures at risk of injury.

Proximity: The deep neck spaces are surrounded by a

network of structures that may become involved in the inflammatory
process. Neural dysfunction, vascular erosion or thrombosis, and
osteomyelitis are just a few of the potential sequelae that can occur
with involvement of surrounding nerves, vessels, bones, and other
soft tissue.
Communication: The deep neck spaces have real and potential
avenues of communication with each other. Infection in one space can
spread to adjacent spaces, thus gaining access to increasingly larger
portions of the neck. In addition, certain deep neck spaces extend to
other portions of the body (eg, mediastinum, coccyx), placing areas

outside of the head and neck at risk of involvement when these spaces
are involved.
b. Precipitating and Predisposing Factors

Causes of deep neck infections include the following:

Tonsillar and pharyngeal infections

Dental infections or abscesses
Oral surgical procedures or removal of suspension wires
Salivary gland infection or obstruction
Trauma to the oral cavity and pharynx (eg, gun shot wounds,
pharynx injury caused by falls onto pencils or Popsicle sticks,
esophageal lacerations from ingestion of fish bones or other sharp
objects)
Instrumentation, particularly from esophagoscopy or bronchoscopy
Foreign body aspiration
Cervical lymphadenitis
Branchial cleft anomalies
Thyroglossal duct cysts
Thyroiditis
Mastoiditis with petrous apicitis and Bezold abscess
Laryngopyocele
IV drug use
Necrosis and suppuration of a malignant cervical lymph node or
mass

c. Pathophysiological Diagram

V. MEDICAL MANAGEMENT

A. Doctors Order
Progress
Notes

Doctors Order

2-7-2015
10:00 pm
BP = 140/100

Please admit under ENT dept.

Secure consent

T= 37.0
C

Vital signs every 4 hours

HR = 85

Low fat, low salt, diabetic client

with strict aspiration precaution

RR = 20

LABS:
o CBC with PC
o U/A,
o Chest x-ray PAL,
Neck APL
o ECG
o RBS, Na, K, Crea
o FBS, Lipid profile in AM
Start IVF: PNSS iL @ 30
gtts/min

Implication
> Admit the pt. to an appropriate
department for care; for management
> Agreement that the patient will
submit to the care; for legal purposes
> Monitors vital signs, normal and
abnormal values
> Appropriate diet for the patient

> To check for possible cause of

illness/ relation to disease condition

> For fluid and electrolyte balance

MEDS:
1. Clindamycin 600g IVTT
> Pharmacologic management
loading dose then 300g IVTT
q6H ANST
2. Ceftazidine 2 grams IVTT
loading dose then 1 gram
IVTT q8H ANST
3. Paracetamol 500g i tab P.O.
q4H PRN for fever
Refer accordingly
Refer to IM for comanagement

> For proper management and to

provide necessary intervention
> For co-management

2-8-2015
9:00 am

Diagnostics
o CBC with PC, U/A, Na,
K, Crea, BUN, FBS,
lipid profile, chloride
Insert NGT and NPO
temporarily

> To check for improvement and for

abnormalities

> For nutrition; appropriate feeding

Advice endotracheal intubation > For maintaining patent airway

Refer accordingly
2-8-2015
4:30 am

Give Captopril 25 g i tab SL

now

BP = 170/90
8:30am
T = 39.3
C
CBG = 613
BP = 150/80

Ff. up referral to IM pls.

> For proper management and to

provide necessary intervention
> Pharmacologic management; to
treat hypertension

> For co-management

Shift paracetamol to 300 g IVTT > For fever; faster effect

q4H RTC
CBG now

> To check for blood glucose

CBG monitoring q6H

> To monitor blood glucose

Give 10 u of regular insulin

IVTT now and 10 u S, rpt.
CBG after 1 hour

> To lower blood glucose

B. Laboratory result

Date: 2-8-15
Result
High 562.5 mg/dl

Normal Range
60-110 g/dl

High - 75.19 mg/dl

10-50

Creatinine

High 2.43 mg/dl

0.6 1.2

Magnesium

Low - 2.07 mg/dl

2.5 - 3.5

Blood Sugar
(FBS, RBS)
BUN

GENERIC NAME

Ceflazidime

BRAND NAME

Tozidime

CLASSIFICATION

Antibiotic, Anti-Infective

Interpretation
Diabetes Mellitus
Increased no. may be
a sign of possible
kidney problem
Increased no. may be
a sign of possible
kidney problem
Decreases no. may be
a sign of
hypoparathyroidism

DOSAGE

1 gram IVTT q 8 hours

MECHANISM OF ACTION

Inhibits

cell

wall

synthesis

promoting

osmotic

instability
INDICATION

Lower respiratory tract infection

SIDE EFFECTS

Headache, dizziness, nausea and vomiting

ADVERSE REACTION

Diarrhea, abdominal cramps, rashes

CONTRAINDICATION

Hypersensitivity to drug or other cephalosphorin.

NURSING CONSIDERATION

Allergies to penicillin and cephalosphorin.

If large doses are given, therapy is prolonged,
monitor signs and symptoms of superinfection.

C. Drug Study

GENERIC NAME
BRAND NAME
CLASSIFICATION

Paracetamol
Perfalgan
Analgesic, Antipyretic

DOSAGE
MECHANISM OF ACTION
INDICATION
SIDE EFFECTS
ADVERSE REACTION
CONTRAINDICATION
NURSING CONSIDERATION

300 mg IVTT q 6 hours

Binds to non-opioid receptors
Management of pain and fever.
Headache, dizziness, nausea
Abdominal pain, dry mouth
Use cautiously with CVD and hepatic conditions.
Patient dependent with opioids must use this cautiously.

GENERIC NAME
BRAND NAME

Clindamycin
Cleocin

CLASSIFICATION
DOSAGE
MECHANISM OF ACTION
INDICATION
SIDE EFFECTS
ADVERSE REACTION
CONTRAINDICATION
NURSING CONSIDERATION

Antibiotic, Anti-Infective
300 mg IVTT q 6 hours
Inhibits bacterial protein synthesis.
Infections caused by sensitive staph, strep.
Headache, nausea, flatulence
Abdominal pain, rash, diarrhea
Hypersensitivity to drug or lincomycin.
Assess patients infection before and
regularly throughout therapy.
Use cautiously in patients with renal, or
hepatic disease, asthma, history of GI disease.

NURSING ASSESSMENT
Complete Physical Assessment
Time Assessed: 3:00 P.M.
Initial Vital Signs:
Temperature: 37.0 degree C
Pulse Rate: 85 bpm
Respiratory Rate: 20 cpm
Blood Pressure: 140/80 mmHg
General Appearance:
The pt. is lying on bed, stuporous with an IVF of PNSS regulated @ 50cc/hr @350ml level
infusing well @ left hand.
With Nasogastric Tube inserted.
With Foley catheter inserted.
With oxygen @ 4 lpm via nasal cannula

BODY PART

FINDINGS

IMPLICATION

Head/ Skull

Proportional to the size of the body, Normal

round, with prominence in the frontal
area anteriorly & the occipital area
posteriorly, symmetrical in all planes,
gently curved. But has a scar in the
parietal area

Scalp/ Hair

No areas of tenderness
palpation; hair is gray

Face

Oblong shaped, symmetrical, smooth Normal

& no involuntary muscle movements

Eyes/ Vision

Eyes are parallel & evenly placed, Cannot

open
symmetrical and non-protruding, with completely
scant amount of secretions, both
eyes black & clear.

upon Normal

Sclera is white. eyebrows are black,

symmetrical, and thick, can raise both
symmetrically & without difficulty,
evenly distributed & parallel with each
other;
eyelashes
are
evenly
distributed & turned outward.
Upper eyelids cover a large portion of
the iris, cornea & the sclera when the
eyes are open, when the eyes are
closed the lids meet completely,
symmetrical & the color is the same
as the surrounding skin.
Lid margins are clear, without scaling
or secretions.
Lower palpebral conjunctivas are
shiny, moist, transparent & salmon

eyes

pink in color.
Both irises are proportional to the
size of the eye, round & symmetrical.
Pupils are from pinpoint to almost the
size of the iris, round, symmetrical,
constricts with increasing light &
accommodation.
Able to move eyes in full range of
direction.
Ears/ Hearing

Ears are parallel, symmetrical, Normal

proportional to the size of the head,
bean-shaped, helix is in line with the
outer canthus of the eye, and skin is
the same color as the surrounding
area & cleans.
Ear canal is pinkish, clean, with scant
amount of cerumen & a few cilia.
Able to hear whisper spoken 2 feet
away.
1 piercing are found in both ear

Nose

Nose is in midline, symmetrical, Normal

patent.
Internal nares are clean, dark pink
with few cilia
With NGT in placed, inserted in the
right nostril.

Mouth/ Lips

Lips are pinkish ,asymmetrical; has Lower lip laceration

lower lip laceration. Gums are
pinkish, Tongue is pinkish, slightly

rough on top, smooth along the

lateral margins, moist, shiny & freely
movable .Soft palate is pinkish,
smooth & moist. Hard palate is
slightly pinkish.
NECK

THORAX
LUNGS

Proportional to the size of the body & Right lateral neck mass
head, asymmetrical, has palpable
lump, mass or area of tenderness on
the right lateral neck.
& Chest contour is symmetrical, spine Normal
is straight

HEART

No abnormal pulsations, pulsations Normal

are palpable & visible in apical area.

ABDOMEN

Abdominal skin is blemished, no Normal

bruises, abdomen is rounded with
symmetric movements caused by
respiration; umbilicus is concave.

UPPER
EXTREMITIES

Symmetrical, with visible veins, fine Bruises due to injections

hair evenly distributed, warm, dry & and IV insertions
elastic upon palpation.
Palms are pinkish, warm, soft &
elastic.
Nails are transparent, smooth &
convex with light pink nail beds &
white translucent tips.
5 fingers in each hand.
Left shoulder, arm, elbow, hand &
wrist can be moved in different range
of motion with relative ease while

weak on the right and limited range of

motion.
With marks of bruises
With IVF in left hand
LOWER
EXTREMITIES

Skin is smooth, fine hair is evenly With bruises

distributed, absence of varicose
veins, muscles symmetrical, length
symmetrical, 5 toes in each foot, sole
& dorsal surface is smooth with pink
nail beds & white translucent tips.
Both legs, knees, ankles, & toes can
be moved in limited range of motion
with relative ease
bruises on both patellar surface.

VI. NURSING MANAGEMENT

ASSESSMENT
SUBJECTIVE:

OBJECTIVE:
Nose flaring
Galisod siyag ginhawa as verbalized by the son of
Dyspnea
the patient.
Pale skin
NURSING DIAGNOSIS
Impaired gas exchange related to altered oxygen supply
EXPECTED OUTCOME
After 15 minutes of nursing intervention, the client will be able to breathe easily via nasal cannula.
PLANNING/INTERVENTION
RATIONALE
Independent:
1. Assess respirations: quality, rate, pattern, depth > Rapid, shallow breathing and hypoventilation
and breathing effort.
affect gas exchange by affecting CO 2 levels. Flaring
of the nostrils, dyspnea, use of accessory muscles,
tachypnea and /or apnea are all signs of severe
distress that require immediate intervention.
2. Assess for life-threatening problems. (i.e. > Absence of ventilation, asymmetric breath sounds,
respiratory arrest, flail chest, sucking chest wound). dyspnea with accessory muscle use, dullness on
chest percussion and gross chest wall instability (i.e.
flail chest or sucking chest wound) all require
immediate attention.
3. Assess for signs of hypoxemia
> Tachycardia, restlessness, diaphoresis, headache,
lethargy and confusion are all signs of hypoxemia.
4. Monitor vital signs.
> Initially with hypoxia and hypercapnia blood
pressure (BP), heart rate and respiratory rate all
increase. As the condition becomes more severe
BP may drop, heart rate continues to be rapid with
arrhythmias and respiratory failure may ensue.
5. Assess skin color for development of cyanosis, > Lack of oxygen delivery to the tissues will result in
especially circumoral cyanosis.
cyanosis. Cyanosis needs treated immediately as it
is a late development in hypoxia.
Dependent:
1. Treat the underlying injuries with appropriate > Treatment needs to focus on the underlying
interventions.
problem that leads to the respiratory failure.
EVALUATION
At the end of 8 hours nursing intervention, the client is free of signs of distress.
A. IDEAL NURSING CARE PLAN

ASSESSMENT
SUBJECTIVE:

OBJECTIVE:
Pain scale: 7 out of 10
Ga ngut-ngot man na panagsa iyang liog as
Sleep Disturbance
verbalized by the son of the patient.
Facial Grimace
NURSING DIAGNOSIS
Acute Pain related to Post Surgery
EXPECTED OUTCOME
After 30-45 minutes of nursing intervention, the client will be able to reduce pain from 7 to 5 out of 10.
PLANNING/INTERVENTION
Independent:
1. Accept patients description of pain.
2. Observe non-verbal cues.

RATIONALE
> Pain is subjective experience.
> Observations may/may not be congruent to verbal
respond.
> Usually altered when in pain.
> For non-pharmacological pain management.
> To prevent fatigue.

3. Monitor vital signs.

4. Provide comfort measures.
5. Encourage adequate rest period.
Dependent:
1. Administer analgesics as indicated per doctors > To maintain acceptable level of pain.
order.

EVALUATION
At the end of 8 hours nursing intervention, the client was able to reduce pain from 7 to 4 out of 10.

ASSESSMENT
SUBJECTIVE:
OBJECTIVE:
Luya man siya as verbalized by the son of the
Restlessness
patient.
Fatigue
NURSING DIAGNOSIS
Risk for infection related to inadequate primary defenses
EXPECTED OUTCOME
After 15 minutes of nursing intervention, the client will be able to maintain normal vital signs.
PLANNING/INTERVENTION
RATIONALE
Independent:
1. Assess for presence of risk factors: open wounds, > Represent a break in bodys first line of defense.
abrasions; indwelling catheters; drains; artificial
airways; and venous access devices.
2. Monitor white blood count (WBC).
> Normal WBC is 4-11 mm3. Rising WBC indicates
the bodys attempt to combat pathogens.
3. Monitor incisions, injured sites and exit sites of > Redness, swelling, increased pain, or purulent
tubes, drains and catheters for signs of infection.
drainage is suspicious of infection and should be
cultured.
4. Monitor temperature and the presence of > In the first 24-48 hours fever up to 38 degrees C
sweating and chills.
(100.4F) is related to the stress of surgery. After 48
hours fever above 37.7C (99.8F) suggests infection.
High fever with sweating and chills suggests
septicemia.
5. Monitor the color of respiratory secretions.
> Yellow or yellow-green sputum indicates a
respiratory infection.
Dependent:
1. Administer and teach the use of antimicrobial > All agents are either toxic to the pathogens or
drugs as ordered.
retard the pathogens growth. Ideally medications
should be selected based on a culture from the
infected area. A broad-spectrum agent may be
started until culture reports are available.
EVALUATION
At the end of 16 hours nursing intervention, the clients WBC within normal limits. No further infections
noted.

B. ACTUAL NURSING CARE PLAN

S
O
A
P
I

S
O
A
P
I

No subject cues. The patient is unable to speak.

Restlessness, facial grimace, sleep disturbance
Acute Pain related to Post surgery as evidenced by facial grimace
Short term: At the end of 30 minutes, the patient will be able show cues of reduced pain.
Long term: At the end of 8 hours, the patient will be able to show less stressful and relieved
from pain that she was experiencing.
1. Monitored the patient closely by taking vital signs
- This is to check the patients status to prevent any complication and to know if there
progress of the status of the patient.
2. Encouraged adequate rest periods.
- To prevent fatigue
3. Provided comfort measures.
- To lessen pain and promotes relaxation.
4. Provided diversional activities, like encouraging expressing the feeling in other form of
communication through actions to lessen the feeling of having the pain.
5. Administered medication as ordered by the attending physician
- This is for the treatment of the present illness of the patient
At the end of 30 minutes the patient shows gestures and facial expressions that indicates
no pain.
No subject cues. The patient is unable to speak.
Nose flaring, dyspnea, pale skin
Impaired gas exchange related to altered oxygen supply
Short term: After 15 minutes, the patient will be able to maintain normal vital signs.
Long term: At the end of 8 hours, the patient will maintain high oxygen supply.
1. Monitored the patient closely by taking vital signs
- This is to check the patients status to prevent any complication and to know if there progress of
the status of the patient.
2. Assessed for signs of hypoxemia.
- Tachycardia, restlessness, diaphoresis, headache, lethargy and confusion are all signs of
hypoxemia.
3. Provided a quiet and comfortable place for patient to have adequate rest.
4. Assessed skin color for development of cyanosis.
- Lack of oxygen delivery to the tissues will result in cyanosis. Cyanosis needs treated immediately
as it is a late development in hypoxia.
5. Administered oxygen as ordered by the attending physician
- This is to improve oxygen supply of the patient.
At the end of 15 minutes, the patient maintains normal vital signs.

VII. HEALTH TEACHINGS

MEDICATIONS

Instructed complete procurement of stocks of medicine and take it

on right time, dosage, and route as prescribed. Emphasized the
importance of following proper protocol and consideration upon
taking the medicine.

EXERCISE

A. Antibiotic
B. Oral hypoglycemic
Encouraged to have range of motion exercises to promote blood
circulation throughout the body.
Encouraged also to have adequate balance between sleep and
daily exercise to prevent further stress that can more complicate

TREATMENT

the situation.
Instructed to follow what has been ordered by the doctor and
stressed the importance of strict compliance of all the medications

OUT-PATIENT
(Check-up)

and treatment prescribed by the physician.

With patients critical case. She should see the doctor regularly for
check-up. Doing so will help foresee probable readmission and
management. Proper compliance to every instruction given before
discharge will help prevent untoward complications, and help

DIET

patient live a normal life again.

Eat well-balanced diet for proper nutrition; nutritious foods like
fruits and green leafy vegetables (eg. pechay, Malunggay, and
oranges, apple, banana, etc.)
Instructed to avoid foods that are high in cholesterol, fats, and

SEXUAL/SPIRITUA
L

VIII. RECOMMENDATION

sodium.
Encourage patient and significant others to pray to God for healing
and strengthen faith.
Encourage to have positive outlook.

Patient E.T.C. will be referred to a doctor after discharge persistence of chief complaints
reoccurs and complicates. Schedules for follow-up visits should not be overlooked to evaluate
progress of the patients health condition after termed medical and nursing management. She
should have check up at the nearest hospital a week after discharge as scheduled by her
physician. The physician also ordered to continue on using all the medications prescribed.

IX. CONCLUSION
I, therefore conclude, that deep neck abscess may lead to complications that may threaten life and
cause death to individual, especially with old age. People who are old have less tolerance to pain
and unable to recover easily with such diseases. It is important to take good care of our health and
to refrain from things that can lead to diseases. Also, family support is very important, aside from
medical management.

X. PROGNOSIS

CRITERIA
A.) Onset of Illness

GOOD PROGNOSIS

POOR PROGNOSIS
/

B.) Duration of Illness

C.) Precipitating Factor

D.) Attitude and Willingness

/
/

toward taking medication and

treatment
E.) Family Support

On the criteria listed above, it shows only 2 out of 5 criteria falls under good prognosis
therefore the clients prognosis is poor.

XI. BIBLIOGRAPHY

I.

Brunner and Suddarth Textbook of Medical-Surgical Nursing, 11 th Edition by Johnson

Pocket Guide Nursing Diagnosis with Interventions, 3 rd Edition by M. Doenges

Nursing 2010 Drug Handbook, 20th Anniversary Edition by Davis drug guide

Medical Surgical Nursing, 7th Edition by Black and Hawks

Manual of Nursing Practice, 7th edition, Volume 1, Lippincott

DOCUMENTATION
I wasnt able to take any pictures with the patient due to confidentiality purposes.