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A CASE PRESENTATION OF A PATIENT WITH A CARBUNCLE ON THE LOWER

LEFT LABIA MAJORA AND PERINEUM AREA

Submitted by:

Diangco, Annielyn

Legaspi, Richard

Mabborang, Princess Charlyne

Martizano, Marephine

Medrano, Lord Lyle Christian

BSN –4A

Group 2-A

A. and the patient chart. It presents with painful boils discharging pus and necrotic (dead cells) material involving the skin and deeper tissue.0 C.) of the overlying skin. C. B. I. and a fever of 38. close to the perineal skin. Patient AC. SOURCE AND RELIABILITY OF INFORMATION: The source and data came from patient herself. Female and single. with erythemia (superficial reddening of the skin. 21 years of age who lived at Bacoor. Cavite Roman Catholic and born on January 18. The infection is contagious and may spread to other areas of the body or other people. 1996. usually in patches. She noted a palpable mass on the said area the following day measuring approximately 5x4 cm. She first consulted with a different physician and was prescribed cloxacilin and an unrecalled pain reliever taken for a day but discontinued due to inadequate pain relief. HISTORY OF PRESENT ILLNESS -Based on patient chart- Three days prior to admission of the patient. left perianal area. the patient began to note a painful area lateral to her left labia majora. as a result of injury or irritation causing dilatation of the blood capillaries. . It can occur anywhere in the body caused due to bacteria called Staphylococcus aureus. CHIEF COMPLAINT: Carbuncle. Carbuncles are commonly seen around the nape of neck and the back. INTRODUCTION A carbuncle is a skin infection presenting with multiple boils on the skin.

the pain had increased to severe. 2017 D. hence. FAMILY HISTORY F. The developmental history information was mostly based on what the patient remembers. She lives with her parents with her one younger brother. Few hours prior to admission. SOCIO. PAST MEDICAL HISTORY OR PAST HEALTH No pass medical history E. G. such that the patient was now unable to sit or lie down flat due to pain.ECONOMIC Patient AC is currently a 4th year student she has no kids. current admission January 15. She has one younger brother he is 17 years old. . She consulted with her attending physician and was advised intravenous antibiotics. DEVELOPMENTAL HISTORY Patient AC is a 21 years old woman who was raised in a middle class household.

As a teenager. She can recall that at the age 4-5. first husband. At twelve. She practically grew up with a good training just like her other sibling. sometimes Success in this depressed. fearing She has a live in Intimacy vs. REVIEW OF SYSTEMS Regional Examinations . stage will lead to the virtue of love. commitment and partner. she can already clean the home and the yard. at 7. She was really into sports. others. and did go through an isolation. 18 to 40 years’ old Intimacy. and depression. Erik Erickson Psychosocial Theory PATIENT’S THEORIST AGE TASK DETION Teenager integrates Patient is friendly Intimacy vs fidelity to other and never had a Isolation 12-20 years’ old friends. she can already errands for her mother like buying something at a nearby store. H. Value problem in importance of establishing beauty. she did not indulge in drugs nor alcohol. loneliness sometimes phase. She loneliness. she was already trained for her self-hygiene and grooming. Establish interpersonal relationship with relationships. She is also Isolation relationships can separated from her lead to isolation.

31 High Blood Cell cells/cumm cells/cumm (WBC) January Hemoglobin 12-16mg/dL 15 mg/dL Normal 21.7 mg/dL Normal 16.diarrhea. 3. no hematuria GIT: (+) Epigastric Pain. .6mil. 2017 January Red Blood 4.9 Normal .Extremities: GUT: No dysuria. 2017 (Hg) mg/dL Hematocrit 38-47% 38. (-) Dry skin.7% Normal (Hct) Platelet 150.6mil.4% Normal (Hct) January Platelet 150-450k 356k Normal 16. (+) Muscle cramps Laboratory Results Blood Chemistry Procedure Indication Normal Actual Interpretation Date Values/ Findings Findings January Hemoglobin 12-16 12. no palpitations CNS: (+) vomiting. (+) headache. 3.450k 279k Normal Red Blood 4. 2017 Cell (RBC) cells/cumm cells/cumm White 5-10k 18. (+) dizziness Constitutional: (+) Edema. (+) vomiting Respiratory: (-) cough ---> (-) dyspnea Cardiovascular: (-) chest pain.3 Low 16.9 cells/ Normal Cell (RBC) cells/cumm cumm White 5-10k 7. 2017 (Hg) Hematocrit 38-47% 43.

4. Blood Cell cells/cumm cells/cumm (WBC) I. Nutrition: . Self Concept/Self Perception Pattern Tries to maintain a positive outlook in life Happy that she is able to spend time with her family 3. Health Perception/Health Management Pattern Client is well aware of her condition Takes her prescribed medication on time. FUNCTIONAL ASSESSMENT 1. 2. and goes to the gym when she remembers. Activity/Exercise Pattern Plays badminton. Self-Esteem. Sleep/Rest Pattern Client does not have any problem getting proper rest 5.

Sexuality/Reproductive: Patient is single and doesn’t have kids. Has close relationship with her family 9. Coping & Stress Management/Tolerance Pattern: Client is verbally expressive. Patients states she likes to eat. Interpersonal Relationships/Resources: Patients is single. and she knows that she is overweight. 7. Values/Beliefs: Roman Catholic Attends worship when she can. 6.Tries not to eat too much junk food. Elimination: Patients states she has regular bowl movements. . 8. 10.

J. Physical Assessment .

Presence of edema on both hands. C. Skin Temperature 37. Normal equal in size. the (+) pallor lips teeth are still complete.Areas to Assess Findings Interpretation A. Eyes Eyes and Eyebrows are Normal normal. symmetric in movement with moist conjunctiva. Head The head is normocephalic. no cavities and clean. H. well-trimmed. with swelling. Normal clean without presence of swelling or discharge. reactive to light and accommodation. No tenderness during palpation in auricle and tragus G. B. based on Normal the equal stance of the head . E. Pupils are equally rounded. F. Ears Ears are clean with no visible Normal earwax and no odor.1° C. Normal dry with lesions and discoloration. Mouth and Throat The lips are pale and dry. and increased skin pigmentation. Nose The nose is equal in size. Hands The nails are pale in color. D. The Normal skin is dry. The eyes are normal in movement. No lesions present in the buccal mucosa. lesions. Neck Symmetrical in size.

2. Do not smoke and drink alcohol 3. Follow up check-up . Advise patient to maintain a healthy weight. Discharge Plan 1.K.