INCISION AND DRAINAGE OF

ABSCESS
(ACTIVITY # 1 MEDICAL SURGICAL)

manalac , eunice jade a.

Bsn 3-a

Introduction:
Abscess - confined collection of pus surrounded by inflamed tissue. Most
abscesses are found on the extremities, buttocks, breast, axilla, groin, and
areas prone to friction or minor trauma, but they may be found in any area of
the body. Abscesses are formed when the skin is invaded by microorganisms.
Cellulitis may precede or occur in conjunction with an abscess. The two most
common microorganisms leading to abscess formation are Staphylococcus and
Streptococcus.

ETIOLOGY:
Most abscesses are caused by bacterial infection.
- When bacteria enter your body, your immune system sends infection-
fighting white blood cells to the affected area. As the white blood cells
attack the bacteria, some nearby tissue dies, creating a hole which then
fills with pus to form an abscess.

MANAGEMENT:
- Incision and Drainage.
- Smaller abscess <5mm may resolve spontaneously with the application
of warm compresses and antibiotic therapy.

Patient’s profile:
NAME: Mr. X
AGE: 38
SEX: Male
CIVIL STATUS: Married
CC: Pain and swelling at the abdomen
ADMITTING DIAGNOSIS: Intra-abdominal Abscess

HISTORY OF PRESENT ILLNESS:

● Pta patient have pain and swelling at the abdomen
● Paracetamol for 3 days for the pain
Physical findings:

General Survey: Awake and Alert

Vital Signs: BP: 100/80mmHg

HR: 110
RR: 21
TEMP.: 36.0

HEENT: Sunken Eyeballs

Chest/Lungs: Asymmetrical.

CVS: Essentially Normal.

Abdomen: Palpable fluctuant abscess,

tenderness to palpation

Skin extremities: Essentially normal

Neuro-exam: Essentially Normal

COURSE IN THE WARD:

DATE: TIME: ADMITTING ORDERS: NURSING

 RESPONSIBILITY:
September 1, 2021 9:00am Please admit to
the room of
choice (Private
Room) under Dr.
Surgeon

Secure consent ➔ Ensure

for admission and that the
management consent
form is
signed by
the patient
(S/O)
➔ Ensure that
the patient
(S/O) is
aware of
the
procedure.

Monitor VS q6
and record

Monitor I & O q
shift

IVF: PNSS 1L x
15cc/hr

VS: Diagnostics: ➔ Proper

BP: 100/80mmHg documenta
HR: 110 ➔ CBC w/ diff. tion of
RR: 21 ➔ Blood baseline
TEMP.: 36.0 culture and data.
drug ➔ Verify the
susceptibili doctor’s
ty. order for
➔ Urinalysis the
particular
diagnostic
 test.

SIDE NOTE: Therapeutics: ➔ Verify any

- Pain scale medication
of 9/10 ➔ Ceftriaxone order and
- Guarding 680mg IV make sure
behavior in 30mL it's
- Restlessnes IVF to run complete.
s q8h ➔ Check the
- Agitation ➔ Ibuprofen patient’s
200mg 1 medical
tab PRN record for
➔ Give an allergy
Lidocaine or
10mg + contraindic
Diphenhydr ation to the
amine prescribed
25mg (IM) medication.
at 12pm ➔ Educate
Anesthesiologist patient
(S/O) about
medication
s.
➔ Follow the
eight rights
of
medication
administrat
ion.

10:54am No objection for ➔ Ensure that

Incision and the patient
Drainage of understand
Intra-abdominal s the
abscess. procedure
and
consents
about it.
 2:00pm Doctor’s Order:
➔ Status post
I&D intra-
abdominal
➔ Keep the
wound
clean, dry
and
covered
with
absorbent
material.
➔ Give
Tramadol
50mg tab
q8

3:00pm Post-Op Order

➔ Continue
present
meds
Diagnostics (to
repeat):
➔ CBC w/ diff.
➔ Urinalysis

➔ Refer
accordingly

3:30pm May transfer to

room

Dr. Surgery

VS: 5:00pm IVF to consume

BP: 110/90mmHg
HR: 97
RR: 19 Dr.
TEMP.: 36.2
02SAT%: 99%

NOTE: 6:55pm Relay official

CBC, urinalysis
Pain Scale of 4/10 results to Dr.

September 2, 7:00am ➔ MGH

2021 ➔ THM
Tramadol
50mg 1 tab
for pain
PRN &
Metronidaz
ole 500mg 1
tab OD x
7da

9:00am Ok to discharge

10:11am ➔ Ok with
planned
discharge
➔ Advised

Home meds:
1. Tramadol
5omg 1 tab
PRN
2. Metronidaz
ole 500mg 1
tab OD

LAB RESULT:
Date ordered: sept. 1, 2021
Time: 11:00am
COMPLETE RESULT UNIT REFERENCE
BLOOD RANGE
COUNT

HEMOGLOBIN 121.0 g/dL 120-150

HEMATOCRIT 0.39 0.37-0.45

RED BLOOD 4.8 10^12/L 4.6-5.2

CELLS

WHITE BLOOD H 11.0 10^9/L 5.10

CELLS

PLATELET H 350.0 10^3/uL 140-340

COUNT

DIFFERENTIA
L COUNT
0.55 0.55-0.65
SEGMENTERS 0.25-0.35
LYMPHOCYTE 0.38
H 0.05 0.02-0.1
S
0.02 0.02-0.04
MONOCYTES
0.0-0.05
EOSINOPHILS 0.00
BASOPHILS
L fL
80.0
MCV pg 86-100
25.2 g/dL 26-31
MCH
MCHC 31.4 31-37

Date ordered: september 1, 2021

Time: 12:00am
Test: blood culture and drug susceptibility

Organism antibiotic MIC (mcg/ml) Interpretation

Penicillin <=0.5 S

Pip/taz <=32/4 S

Ceftriaxone <=16 S

Ertrapenem <=4 S

Ciprofloxacin <=4 S

Metronidazole <=8 S

S = susceptible i - intermediate r = resistant n = not susceptible d = susceptible dose dependent

Date ordered: september 1, 2021

Time: 11:00am

Test Normal Value Specimen Result

Color Yellow to amber, clear Clear light yellow

pH 5.0-9.0 8.0

Leukocytes NEGATIVE NEGATIVE

PROTEIN NEGATIVE TRACE NEGATIVE TRACE

GLUCOSE NEGATIVE NEGATIVE

KETONES NEGATIVE NEGATIVE

BLOOD NEGATIVE/TRACE NEGATIVE

 SPECIFIC GRAVITY 1.010-1.025 DIPSTICK: 1.005

Date ordered: september 1, 2021

Time: 4:00pm

COMPLETE RESULT UNIT REFERENCE

BLOOD RANGE
COUNT

HEMOGLOBIN 120.0 g/dL 120-150

HEMATOCRIT 0.38 0.37-0.45

RED BLOOD 4.8 10^12/L 4.6-5.2

CELLS

WHITE BLOOD 10 10^9/L 5.10

CELLS

PLATELET H 350.0 10^3/uL 140-340

COUNT

DIFFERENTIA
L COUNT
0.55 0.55-0.65
SEGMENTERS 0.25-0.35
LYMPHOCYTE 0.30
0.05 0.02-0.1
S
0.02 0.02-0.04
MONOCYTES
0.0-0.05
EOSINOPHILS 0.00
BASOPHILS
fL
87.0
MCV pg 86-100
25.2 g/dL 26-31
MCH
MCHC 31.4 31-37

Date ordered: september 1, 2021

Time: 4:00pm

Test Normal Value Specimen Result

Color Yellow to amber, clear yellow

pH 5.0-9.0 7.0

Leukocytes NEGATIVE NEGATIVE

PROTEIN NEGATIVE TRACE NEGATIVE TRACE

GLUCOSE NEGATIVE NEGATIVE

KETONES NEGATIVE NEGATIVE

BLOOD NEGATIVE/TRACE NEGATIVE

SPECIFIC GRAVITY 1.010-1.025 DIPSTICK: 1.008