GENERAL MANAGEMENT

The nursing objective for handling patients with abdominal wall abscesses is to manage
drainage; when the source is present, it should be dealt with; antibiotic treatment is of
marginal importance. (Mehta, 2023). Mr. A's abdomen was dressed daily with betadine.
According to Vogel et al. (2017), betadine helps in lowering the bacterial count and restoring
wound healing through rapid re-epithelialization of larger wounds. It is very important to
dress daily to debride any necrotic tissues to accelerate healing by preventing the growth of
pathogenic organisms (Aboud, 2023). The opening wound was also packed with betadine
dressing, allowing pus to drain out and the wound to heal properly. Because there was lots of
pus, a bag of colostomies was also applied on both sides for drainage. Dressing the
abdominal abscess daily is necessary to remove and drain the abscess in order to prevent the
infection from spreading throughout the body, which can be life-threatening.

Secondly, the patient was administered intravenous potassium chloride (KCL) and sodium
chloride (NaCl) 8 hours a day to maintain proper electrolyte balance. Vital signs were taken 4
hours a day, and her potassium level was dropped. According to Amelia V (personal
communication, October 27, 2023), it is very important to monitor input and output because a
decrease in output of less than 50 mL per hour may lead to oedema or an indication of
damage to other organs, especially her kidney, regarding the patient’s conditions since she
has other co-morbidities (diabetes) and is highly at risk. An increase in her output compared
to her input (dehydration) can cause hypotension. Taking vital signs is very important to
monitor any signs of fever, which can indicate an infection. A continuous high temperature is
often a sign of excessive inflammation or infection, which indicates an urgent need for
intervention and treatment. (Zhong et al., 2023).

She was also advised to consume a high-protein diet (ensure) to maintain her albumin level. It
is very important to avoid malnutrition. Poor nutrition status affects the normal process of the
abdomen wound healing stage by prolonging the inflammatory phase, decreasing
proliferation, and altering collagen production, which decreases wound tensile strength and
increases infection rates. (Fentahun et al., 2021).

Due to low hemoglobin levels, the patient is also given blood intravenously. Blood contains
hemoglobin, which is a protein in red blood cells that carries oxygen, and low hemoglobin
levels indicate anemia. According to Szczepiorkowski & Bunbar (2013), guidelines for RBC
transfusion, transfusion of RBCs should be considered when Hb is less than 7 to 8 g/dl. If the
patient's Hb level is 6.5 g/dl, having a low Hb level also means delayed wound healing.

Furthermore, Mr. A was also advised to sponge daily, do pressure care, and reposition after
2–3 hours. According to Amelia V (personal communication, October 27, 2023), sponging
will help maintain hygiene, keep the surrounding area of the abdomen wound clean, and
lessen the risk of infections and the development of bacteria. On the other hand, doing
pressure area care will help prevent the development of ulcers and allow blood to flow to her
posterior site due to the skin and tissue underneath being damaged by pressure on the area, as
well as reposition to reduce the pressure on her posterior site while maintaining adequate
blood flow.

Lastly, a physical assessment was conducted. According to Viliami.L. (personnel

communication, October 29, 2023), the skin color of her bottom eye was pale, which
indicates anemia, and further support was provided by the low hb level after her blood test.
Her abdomen was also fluctuating when palpated, which indicates there were still abscesses.
Swelling of her lower limbs was also identified, which is a sign of oedema. Oedema is the
retention of fluid, and patients can gain up to 10 lbs of fluid before exhibiting oedema. Her
wound was also assessed for necrosis. Necrotic occurs as a sign of tissue death caused by an
infectious bacterium present, which helps a lot with the care provided.

PHARMACOLOGICAL MANAGEMENT

Mr. A was given intravenous flucloxacillin (gram-positive) at a dose of 1g every 6 hours.

This is to eliminate the bacteria that is causing harm to her skin or fleshy tissue, leading to
acquired sepsis and infecting wounds. Flucloxacillin is used to treat skin and soft tissue
infections, such as abscesses, boils, cellulitis, impetigo or infected ulcers, eczema, wounds, or
burns (Henderson, 2022). This is to resolve any further complications of the infectious
bacteria by killing it within a short period of time, thus preventing the spread of infections to
other tissues. After 1 week, Mr. A was given intravenous flagyl with a dose of 500mg twice a
day. This was to treat wounds infected with gram-negative bacteria such as pseudomonas
aeruginosa, but was stopped after the patient refused due to feeling pain when the antibiotic
was administered.

Intravenous omeprazole was also given with a dose of 20mg twice a day. This is to prevent
gastric ulcers and other gastrointestinal disorders caused by infection with Helicobacteria
pylori. She was also given intravenous ceftriaxone with a dose of 1 gram twice a day. This is
to treat severe infections against gram-positive and gram-negative bacteria such as gonorrhea,
pelvic inflammatory disease, meningitis, and infections of the lungs, ears, skin, urinary tract,
blood, bones, joints, and abdomen. This is to prevent infections that may develop after the
operation by killing bacteria. (Ceftriaxone Injection: MedlinePlus Drug Information, n.d.)

Mr. A was given slow potassium chloride with a dose of 600mg orally three times a day. This
is a mineral supplement used to prevent or treat low levels of potassium in the blood
(hypokalemia). Her blood test for potassium (k) was 3.03 mmol/L, which is quite low; a
normal k ranges from 3.5 to 5.2 mmol/L. According to Amelia V (personal communication,
October 27, 2023), Slow K maintains adequate potassium levels in the body, which is
essential for wound healing. Potassium is necessary for cellular functioning, and ensuring
proper potassium levels supports the healing process of an infected wound. (Dinu et al.,
2020).

Mr. A was also given intravenous maxalon with a dose of 10mg every 8 hours. This is used to
prevent gastrointestinal disorders such as nausea and vomiting by simulating gastrointestinal
mobility and appetite. Having proper and adequate nutrients is essential for wound healing, as
they provide the necessary nutrients and energy for tissue repair. One of the key factors in
wound healing is the delivery of oxygen and nutrients. Maxalon can help improve gastric
motility, which may enhance the absorption of nutrients from food. By increasing
gastrointestinal motility, maxalon can potentially aid in the breakdown and absorption of
proteins, carbohydrates, fats, vitamins, and minerals necessary for wound healing and
simulate appetite in patients such as Mr. A to increase appetite, which can result in high
caloric intake and provide the body with the energy required for tissue repair and
regeneration.
Mrs. A was also given intravenous vancomycin with a dose of 1g twice a day. This is to
inhibit the synthesis of the bacterial wall, which ultimately leads to the death of the bacteria,
particularly grampositive bacteria. Vancomycin promotes the healing of wounds by reducing
the number of bacteria present in the wound. By doing so, it prevents the development of
infection and promotes the healing process, especially in large wounds that are prone to
infection. (Metoclopramide: MedlinePlus Drug Information, n.d.)

Mr. A was also given oral Panadol with a dose of 1g every 6 hours in order to reduce fever
and chills. Fever often occurs with a viral infection and can be a good sign that the body is
fighting an infection. Panadol contains an ingredient called acetaminophen, an antipyretic
that helps reset the body thermostat and lowers the raised temperature to reduce fever. (myDr,
2021). So, because Mr. A complained most of the time of having chills and a high
temperature after vital signs, Panadol was given orally every 6 hours to reduce chills and
fever while on IV antibiotics for infections. Mr. A was also given intravenous normal saline
eight hours a day in order to retain fluid balance and resolve fluid retention. This is also to
ensure fluid enters the blood stream right away in order to replace the fluid she loses every
time she vomits and replace the loss of fluids from the abscess, eliminating any chance of
dehydration.

Mr. A was given an intramuscular injection of pethidine with a dose of 100mg when needed.
This was used to relieve severe pain in her abdomen. Pethidine is a painkiller that only works
to ease the pain. by Mr. A (News-Medical.net, n.d.-b). According to Viliami.L. (personnel
communication, October 29, 2023), the administration of pethidine could have also
contributed to the patient vomiting and feeling nausea manifested during her stay in the
hospital. According to Healthdirect Australia, 2023, nausea and vomiting are side effects of
repeated dosing of pethidine.

Additionally, Mr. A was given antidiabetic-soluble insulin three times a day and isophase
insulin two times a day, depending on the level of blood sugar measured. This was to lower
blood sugar levels if they were high. Soluble insulin acts quickly within 30 minutes of
injection, whereas isophane insulin is absorbed much more slowly during the day.

Lastly, Mr. A was given oral enalapril at a dose of 10mg once a day. This was to control her
high blood pressure since she was known to have hypertension and prevent other
complications such as kidney failure, nerve damage, or stroke. (Diabetes Treatment: Using
Insulin to Manage Blood Sugar, 2023) Enalapril is an angiotensin-converting enzyme
inhibitor. It works by blocking a substance that causes the vessels to tighten; as a result,
enalapril relaxes blood pressure and increases the supply of blood and oxygen to the heart
(Enalapril (Oral Route), 2023). This was to reduce her unstable high blood pressure, which
can further cause strokes and other additional complications, making it harder for her wound
to heal.
RECOMMENDATIONS

Even though Mrs.A’s abdominal abscess was properly managed and resolved, there are a few
areas that require improvement for further management of the abdominal wall abscess.
Firstly, always assess the risks of an abdominal wall abscess, especially if the patient has
other co-morbidities such as diabetes that can delay abdominal wound healing. Secondly, to
educate patients about possible strategies for adequate and accurate ways to prevent wound
infections after discharge and why it is crucial to follow these strategies and follow up.
Thirdly, it is to advise on the danger signs of abdominal wound infections along with early
detection so that they can be eliminated early, preventing them from spiraling into further
complications. Fourth, continuous prescription of antibiotics is important to completely
destroy bacteria and ensure infection is controlled, aiding in wound healing with continuous
dressing to remove pus and maintain sterility, thus avoiding infection on the abdomen
surrounding the outer and inner layers. Additionally, continuous monitoring of the IDC for
controlled input and output is important to maintain electrolyte balance and, at the same time,
prevent oedema. Lastly, continue to monitor vital signs every 4 hours to detect any changes
to temperature, which can indicate infections, blood pressure, breathing rate, and oxygen
level, where the next care provided will depend on them.

CONCLUSION

To conclude, abdominal wall abscess is a major challenge and is quite a common and serious
condition. In particular, abdominal sepsis exhibits the highest mortality rate at 72%. People
who are at risk for abdominal wall abscess are those who have had abdominal surgery,
diabetes, or inflammatory bowel disease. It can be caused by a bacterial infection. If left
untreated, an abdominal abscess may grow, causing damage to nearly all organs and blood
vessels. Bacteria can also enter the bloodstream, spread to other organs, and cause death. This
is why it is very important to ensure the causes and risk factors are properly identified so that
proper care and management, along with the right drugs, are given to resolve abdominal wall
abscesses.

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