INTRA-Abdominal abscess

Definition

Intra-abdominal abscesses are localized collections of pus that are confined in the peritoneal cavity by an inflammatory barrier. This barrier may include the omentum, inflammatory adhesions, or contiguous viscera. The abscesses usually contain a mixture of aerobic and anaerobic bacteria from the GI tract.Although multiple causes of intra-abdominal abscesses exist, the following are the most common: (1) perforation of a diseased viscus, which includes peptic ulcer perforation, (2) perforated appendicitis and diverticulitis, (3) gangrenous cholecystitis, (4) mesenteric ischemia with bowel infarction, and (5) pancreatitis or pancreatic necrosis progressing to pancreatic abscess. Microbiology includes a mixture of aerobic and anaerobic organisms.

S/S-swelling-bloating-lack of appetite-nausea-vomiting-rectal tenderness/fullness-diarrhea

Nursing interventions -empty and irrigate drain as ordered -provide pain medication as ordered on a routine basis - provide non-medication comfort measures in nursing scope of practice-practice good hand hygiene before and after working with patient

Complications

Complications include recurrent abscesses, spontaneous rupture of an abscess, and occasionally, spread of the infection to the blood stream and widespread infection.

Name: Patient X Age: 1 Gender: Female Birthday: September 09, 2008

Address: Balagtas Orion Bataan Nationality: Filipino Religion: Catholic

Date admitted: September 24, 2009 4:45 pm Attending Physician: Dr. Lopez

Nursing History

A. History of present illness:The mother said that her daughter which is the patient had a recurrent fever for 3about a week, that’s why she decided to bring her daughter to the hospital.

B. Past Health History:

1. Childhood illness: The patient had measles when she was eight month old . Sometimes she’s having coughs , colds and fever, other than that there were no illnesses experienced

2. Vaccination: The mother said that her daughter completed

all vaccinations.

3. Allergies: The patient had an allergy on cold environment or cold foods. When she was exposed to these cold things, redness appearance of the skin occur.

4. Accidents: There were no accidents happened to the patient as a confirmation by her mother.

5. Hospitalizations: The patient was no hospitalization said by her mother since now.

6. Medications used orCurrently taking: As of now, based on the Hospital record, the

Doctor ordered to gave her Cefazolin 250 mg IV q 8 hours ANST & Metronidazole 125 mg IV q 8 hours ANST.

7. Foreign Travel: The patient is not yet traveled abroad as the

mother said.

C. Family History The patient’s parents said that there were no reported or known issue of diseases on both sides of their families

Activities of Daily Living

ADL Before Illness During Illness Interpretation

1. Nutrition:The patients has a big The Doctor ordered Intra-abdominal appetite. She is frequently Milk feeding diet abcess breast fed by her mother because she’s being ↓ she likes to eat rice meals prepared for for CT scan two times a day. Diagnostic test. ↓ restriction of diet(M/F)

↓

Impaired nutrition 2. Elimination She has a regular bowel She took her bowel

Restricted diet Movement of once every movement of once ↓ day. every 2 days. ↓fiber intake ↓ Constipation 3. Exercise The patient always like She cant walk Keep rested to walk . because of limited ↓

movement . Activity intolernce

4. Hygiene Took a bath once a Only TSB is Always on bed day. done ↓ Limited way to take a bath ↓

Poor hygiene

5.Substance Use NO SUBTANCE USED REPORTED

6. Sleep & Rest She slept 8-10 hrs a day Disturbed Hospital env. sleeping pattern uncomfortability ↓ Prolonged hour

w/o sleep ↓ Sleep deprivation

BODY PARTS

NORMAL FINDINGS INTERPRETATION

A. HeadSkull Rounded

smooth Skull contour. Smooth, uniform Consistency, Absence of nodules or masses

Rounded smooth Skull contour. Smooth, uniform Consistency, Absence of nodules or masses

Normal

Scalp White, clean, free From masses,lumps, scars, lice, Nits, dandruff and Lesions, no areas of Tenderness

oily

Always on bed ↓ Limited way to take a bath ↓Poor hygiene

Hair Normal hair is Evenly distributed, Thick, silky, resilent Hair. Amount of hair is variable, coarse Or fine.

Normal hair is Evenly distributed, Thin, silky, resilent Hair. Amount of hair is variable, coarse Or fine.

Normal

Face Symmetrical facialmovement

Eyes aligned and symmetrical

Normal

Eyes Eyes should be Aligned, Symmetrical

Eyes aligned and symmetrical

Normal

Eyebrows Hair evenly Distributed, skin Intact. Eyebrows Symmetrically Aligned, equal Movement

Normal

Eyelashes Equally distributed Curled slightly Outward.

Equally distributed Curled slightly Outward

Normal

Eyelids Skin intact, no Discharged, no Discoloration

Skin intact, no Discharged, no discoloration

Normal

Lower Palpebral Conjunctive

Shiny, smooth, and Pink or red

Shiny, smooth, and

Pink or red

Normal

Sclera Sclera appears white

white Normal

Cornea Transparent, shiny and smooth

Transparent, shiny

and smooth

Normal

Pupil Black in color, equal in size, Round and smooth

Black , equal in size, Round and smooth

Normal

Iris Proportional to the size of the eye Round, brown or black, symmetrical

Black, proportional to the size of the eye Round, symmetrical

Normal

Ear Firm, symmetrical, Parallel with each Other and not Tender

Firm, symmetrical, Parallel with each Other and not Tender

Normal

External Ear Canal

Scant amount of cerumen, With hair follicles

Scant amount of cerumen, With hair follicles

Normal

Symmetric Symmetric and Normal

Nose and straight, No discharge

straight, No discharge

B. Mouth and Lips

Uniform, pink in color soft, Moist, smooth Texture

dryMilk feeding

↓Limited fluid intake

↓Dry lips

↓Risk for deficient

Fluid volumeGums Pink gums

moist Firm texture to Gums

Slightly moist

Milk feeding↓

Limited fluid intake↓

Slightly moist gums↓

Risk for deficientFluid volume

Teeth 6 teeth 6 teeth NormalNeck Muscles equal

in Size, head centered, Coordinated, Smooth Movements With no discomfort. Freely movable

Muscles equal in Size, head centered, Coordinated, Smooth Movements With no discomfort. Freely movable

Normal

Thorax Symmetrical, Skin Intact, uniform in Temperature. No Tenderness.

Symmetrical, Skin Intact, uniform in Temperature. No Tenderness

Normal

Abdomen Unblemished skinUniform in color, Flat, rounded. Symmetric in Movements caused By respiration. Audible bowel Sounds

Mass at the Upper right side of the abdomen

Intra-abdominal abscess

Infection↓

Accumulation of puss↓

Abscess in the internal organs(Liver abscess)

↓Intra-abdominal abscess

Upperextremities

Symmetrical, Well aligned and Proportion relative to the body trunk

Symmetrical, Well aligned and Proportion relative to the body trunk

Normal

Nails Convex curvature, Capillary refill < 3 sec. Smooth texture

Capillary refill= < 3 sec.

Normal

Lower extremities

Symmetrical. Hair Distribution is even. Skin smooth, same Color, no lesion or Masses. Texture Smooth, temperature uniform

Symmetrical. Hair Distribution is even. Skin smooth, same Color, no lesion or Masses. Texture Smooth, temperature uniform

Normal

Mobility Ability to perform Range of motion and Strength.

limited range of motion

IV infusion↓

Restricted movement↓

Limited range of motion↓

Impaired mobility

PATHOPHYSIOLOGY

INTRA-ABDOMINAL ABSCESS UNKNOWN

DIAGNOSTIC TEST

EXPLORATORY

LAPAROTOMY

ULTRASOUND/CT SCAN↓

LIVER ABSCESS ↓ ↓

ENTAMOEBA HYSTOLIITICA PYOGENIC LIVER ASCESS ↓ ↓ AMEBIC LIVER ABSCESS ADMINISTRATION OF ↓ ANTIBACTERIAL DRUGS ADMINISTRATION OF ↓ AMEBICIDAL DRUG CEFAZOLIN ↓ (250 MG IV q8 ANST) METRONIDAZOLE (125 MG IV q8 ANST) _________________________________ ↓ IF NOT EFFECTIVE ↓ REQUIRED OPEN SURGICAL DRAINAGE

INTRODUCTION

BIOGRAPHICDATA

PATHOPHYSIOLOGY

ACTIVITIESOF

DAILYLIVING

PHYSICALASSESSMENT

ANATOMY &

PHYSIOLOGY

N.C.P.

DRUG

STUDY

DISCHARGE

PLANNING