UNCIANO COLLEGES, INC.

Antipolo City

COLLEGE OF NURSING

In Partial Fulfillment of the Requirements in Micro/Para

LIST OF DISEASES
AND ITS CAUSATIVE AGENT

SUBMITTED BY:

LEAH P. GAMBOL
 TABLE OF CONTENTS

I. BACKGROUND OF THE STUDY

II. OBJECTIVES

1. Cognitive

2. Affective

3. Psychomotor

III. PATIENTS PROFILE

IV. NURSING HISTORY

V. GORDONS FUNCTIONAL HEALTH PATTERN

VI. PHYSICAL EXAMINATION

VII. ANTOMY AND PHYSIOLOGY

VIII. PATHOPHYSIOLOGY

IX. COLLABORATIVE MANAGEMENT

1. LABORATORY AND DIAGNOSTIC TESTS

2. FDAR STUDENT NURSES NOTES

 X. ACKNOWLEDGEMENT

XI.

XII. First and foremost praise is to God, the Almighty, and the Greatest of all, on

whom ultimately we depend for sustenance and guidance. Thank thee to God for showering all

His kindness that weve used in taking care of other people, for blessing us with patience and

giving us knowledge, strength and determination to prioritize our work and do our entire task in

time.

XIII.

XIV. Secondly, we would like to show our sincere gratitude to our beloved Dean of the

College of Nursing, Ms. Maria Haydi P. Medina RN, MAN for sharing her pearls of wisdom with

us during the course of this study and for her professed insights. We deeply show appreciation

for her assistance and commentary observations that greatly improved our work.

XV.

XVI. Third, we would like to express our gratitude to Ms. Milagros Javier-Nuez, RN,

MAN, our clinical instructor for guiding us in every step weve done. For giving a lot of patience,

for throwing a big smile even if theres a mistake weve done and for the knowledge that she

have shared to us. We attribute all our accomplishments to her encouragement and effort and

without her this thesis, too, would not have been completed or written.

XVII.

XVIII. We would also like to thank the staff nurses at Unciano Medical Center for letting

us see all important charts and documents related to our case study. Thank you for

accommodating us.

XIX.

XX. And finally, we wish to extend our sincerest thanks and gratitude to our parents

for the support, encouragement and contribution in the accomplishment of this study.

XXI.
XXII.

XXIII. BACKGROUND OF THE STUDY

XXIV. An abscess is a collection of pus that has built up within the tissue of the

body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The

swelling may feel fluid filled when pressed. [1] The area of redness often extends beyond the

swelling. Carbuncles and boils are types of abscess that often involve hair follicles with

carbuncles being larger.

XXV. Abscesses may occur in any kind of solid tissue but most frequently on skin

surface (where they may be superficial pustules (boils) or deep skin abscesses), in the

lungs, brain, teeth, kidneys and tonsils. Major complications are spreading of the abscess

material to adjacent or remote tissues and extensive regional tissue death (gangrene).

XXVI. The main symptoms and signs of a skin abscess are redness, heat, swelling,

pain and loss of function. There may also be high temperature (fever) and chills. Risk factors for

abscess formation include intravenous drug use. Another possible risk factor is a prior history of

disc herniation or other spinal abnormality, though this has not been proven.

XXVII. Abscesses are caused by bacterial infection, parasites, or foreign substances.

Bacterial infection is the most common cause. Often many different types of bacteria are

involved in a single infection. In the United States and many other areas of the world the most

common bacteria present is methicillin-resistant Staphylococcus aureus. Among spinal subdural

abscesses, methicillin-sensitive Staphylococcus aureus is the most common organism involved.

XXVIII. An abscess is a defensive reaction of the tissue to prevent the spread of

infectious materials to other parts of the body. The organisms or foreign materials kill the

local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response,
which draws large numbers of white blood cells to the area and increases the regional blood

flow.

XXIX. The final structure of the abscess is an abscess wall, or capsule, that is formed

by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures.

However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus,

or from reaching the causative organism or foreign object.

XXX. Abscesses may be classified as either skin abscesses or internal abscesses.

Skin abscesses are common; internal abscesses tend to be harder to diagnose, and more

serious. Skin abscesses are also called cutaneous or subcutaneous abscesses. Abscesses

should be differentiated from empyemas, which are accumulations of pus in a preexisting rather

than a newly formed anatomical cavity. Other conditions that can cause similar symptoms

include: cellulitis, a sebaceous cyst and necrotising fasciitis. Cellulitis typically also has an

erythematous reaction, but does not confer any purulent drainage.

XXXI. The standard treatment for an uncomplicated skin or soft tissue abscess is

opening and draining. There does not appear to be any benefit from also using antibiotics in

most cases A small amount of evidence did not find benefit from packing the abscess with

gauze. The abscess should be inspected to identify if foreign objects are a cause, which may

require their removal. If foreign objects are not the cause, incision and drain of the abscess is

standard treatment. In critical areas where surgery presents a high risk, it may be delayed or

used as a last resort. Warm compresses and elevation of the limb may be beneficial for a skin

abscess.

XXXII. Most people who have an uncomplicated skin abscess should not use

antibiotics. Antibiotics in addition to standard incision and drainage is recommended in persons

with severe abscesses, many sites of infection, rapid disease progression, the presence

of cellulitis, symptoms indicating bacterial illness throughout the body, or a health condition
 causing immunosuppression. People who are very young or very old may also need antibiotics.

If the abscess does not heal only with incision and drainage, or if the abscess is in a place that

is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated.

XXXIII. In those cases of abscess which do require antibiotic treatment, Staphylococcus

aureus bacteria is a common cause and an anti-staphylococcus antibiotic such

as flucloxacillin or dicloxacillin is used. The Infectious Diseases Society of America advises that

the draining of an abscess is not enough to address Staphylococcus aureus (MRSA), and in

those cases, traditional antibiotics may be ineffective. Alternative antibiotics effective against

often include clindamycin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole.. If the

condition is thought to be cellulitis rather than abscess, consideration should be given to

possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus

agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin. Antibiotic therapy

alone without surgical drainage of the abscess is seldom effective due to antibiotics often being

unable to get into the abscess and their ineffectiveness at low pH levels.

XXXIV. Culturing the wound is not needed if standard follow-up care can be provided

after the incision and drainage. Performing a wound culture is unnecessary because it rarely

gives information which can be used to guide treatment.

XXXV. Skin abscesses are common and have become more common in recent

years. Even without treatment they rarely result in death as they will naturally break through the

skin. Risk factors include intravenous drug use with rates reported as high as 65% in this

population. In 2005 in the United States 3.2 million people went to the emergency department

for an abscess. In Australia around 13,000 people were hospitalized in 2008 for the disease.

XXXVI. About one in four healthy people are colonized by staphylococcus bacteria. Those who

are colonized have the bacteria present in their skin and nasal passages, but the

presence of the bacteria doesnt make them ill. Historically, most staph was sensitive to
 beta-lactam antibiotics, such as penicillin, methicillin, and ampicillin. Some strains of

staph developed resistance to beta-lactam antibiotics.

XXXVII.

XXXVIII. OBJECTIVES

A. General Objectives
XXXIX.
XL. After 8 hours of exposure in the General Ward at t San Lazaro Hospital, we as

student nurses are here to present a case study of a 18 year old, male patient diagnosed

of having a Right Tissue Swelling at the right thigh. This is to identify and determine the

patients health, problems and needs, and to develop the skills needed to render proper

nursing care to the patient.

XLI.
B. Specific Objectives
XLII.
1. Knowledge/Cognitive
To establish therapeutic communication to gather pertinent data
To analyze the diagnostic and laboratory exams done to the patient and

understand its significance to the disease condition.

To formulate an effective and efficient nursing care plan
XLIII.
2. Skills/Psychomotor
To perform physical examinations and necessary nursing procedures.
XLIV.
3. Attitude/Affective
To establish good rapport with the client, clients relatives and to the

staff nurses assigned at the emergency room.

To cooperate with each member of the group for the success of our

case study.

XLV. PATIENTS PROFILE

XLVI. A. Patients Data

XLVII. Name: RSG

 XLVIII. Age: 18 years old

XLIX. Sex: Male

L. Birthdate: September 13, 1997

LI. Birth Place: Danao, Bohol

LII. Address: Antipolo City

LIII. Religion: Roman Catholic

LIV. Nationality: Filipino

LV. B. Admission Data

LVI. Date of Admission: January 29, 2016 (03:46PM)

LVII. Hospital: Unciano Medical Center

LVIII. Chief Complain: Swelling Right Thigh

LIX. Admitting Diagnosis: Soft Tissue Swelling Right Thigh

LX. Admitting Physician: Dr. Tipon

C. Medical History

Source and reliability of information:

LXI. The patient himself who seems to be reliable.

LXII. NURSING HISTORY

LXIII. History of Present Illness:

 LXIV. 3 months prior to admission, patient noted pinching pain on right leg, noted

swelling of right leg. Henceconsult done xray of leg, CBC, FNAB done (inflammatory) give

tramadol &coamoxiclav for 1 month. However, swelling persisted 1 week prior to admission

consult and was advised to admission.

LXV.

LXVI. Past Medical History:

LXVII. The patient consulted at the health center in Bohol when he was 10 years old

due to carbuncle (pigsa) at the right leg and was given antibiotics for 1 week.

LXVIII. +

LXIX. The client has no previous hospitalization. He has no allergies to foods and

medications. He hasnt undergone surgery yet. No past illnesses noted.

LXX. Family Health History: GENOGRAM

LXXI. No heredofamilial diseases known on both parents side and siblings.

LXXII. Father Side Mother Side

LXXIII. (+) Hypertension (-) Hypertension

LXXIV. (-) DM (-) DM

LXXV. (-) TB (-) TB

LXXVI.

LXXVII. GORDONS FUNCTIONAL HEALTH PATTERN

LXXVIII. GORDONS 11 FUNCTIONAL HEALTH PATTERN

LXXIX.
LXXX. LXXXI. Before LXXXII. During LXXXIII. Analys
hospitalizatio hospitaliz is
n: ation:
LXXXIV. HEALTH LXXXVIII. Illness
LXXXVI. According to the LXXXVII. He is not able and
PERCEPT
patient, being to do his daily hospitaliz
ION- ations
healthy is important. hygiene
HEALTH generally
A person is healthy routines require
MANAGE modificati
when he is strong; because of his
MENT ons in
he can do what he inability to
hygiene
PATTERN wants and does not move and practice.
LXXXV. experience any walk. Conventi
onal way
pain. A person has a
of
disease when he keeping
feels intolerable the body
pain and can do is altered
because
limited activites. of lack of
Patient said he has facilities
had immunizations and
privacy to
but not sure if it was
do
complete. No known personal
allergies to any food hygiene
practices.
and drugs. When he
His
feels sick or ill, she inability
takes over the to move
freely is
counter drugs like
also a
bio-flu or biogesic. hindrance

LXXXIX. NUTRITIO XCII. The patient XCIV. The

XCI. The patient eats 3 change in
NAL- has loss his
her
times a day and appetite and metabolic
METABOL
with afternoon pattern is
hasnt eaten a
IC due to his
snacks after coming lot. He is on a underlyin
PATTERN g
from school. DAT (Diet as
 XC. XCIII. Tolerated). He condition.
According to the likes to eat
patient, he eats fast food like
meat, fish and also Jollibees fried
vegetables. He chicken and
doesnt have any burgers rather
allergies on foods than the food
and drugs. His prepared by
appetite is moderate the hospital.
and usually His fluid intake
depends on the has decreased
food being served. to 5 glass of
He drinks 7 glass of water daily.
water daily.

XCV. ELIMINATI XCVIII. The patient C. The

XCVII. The patient does change in
ON voids 2-3
his
not have any times a day. eliminatio
PATTERN
problem on his n pattern
He was
XCVI. is due to
elimination pattern. always been lack of
He usually urinates activity
assisted by his
and
5-6 times a day sister when inadequat
without any e fluid
voiding in bed
intake
difficulty. He added pan. The color
that the color of his of his urine is
urine is light yellow. yellow. The
He didnt feel any patient
pain in urination. defecates
The patient once every
defecates once a two days.
day usually early in XCIX.
the morning before
going to school with
yellow to brown
color. He verbalized
 that sometimes
however, it is hard
in consistency with
dark color, which
generally depends
on what he eats.

CI. ACTIVITY- CIII. He could perform CIV. His activity CV. Patient
lacks
EXERCIS his activities daily was limited
activity
E living. According to lying on bed. and
exercise
him, he often plays
PATTERN because
basketball and this he is
CII. immobile
serves as his form
due to his
of exercise. He likes wound.
to converse with his
friends and
neighbors when he
is done with his
chores. He does not
involve himself in
any vigorous
activities. However,
he is aware that his
activity is not
enough and he
recognizes the
importance of
having regular
exercise.
CVI. SLEEP- CVIII. He has the normal CXII. The
CXI. He doesnt change in
REST 6-8 hours sleep. He
his
also has his nap have the sleeping
PATTERN
adequate time pattern is
time for 1-2 hours a
CVII. due to
day. of sleep since adherenc
 CIX. Sleeping and e in time
he is disturbed of
watching the
medicatio
television are his with the n and
nurses that vital signs
form of rest.
monitorin
CX. enters the g.
room every
now and then,
and because
of the
environmental
changes of his
surroundings.
He also has
inadequate
time to rest
since he
doesnt have
enough time
to sleep.

CXIII. COGNITIV CXVII.

CXV. He is normal in CXVI. He was
E-
terms of his normal as
PERCEPT
cognitive abilities. before in his
UAL
He has good cognitive and
PATTERN memory and perceptual
CXIV. reasoning skills. He pattern. He
can easily responds
comprehend on clearly and
things. In terms of well
his perceptual understood.
pattern, he has no He has no
problems with his sensory
senses. deficit; He
responds
 appropriately
to verbal and
physical
stimuli and
obeys simple
commands.

CXVIII. SELF- CXXI. Patient is CXXII. The

CXX. He sees himself as change in
PERCEPT concerned if
his self-
a person with a he will still be perceptio
ION
good personality. n is due
able to move
SELF- to his
He has been a good and walk wound.
CONCEPT He
friend, brother and a normally.
PATTERN worries
son. He said he has Patient is not that he
CXIX. to be a good person might not
satisfied with
be able to
in order not to hurt his health function
others. He also like
status.
before.
describes himself as His body
a typical type of image
changed
student and person. because
he
worries
that he
will
become
depende
nt to
other
people.
CXXIII. ROLE- CXXVIII. Patient
CXXV. He has a close CXXVI. He had more feels that
RELATION he is
relationship with his time to bond inadequat
SHIP
family. They were with his family. e to fulfil
PATTERN and
eight siblings in their He said that it share
CXXIV. himself to
family. He was at was a nice
the
the 7th. I was also feeling to people
able to ask his sister know that your around
him
 because
about his brother family is so he is
incapacit
being a son and she concerned to ated and
confessed that he is him. He cant do
things
a good son but at learned to like
times he doesnt appreciate the before.
obey her. He is also beauty of
a responsible having a
student and knows family that
all his duties as a gives you
friend. strength and
support no
matter what.

CXXVII.
CXXIX. SEXUALITCXXXI. According to him,
CXXXIII. CXXXIV.
Y- he doesnt think of

REPROD the things like

having a girlfriend
UCTIVE
and getting
PATTERN
CXXXII. married yet. He is
CXXX.
still young for such
matters.
CXXXV. COPING-
CXXXVII. He does not fully CXXXIX. He shares his CXLI.
STRESS identify his problems to

TOLERAN situations having his family. He

stress but he always verbalizes his
CE
tell his feelings.
PATTERN
CXXXVIII. parents when CXL.
CXXXVI.
something is wrong.
CXLII. VALUE- CXLV. He prays moreCXLVI. The
CXLIV. He is a Roman change in
BELIEF often to ask for
his value
Catholic. He goes to guidance. belief is
PATTERN
church with his due to his
CXLIII. condition.
family occasionally. He feels
He was taught by that he
 needs
his family to believe more
spiritual
and have fear to guidance
GOD. to give
him
strength
in dealing
with his
current
situation.
CXLVII.
CXLVIII.

CXLIX. PHYSICAL EXAMINATION

CL. Date assessed: February 03, 2016

General assessment: The patient is awake, conscious, and responsive. The client has

an IVF of ________________ @ ___ metacarpal vein, infusing and regulated well.

Initial vital signs: T=____ C, PR=____bpm, RR=___cpm, BP=________mmHg.

CLI. Physical CLII. Metho CLIII. Normal CLIV. Actual CLV. Analysi

assessm ds finding finding s

ent use
I. Head CLVI. Palpat CLVII. Head isCLVIII. Symmetric in CLIX. Normal

ion symmetric, shape, round

round, and in the

erect and midline. No

in midline. Visible

no lesions lesions.

are visible.
A. Hair CLX. Inspec CLXI. Black CLXII. Black inCLXIII. Dry and

tion, evenly color. evenly moist

palpati distributed distributed hair

 on and covers that covers and

the whole the whole presenc

scalp, thick scalp. e of

and shiny Slightly thick, dandruf

free from moist and f.

split ends. dry with split

ends with

presence of

dandruff.
B. Face CLXIV. InspecCLXV. Oval, CLXVI. Round CLXVII.
in Pale

tion square or shape. appear

heart Absence of ance

shape. involuntary Facial

Symmetry muscle. express

and no Face is ion

involuntary slightly pale. shows

muscle. Facial anxiety

expression and

shows irritable

anxiety and due to

irritable his

complai

nt of

pain.
C. Eyes CLXVIII. InspecCLXIX. Parallel CLXX. Eyes are
CLXXI. Normal

tion and evenly black in

placed, color,
 symmetrica Parallel in

l. none position and

protruding equal in size

with scant and shape.

amount of Scleras are

secretions, anicteric.

both eyes

black and

clear.
D. Ears CLXXII. Inspec
CLXXIII. Position CLXXIV.
of Align with
CLXXV. Presen

tion the ears is the eyes, ce of

line up with color is cerume

the eyes. similar to the n is due

the color is face, shape to not

similar with is proportion taking

the facial with the bath

color. head. and

Shape is presence of unable

proportion cerumen in to clean

to the face; the inner part by the

no of ear. relative

drainage, becaus

nodules or e

lesions. patient

is

irritable
 CLXXVI.

CLXXVII.

CLXXVIII.
E. Nose CLXXIX. Inspec
CLXXX. Midline and
CLXXXII. Nose is CLXXXIII.
in Normal

tion/ symmetric. the midline.

Palpat Equal Equal nasal

ion nasal opening and

opening. there is no

Presence nasal

of nasal discharges.

folds

CLXXXI.
F. MouthCLXXXIV. Inspec
CLXXXV. Lips CLXXXVI.
are Lips CLXXXVII.
are Pale

tion pinks, cracked and and

smooth pale in color. cracked

and moist. Dry, rough in lips, dry

Gums are texture. and

moist and Gums are rough

pinkish pale in color and

without any with no foul texture

discharges odor. of the

mouth

is due

to

inadequ

ate fluid

intake.
G. TeethCLXXXVIII. Inspec
CLXXXIX. 3 molar, 2 CXC. Complete CXCI. Comple

tion premolar, 1 teeth without te teeth

canine and dentures are due

1 central use. Align to

incisor. well. calcium

Align well level

and no foul that has

odor been

maintai

ned

upon

childho

od up

to the

present

CXCII.

CXCIII.

CXCIV.
H. Inspectio CXCV. Inspec
CXCVI. ProportionCXCVII. Proportion CXCVIII.
to Normal

n tion/ to the size the size of

palpati of the the body. No

on body, tenderness

symmetrica present.

l in shape,

palpable
 masses.
II. Thora
CXCIX. Inspec CC. Scapula CCI. Scapula are CCII. Normal

x and tion, are symmetric

lungs: palpati symmetric and no

A. Posterior on, and no protrusion.

thorax percus protruding. No

sion, Does not accessory

auscul use muscle use

tation accessory during

muscle in breathing. no

breathing. tenderness,

No pain. Has a

tenderness normal

, pain. has breath sound

a normal and pattern

breath

sound and

pattern.
B. Anterior CCIII. Inspec CCIV. Sternum isCCVI. Sternum CCVII. Normal

thorax tion, positioned located at

palpati at the the midline

on, midline and and straight.

percus straight. Relaxed,

sion, respiration effortless

auscul is relaxed, and quite

tation effortless during

and quite. respiration.

 Use of No use of

accessory accessory

muscle is muscle.

not seen Lung is

with normal resonance in

respiratory sound

effort. No

tenderness

or pain

palpated.

CCV.
C. BreathingCCVIII. Inspec CCIX. Respiratory CCX. Respiratory CCXI. Normal

tion, rate of 12 rate of 15CCXII.

Auscul to 20 per minute

tation counts per

minute.

Lung

sounds are

clear to

auscultatio

bilaterally.
D. Heart CCXIII. PalpatCCXIV. Heart rateCCXV. Heart rate of
CCXVI. Normal

Rate ion of 60 to 60 beats per

100 beats minute. And

per minute. blood

Blood pressure of
 pressure is 100/80

within 90-

120/ 60-90

mmhg
E. Breast CCXVII. Inspec
CCXVIII. Texture is
CCXIX. Breast areCCXX. Normal.

tion, smooth equally in

palpati with no size and

on edema. smooth in

Areolas texture.

vary from Areolas are

pink to dark brown

dark in color.

brown. there is no

nipples are tenderness

equally upon

bilateral in palpation.

size
F. Abdomen
CCXXI. Inspec
CCXXII. AbdomenCCXXIII. Abdomen CCXXIV. Normal

tion, is free from has same

palpati lesions, color with the

on, tenderness face. Bowel

auscul or pain and sound are

tation, palpable slightly heard

percus masses. on

sion Umbilicus auscultation

is free from and there

swelling are no
 bulge and protrusion

masses. and pain felt

upon

palpation

and

percussion.
G. Lower CCXXV. Inspec
CCXXVI. Skin color
CCXXVII. He CCXXVIII.
has Pale

extremitie tion, varies brown texture

s: palpati within the complexion, is due

A. Legs on normal slightly rough to and

range, skin in texture, lack of

is smooth has abcess hygiene

no lesions, in the right and

absence of leg febrile.

varicose

veins. And

there is

presence

of good

muscle

tone.
H. Mental CCXXIX. Listeni
CCXXX. The patient
CCXXXI. Patient CCXXXII.
is Depres

Status ng, should be aware but sed due

Obser conscious dizzy. He is to his

vation and aware depressed conditio

in her and not n.

surroundin cooperative.
 gs.
CCXXXIII.

CCXXXIV.

CCXXXV.

CCXXXVI.

CCXXXVII. ANATOMY AND PHYSIOLOGY

A. Integumentary System
CCXXXVIII. The integumentary system is the organsystem that protects the body from

various kinds of damage, such as loss of water or abrasion from outside.

The system comprises the skin and its appendages (including hair, scales, feathers,

hooves, and nails).

CCXXXIX. Functions of the integumentary system include:

1. Protects the body's internal living tissues and organs

2. Protects against invasion by infectious organisms
3. Protects the body from dehydration
4. Protects the body against abrupt changes in temperature
5. Helps dispose of waste materials
6. Acts as a receptor for touch, pressure, pain, heat, and cold
7. Stores water and fat

CCXL. The three layers of the skin:

a) Epidermis
CCXLI. -the outermost layer of skin, provides a waterproof barrier and creates our

skin tone.
b) Dermis
CCXLII. -beneath the epidermis, contains tough connective tissue, hair follicles,

and sweat glands.

c) Hypodermis
CCXLIII. -is made of fat and connective tissue.
B. Lymphatic System
 CCXLIV. The lymphatic system is a network

of tissues and organs that help rid the body of

toxins, waste and other unwanted materials. The

primary function of the lymphatic system is to

transport lymph, a fluid containing infection-

fighting white blood cells, throughout the body.

CCXLV. Functions of the lymphatic system include:

1. Transport of excess tissue fluid to the blood vascular system.

2. Transport of red blood cells to the blood vascular system.
3. Maintenance of blood pressure in the venous circulation.
4. Excretion of excess dietary fat

CCXLVI. Lymph is a clear-to-white fluid made of white blood cells, especially lymphocytes,

the cells that attack bacteria in the blood and fluid from the intestines called chyle, which

contains proteins and fats.

CCXLVII. Lymph nodes are soft, small, round- or bean-shaped structures. They usually

cannot be seen or easily felt. They are located in clusters in various parts of the body, such as

the neck, armpit, groin, and inside the center of the chest and abdomen

CCXLVIII. Lymph nodes make immune cells that help the body fight infection. They also

filter the lymph fluid and remove foreign material such as bacteria and cancer cells. When

bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white

blood cells, which cause the nodes to swell. The swollen nodes are sometimes felt in the neck,

under the arms, and groin.

CCXLIX.

CCL. Phagocytosis:
 CCLI.CCLII. A phagocyte is a cell able to engulf and digest bacteria, protozoa, cells, cell debris, and

other small particles. Phagocytes include many leucocytes (white blood cells) and

macrophages - which play a major role in the body's defence system.

CCLIII.
CCLIV. Phagocytosis is the engulfment and digestion of bacteria and other antigens by

phagocytes.
 CCLV.

CCLVI. Lymphocytes: CCLVII.

CCLVIII. CCLIX. The term "antigen" refers to something that is not naturally present and 'should
CCLX.not

be in the body'.

CCLXI. CCLXII. T Cells (lymphocytes) are activated by the thymus gland. CCLXIII.

CCLXIV. CCLXV. B Cells (lymphocytes) are activated by other lymphoid tissue. The 'B' indicates
CCLXVI.
'bone marrow' cells.

CCLXVII. CCLXVIII. Both T-cells and B-cells:

CCLXIX.
(1) destroy antigens, and

(2) produce 'memory cells' and anti-bodies.

CCLXX.

CCLXXI.

CCLXXII.

CCLXXIII.

CCLXXIV. Basophils:

CCLXXVI.CCLXXVII. An increased (higher than usual) percentage of basophils in the blood may
CCLXXVIII.
indicate an inflammatory condition somewhere in the body.

CCLXXIX.

CCLXXX. Neutrophils & Monocytes:

 CCLXXXII.CCLXXXIII. Neutrophils are the first leucocytes to respond to bacterial invasion of the

body. They act by carrying out the process of phagocytosis (see opposite),

and also be releasing enzymes - such as lysozyme, that destroy certain

bacteria.
CCLXXXIV.
Monocytes take longer to reach the site of infection than neutrophils - but

they eventually arrive in much larger numbers. Monocytes that migrate into

infected tissues develop into cells called wandering macrophages that can

phagocytize many more microbes than neutrophils are able to.

Monocytes also clear up cellular debris after an infection.

CCLXXXV. Eosinophils:

CCLXXXVII.
CCLXXXVIII. An increased (higher than usual) percentage of eosinophils in the blood
CCLXXXIX.

may indicate parasitic infection somewhere in the body.

CCXC.
CCXCI.

CCXCII.

CCXCIII.

CCXCIV.

CCXCV.

CCXCVI. PATHOPHYSIOLOGY

CCXCVII. Predisposing Factors:

-inflammatory response to an
CCXCVIII.
infectious process
(invasion of bacteria or parasite)
CCXCIX.
-Minor wound/Skin disease
CCC. (boils/folliculitis)
-problems with immune system
-poor nutrition
-poor hygiene
 CCCI.

CCCII.

CCCIII. Entry of foreign material or microorganisms(Staphylococcus aereus)

CCCIV.

CCCV. Microorganism kills/attacks the local cells

CCCVI.

Feve CCCVII. Release of toxins

CCCVIII.

CCCIX. Triggering of an inflammatory response

CCCX.

Localize CCCXI. Drawing of huge amount of white blood cells to the infected site
d
CCCXII.
swelling
Tenderness
CCCXIII. Increase blood flow to affected area and warmth
in the
CCCXIV.

CCCXV. Formation of pus

CCCXVI.

CCCXVII. Adjacent healthy cells forms a barrier around the pus

CCCXVIII.

CCCXIX. ABSCESS FORMATION

CCCXX.

CCCXXI.
CCCXXII. PUS FORMATION
CCCXXIII.
CCCXXIV.
CCCXXV.
CCCXXVI.
CCCXXVII. Blood vessels permit the migration of the wbc,

CCCXXVIII. mainly neutrophils, outside of the blood vessels

CCCXXIX. (extravasation) into the tissue

 CCCXXX.

CCCXXXI.

CCCXXXII. The neutrophils migrate along a chemotactic

CCCXXXIII. gradient created by the local cells

CCCXXXIV. to reach the site of injury

CCCXXXV.

CCCXXXVI.

CCCXXXVII. along with the destruction of the pathogens

CCCXXXVIII. is the death of the leukocytes

CCCXXXIX.

CCCXL.

CCCXLI. dead tissues, dead leukocytes and

CCCXLII. the pathogens destroyed collect

CCCXLIII. *accumulation of cellular debris

CCCXLIV.

CCCXLV.

CCCXLVI.

CCCXLVII.

CCCXLVIII. COLLABORATIVE MANAGEMENT

1. LABORATORY/ DIAGNOSTIC STUDIES

HEMATOLOGY
 CCCXLIX. CCCL. 1/2
CCCLII. 2/2/
CCCLIV. REFER CCCLV. CLINICAL

9/1 26 ENCE SIGNIFICANCE

6
CCCLIII. RE

CCCLI. RE SU

SU LT

LT

CCCLVI. WBC CCCLVIII. 13.

CCCLIX. 11.
CCCLXI. 5 CCCLXIII.
10 Increase.There
0*
CCCLVII. 40* X109/L is a presence of

infection. The
CCCLX. CCCLXII.
body is adapting

to the pathogen

present to

produce

antibodies.

CCCLXIV. Hematocrit
CCCLXVI. 0.3
CCCLXVIII. 0.2
CCCLXX. 0.40CCCLXXI.
Decrease
3*
CCCLXV. 2* 0.54 percentage of
CCCLXVII. red blood cells in
CCCLXIX.
the whole blood

CCCLXXII. Hemoglobin
CCCLXXIII. 110
CCCLXXIV. CCCLXXVI.
73* 140
CCCLXXVII.
Insufficient
*
175 g/L supply of oxygen
CCCLXXV.
to the body

CCCLXXVIII.

CCCLXXIX.
CCCLXXX.

CCCLXXXI.

CLINICAL CHEMISTRY

CCCLXXXV. CLINICAL
CCCLXXXII. 01/29/
CCCLXXXIII. RESULT
CCCLXXXIV. REFERENCE
SIGNIFICANCE
16

CCCLXXXVI. BUN CCCLXXXIX. Normal

CCCLXXXVII. 5.36 CCCLXXXVIII. 2.9-8.20

mmol/L

CCCXC. CREA
CCCXCI. 85.27 CCCXCII. 62-115 CCCXCIII. Normal

CCCXCIV. Sodiu
CCCXCV. 135.5 CCCXCVI. 135 CCCXCVII.
-145 Normal
m
mmol/L

CCCXCVIII. Potas
CCCXCIX. 3.85 CD. 3.5 5.5 CDI. Normal
sium
mmol/L

CDII.

ULTRASOUND REPORT

CDIII.

CDIV. BODY CDV. 1/31/16 CDVII. REFERENCE CDVIII. CLINICAL

PART SIGNIFICANCE
CDVI. IMPRES

SION
 CDIX. RightCDXIII. Large CDXVI. Evaluation of infections,
CDXV. Upper half 22.5
Thigh abscess including abscess, and
x 13.96 x 17.17
necrotizing fasciitis and
CDX. CDXIV. formatio cm
to locate foreign bodies.
n
CDXI. Thus monitoring the

accumulation of pus
CDXII.
extent.

CDXVII.

X-RAY REPORT

CDXVIII.

CDXIX. BODY CDXX. 1/31/16 CDXXII. CLINICAL SIGNIFICANCE

PART
CDXXI. IMPRESSION

CDXXIII. Chest
CDXXIV. Essentially CDXXV. Help come to a diagnosis. The soft

normal chest tissues are also often misleading and it is

important to be aware of the pitfalls.

CDXXVI. RightCDXXX. Negative CDXXXI.

for Help find the cause of symptoms such as

Thigh fracture pain, limp, tenderness, swelling, or

deformity of the upper leg. It can detect a

CDXXVII.
broken bone, and after a broken bone has

CDXXVIII. been set, it can help determine whether

the bone is in satisfactory alignment.

CDXXIX.

CDXXXII.

CDXXXIII.
 CDXXXIV.

CDXXXV.

CDXXXVI.

CDXXXVII.

CDXXXVIII.

CDXXXIX.

2. DRUG STUDY

CDXL. PHARMACOKIN CDXLI. PHARMACODYNAMICS CDXLII. PHARMACOTHER

ETIC APUTIC
CDXLIII. CDL. CDLIX.
CDXLIV. Generic name : CDLI. Indication : CDLX. Therapeutic
gentamicin CDLII. For treatment of serious action :
CDXLV. Brand name : infections caused by CDLXI. entamicin may be
CDXLVI. Dosage : 120mg susceptible strains of the used in the
CDXLVII. following microorganisms: P. treatment of
CDXLVIII. Absorption : aeruginosa, Proteus species infection with gram-
CDXLIX. Injections lead to (indole-positive and indole- negative bacteria
peak serum negative), E. coli,Klebsiella- including
concentrations in Enterobactor-Serratia species, Pseudomonas spp
30-60 minutes. Citrobacter species and Proteus spp.
Topical and Staphylococcus species Resistance will
gentamicin is (coagulase-positive and only appear in
readily absorbed coagulase-negative). suboptimal or too
from large CDLIII. prolonged courses
burned, CDLIV. Contraindication : of treatment and
denuded, or CDLV. Gentamicin should not be used usually is due to
granulating if a person has a history 'multi-step
areas but not of hypersensitivity such as mutation'. This
through intact anaphylaxis shock or other resistance may be
skin. Absorption serious toxic reaction to prevented, among
of gentamicin is gentamicin or any other others, by
faster and Aminoglycosides combined
greater with the CDLVI. treatment with
cream compared CDLVII. Side effects : gentamicin and an
to the ointment.CDLVIII. Side effects of gentamicin can antibiotic of the
Gentamicin is range from less severe beta lactam group.
absorbed in reactions such as nausea and When gentamicin
small quantities vomiting to more severe is used correctly, it
following topical reactions such as: will have few toxic
application to the Low blood counts side-effects. Thus,
eye. Gentamicin Allergic responses 3 mg/kg of body
is also absorbed Neuromuscular problems weight three times
in small amounts Nerve damage daily will usually be
following topical Kidney damage indicated to ensure
application to the Ear disorder an optimum
ear (especially if therapeutic effect.
the eardrum is Parenteral
perforated or if administration of
tissue damage is gentamicin would
present). only appear to be
Gentamicin is useful in cases of
very poorly bacteraemia and/or
absorbed orally bacterial infection
of the kidney
and/or urinary
excretory ducts; in
the last-named
case, the dose
given at one time
may be reduced by
fifty per cent. Local
treatment, the most
recent method of
which consists in
administration by
I(ntra-)T(racheal)
route, apparently
offers more
prospects.
 CDLXII. CDLXXVI. CDLXXXV.
CDLXIII. Generic name CDLXXVII.
: Indication : CDLXXXVI. Gentamicin may be
CDLXIV. Cloxacillin CDLXXVIII. Systemic infections by penicillin used in the
CDLXV. Brand name : as e-producing staphylococci treatment of
CDLXVI. Dosage : 500 organisms. infection with gram-
mg/cap CDLXXIX. negative bacteria
CDLXVII. CDLXXX. Contraindication : including
CDLXVIII. Absorption : CDLXXXI. Contraindicated in patients Pseudomonas spp
CDLXIX. Absorbed rapidly hypersensitive to drug or other and Proteus spp.
but incompletely penicillins. Resistance will
(37% to 60%) CDLXXXII. only appear in
from the GI CDLXXXIII.
tract; Side effects : suboptimal or too
its relativelyCDLXXXIV.
acid CNS: lethargy, prolonged courses
stable. Food hallucinations, seizures, anxiety, of treatment and
may decrease confusion, agitation, usually is due to
both rate and depression, dizziness, fatigue. 'multi-step
extent of GI: nausea, vomiting, epigastric mutation'. This
absorption. distress, resistance may be
CDLXX. diarrhea, enterocolitis, pseudom prevented, among
CDLXXI. Metabolism : embranous colitis, black "hairy" others, by
CDLXXII. Only partially tongue, abdominal pain. combined
metabolized. GU: interstitial nephritis, treatment with
CDLXXIII. nephropathy. gentamicin and an
CDLXXIV. Excretion : Hematologic: eosinophilia, antibiotic of the
CDLXXV. Excreted in urine anemia, thrombocytopenia, beta lactam group.
by renal tubular leukopenia, hemolytic When gentamicin
secretion and anemia, agranulocytosis. is used correctly, it
glomerular Hepatic: intrahepatic will have few toxic
filtration; also cholestasis. side-effects. Thus,
appears in Other: hypersensitivity 3 mg/kg of body
breast milk. reactions (rash, urticaria, chills, weight three times
Elimination half- fever, sneezing, daily will usually be
life in adults is wheezing, anaphylaxis, indicated to ensure
1/2 to 1 hour, overgrowth of nonsusceptible an optimum
extended to 2 organisms. therapeutic effect.
1/2 hours in Parenteral
patients with administration of
renal gentamicin would
impairment. only appear to be
useful in cases of
bacteraemia and/or
bacterial infection
of the kidney
and/or urinary
 excretory ducts; in
the last-named
case, the dose
given at one time
may be reduced by
fifty per cent. Local
treatment, the most
recent method of
which consists in
administration by
I(ntra-)T(racheal)
route, apparently
offers more
prospects.
CDLXXXVII. CDXCVII. DIX.
CDLXXXVIII. Brand name CDXCVIII.
: Indication : DX. antibacterials for
CDLXXXIX. Cefuroxime CDXCIX. is indicated for the treatment of systemic use,
CDXC. Brand name : patients with infections caused second-
zinacef by susceptible strains of the generationcephalo
CDXCI. Dosage : 750 mg designated organisms sporins
tab D.
CDXCII. DI. Contraindication :
CDXCIII. Absorption :
CDXCIV. After oral DII. Hypersensitivity to cefuroxime
administration or to any of the excipients listed
cefuroxime axetil in section 6.1.
is absorbed from
the DIII. Patients with known
gastrointestinal hypersensitivity to
tract and rapidly cephalosporin antibiotics.
hydrolysed in the
intestinal DIV. History of severe
mucosa and hypersensitivity (e.g.
blood to release anaphylactic reaction) to any
cefuroxime into other type of betalactam
the circulation. antibacterial agent (penicillins,
Optimum monobactams and
absorption carbapenems).
occurs when it is
administered DV.
shortly after a
meal. DVI. Adverse effect:
CDXCV.
CDXCVI. DVII. Less serious side effects may
include:
 nausea, vomiting, stomach
pain, mild diarrhea, gas, upset
stomach;
cough, stuffy nose;
stiff or tight muscles, muscle
pain;
joint pain or swelling;
headache, drowsiness;
feeling restless, irritable, or
hyperactive;
white patches or sores inside
your mouth or on your lips;
DVIII.
DXI. DXXIV. DXXXIV. .
DXII. Brand name : DXXV. Indication : DXXXV. This drug is an
DXIII. Clindamycin DXXVI. Clindamycin is indicated in the antibiotic generally
DXIV. Generic name: treatment of serious infections used for infections
DXV. Dosage : caused by susceptible caused by
DXVI. 300 mg/tab anaerobic bacteria. sensitive
DXVII. DXXVII. staphylococci,
DXVIII. Absorption : DXXVIII. Contraindication : streptococci,
DXIX. Serum level DXXIX. Clindamycin hydrochloride is pneumococci,
studies with a contraindicated in individuals Bacteroides,
150 mg oral with a history of hypersensitivity Fusobacterium,
dose of to preparations containing Clostridium
clindamycin clindamycin or lincomycin. perfringens, and
hydrochloride in DXXX. other sensitive
24 normal adult DXXXI. Adverse effect : aerobic and
volunteers DXXXII. Less serious side effects may anaerobic
showed that include: organisms.
clindamycin was change in bowel habits
rapidly absorbed (especially in older adults);
after oral mild nausea, vomiting, or
administration.
stomach pain;
An average peak
serum level of joint pain;
2.50 mcg/mL vaginal itching or discharge;
was reached in
mild rash or itching; or.
45 minutes;
serum levels heartburn, irritation in your
averaged 1.51 throat.
mcg/mL at 3 DXXXIII.
hours and 0.70
mcg/mL at 6
hours.
Absorption of an
oral dose is
virtually
complete (90%),
and the
concomitant
administration of
food does not
appreciably
modify the
serum
concentrations;
serum levels
have been
uniform and
predictable from
person to person
and dose to
dose. Serum
level studies
following multiple
doses of
clindamycin
hydrochloride for
up to 14 days
show no
evidence of
accumulation or
altered
metabolism of
drug. Doses of
up to 2 grams of
clindamycin per
day for 14 days
have been well
tolerated by
healthy
volunteers,
except that the
incidence of
gastrointestinal
 side effects is
greater with the
higher doses.
DXX.
DXXI. Excretion :
DXXII. The average
biological half-
life is 2.4 hours.
Approximately
10% of the
bioactivity is
excreted in the
urine and 3.6%
in the feces; the
remainder is
excreted as
bioinactive
metabolites
DXXIII.
DXXXVI. DL. DLIX.
DXXXVII. Brand name : DLI. Indication : DLX. his study compared
DXXXVIII. Ketorolac the efficacy and
DXXXIX. Generic name : DLII. Ketorolac tromethamine is safety of ketorolac
DXL. Toradol tromethamine and
a nonsteroidal anti-inflammatory
DXLI. Dosage : morphine sulfate in
DXLII. 30 mg drug (NSAID) that exhibits alleviating
DXLIII. analgesic activity in animal moderate or severe
DXLIV. Absorption : models. The mechanism of pain immediately
DXLV. TORADOL action of ketorolac, like that of after major surgery.
(ketorolac One hundred
other NSAIDs, is not completely
tromethamine) is twenty-two patients
100% absorbed understood but may be related were randomly
after oral to prostaglandin synthetase assigned to receive
administration inhibition. The biological activity single intravenous
Oral of ketorolac tromethamine is injections of
administration of ketorolac 10 mg,
associated with the S-form.
TORADOL ketorolac 30 mg,
Ketorolac tromethamine
(ketorolac morphine 2 mg, or
tromethamine) possesses no sedative or morphine 4 mg;
after a high-fat anxiolytic properties. patients could
meal resulted in receive a second
decreased peak DLIII. The peak analgesic effect of dose 15 minutes
and delayed TORADOL (ketorolac thereafter, upon
time-to-peak request, and most
tromethamine) occurs within 2
 concentrations of received both
ketorolac to 3 hours and is not statistically available doses.
tromethamine by Analgesic efficacy
significantly different over the
about 1 hour. was measured by
Antacids did not recommended dosage range of interviewing
affect the extent TORADOL (ketorolac patients and
of absorption. tromethamine) . The greatest assessing pain
DXLVI. difference between large and intensity and pain
DXLVII. Metabolism: relief for 6 hours
small doses of TORADOL
DXLVIII. Ketorolac after the first
tromethamine is (ketorolac tromethamine) is in medication
largely the duration of analgesia. administration. The
metabolized in two drugs showed
the liver. The DLIV. Adverse effect : a similar onset of
metabolic DLV. Less serious side effects action, peaking 1
products are hour after
may include:
hydroxylated and upset stomach, mild nausea or administration.
conjugated vomiting, diarrhea, constipation; When placed in
forms of the order of
mild heartburn, stomach pain,
parent drug. The descending
products of bloating, gas; efficacy, the mean
metabolism, and dizziness, headache, scores for most
some drowsiness; efficacy measures
unchanged drug, sweating; or. fell into the
are excreted in following
ringing in your ears.
the urine. sequence:
DXLIX. ketorolac 30 mg,
DLVI. ect :
ketorolac 10 mg,
morphine 4 mg,
DLVII. and morphine 2
mg. There were no
DLVIII.
statistically
significant
differences among
the two ketorolac
doses and the high
dose of morphine,
but all three of
these treatments
were significantly
superior to the low
morphine dose.
One patient who
took morphine 4
 mg withdrew
because of
drowsiness; other
common adverse
events reported
included nausea,
vomiting,
somnolence, and
dyspepsia. There
were no statistically
significant
differences in the
frequency of
adverse events
among the
treatment groups.
Intravenous
ketorolac is
effective for the
treatment of
posterative pain.
DLXI.

DLXII.

DLXIII.

DLXIV.

DLXV.

DLXVI.

DLXVII.

DLXVIII.
3. FDAR STUDENT NURSES NOTES

DLXIX. DATE/HO DLXX. FOCUS DLXXI. PROGESS NOTES

UR
 DLXXII. DLXXIII. Impaired DLXXIV. D:
skin Vital Sign
integrity BP: 110/70
related to PR: 73
slow wound RR: 20
healing at T: 36.1
the right Presence of large abscess(57 cm)at
thigh. right thigh
DLXXV.
DLXXVI. A:
Monitor Vital Sign and recorded
Input and output taken and monitor
Kept affected leg elevated
Provide calm and safe environment
Health teaching on proper hygiene
Administered medication
DLXXVII.
DLXXVIII. R:
The patient displayed a timely wound
healing
DLXXIX. DATE/H DLXXX. FOCUS DLXXXI. PROGRESS NOTES
OUR
DLXXXII. DLXXXIII. Acute pain
DLXXXIV. D:
related to Pain scale of 5 out of 10
increased (+) facial grimace
permeability Less movement on the (R) leg as
and compared to the (L) leg
stimulation
DLXXXV.
of pain DLXXXVI. A:
receptors Monitor Vital Sign
secondary Performed pain assessment
to release of Provide comfort measure
inflammator - Placing pillow under the right
y mediators buttock
- Placing warm compress over
affected area of pain
Encouraged diversion activities
- Talking with family and friends
Administered ketorolac 30mg
Informed patient when some
procedure can cause pain
Informed S.O a way to assist patient
in activities of daily living.
DLXXXVII. R:
 Pain scale reduced from 5 to 2
DLXXXVIII.
DLXXXIX.

DXC. DATE/H DXCI. FOCUS DXCII. PROGRESS NOTES

OUR
DXCIII. DXCIV. Ineffective DXCV. D:
tissue (R) thigh circumference larger than (L)
perfusion thigh
related to Abscess on right thigh (57cm)
obstruction Sign of inflammation on the (R) thigh
secondary - Pain
to abscess - Swelling
formation - redness
- heat
DXCVI. A:
Monitor Vital Sign
Observed nonverbal cues
Measured affected area
Provide measured comfort
Performed assistive range of motion
exercise
Administered ketorolac 30mg
Discouraged sitting for a long period
of time
DXCVII.
DXCVIII. R:
Removal of the obstruction and
increased tissue perfusion
DXCIX.

DC.

DCI.

DCII.

DCIII.

DCIV.

DCV.

DCVI. DATE/H DCVII. FOCUS DCVIII. PROGRESS NOTES

OUR
DCIX. DCX. Altered DCXI. D:
physical Limited movement on the (R) leg
 mobility Slowed movement as compared to the
related to (L) leg
decreased (R) thigh circumference larger than
muscle (L) thigh
strength Abscess on right thigh
secondary Sign of inflammation on the (R) thigh
to abscess - Pain
formation - Swelling
- redness
- heat
Flaccid right leg
DCXII.
DCXIII. A:
Assess degree of pain or affected area
Observed nonverbal cues
Determine degree of immobility
Note emotional and behavioral
response on the problem
Reposition patient on regular schedule
Administered pain medication as
ordered
Performed assistive range of motion
exercise
Informed S.O a way to assist patient in
activities of daily living.
DCXIV.
DCXV. R:
Removal of obstruction and increased
physical mobility.
DCXVI.

DCXVII.