St.

Mary’s College of Baliuag

College of Nursing
AY 2010-2011
Second Semester

A Case Study
Skin Abscess
(A Requirement for NCM 102: Pedia Wad)

Presented by:
Gregg Andrew J. de Leon

Presented to:
Mrs. Rhodara Sulit
Clinical Instructor
I. Objectives
1. To understand what Skin Abscess is all about
2. To determine the underlying cause of the occurrence of Skin
Abscess
3. To know the prevention and treatment for Skin Abscess
4. To provide the necessary nursing management for patients with
Skin Abscess

II. Introduction

Abscess is a pocket of pus collection caused due to suppuration after

bacterial infection (mostly) or injury or foreign substances. It can occur
anywhere in the body, i.e., outer surface or inner deeper organs or tissues. A
boil or a pustule or a pimple in skin can be considered as small abscess.
Initially, it will start with tender swelling with throbbing pain and its fate ends
in draining of pus either inside or outside where the points are weak and
easily prone for a let out. 

Incidences – Even though it can occur in any part of the body, most
commonly it occurs in and around the armpits and around anus (in buttocks).
It can also occur in the root of the tooth, tonsils, liver, kidney, intestines,
brain and spinal column. It is commonly noted in persons with poor hygiene,
diabetics, alcoholics and in allergic personalities (with drug or food or
irritants). Also it happens to crop up often in auto-immune disorders like
psoriasis, SLE and in cancers and also with their treatment.

Types – Abscess can be classified as acute and chronic depending upon the
period of suffering. Also it can be classified as septic abscess and sterile
abscess. 

Septic abscess is caused by bacterias and the bacteria can be identified with
culture reports, whereas sterile abscess is caused by injury or injection or
foreign substances without bacterial invasion. The abscess can be localised or
become multiple (generalised) with blood contamination. 

Symptoms - The most common symptoms are:

 Pain and sensitivity to touch. Pain will be mostly pricking in character.

 Redness and warm swelling

 Discharge of pus - when it opens

 Fever with chill and bodyache

  Nearby lymph node enlargement 

 Even though all the abscesses feel warm due to increased blood circulation,
tubercular abscesses usually remain cold and so are called cold abscess which
need immediate critical care. 

Causes – The most common causative factors are 

 Infection - Bacteria (Staphylococcus aureus or Streptococcus), fungus, viral,

etc.

 Injections and injuries including thorn pricks and insect bites 

 Diseases – diabetes, cancer and AIDS

 Drugs and therapy (steroidal and chemotherapy)

 Skin diseases – psoriasis, eczema,herpes, etc

 In all the cases, poor hygienic measures and negligence in taking treatment
account for the increased intensity of disease / suffering.

Diagnosis – The key symptoms, i.e., redness, heat, swelling and pain,
usually make diagnosis easy. Even though simple physical examination
is enough to diagnose the condition, persistent cases often require
routine blood tests and culture of the discharge. In suspected cases,
auto immune antibodies need to be analysed. 

complication – Usually, abscess drains (either by natural or by

surgical drainage) and gets healed. If there is lack of care in letting out
the pus and helping in the healing, the chances for spread of infection
through blood (septicaemia), formation of sinus / fistula / gangrene
may occur. Also, delayed wound healing usually ends in scar formation
with contractures and puckering. Above all, rupture of abscess in
deeper organs can threaten one’s life with the symptoms of shock.
Complications of most of cases are only due to negligence or because
of what is leftover.

III. Overview of the Disease

A. Review of Related Anatomy and Physiology
B. Pathophysiology

 – Normally, abscess formation is a natural process

in expelling the disease/foreign substances from our body. It needs to
get opened on its own or with surgical intervention to expel the liquid
contents. Initially, the infected or injured part will be flooded with
blood. This causes redness, swelling and heat on that part. Increased
blood supply also dilutes the toxins, supplies defence forces (white
blood cells, enzymes and antibodies) to the affected part and
nourishment to the inflamed part for better healing. Abscess finally
makes destruction/necrosis of the solid tissue around infective agent /
bacteria / foreign substance to form pus (yellow or green inflammatory
liquid containing digested / active germs, WBCs, cell debris, etc.), so
that it can simply wash out with the disease / foreign substances from
our body. Normally, it will take a week or two. Sometimes it can even
persist for months and also be recurrent in nature. 

IV. Medical and Surgical Management

General treatment and surgery – The first and foremost approach

of the modern school of medicine is to start with antibiotic treatment
to arrest infection and its spread. Usually, they follow antibiotics and
allow some time for the abscess to get ripened before doing I & D
(incision and drainage). They also provide analgesics to reduce pain
and anti-pyretic to reduce fever. Then, depending upon the cause and
symptoms, they will try to eliminate the cause and make drain to
switch off the pain and symptoms. Proper diagnosis, proper drainage
and proper hygienic care will cure the abscess at the earliest. In some
cases, even after surgical drain, wound healing may be difficult (if
wound is very deep). 

V. Nursing Management

Do’s

 Keep infected area dry and clean

 Give rest to part involved

 Elevate the infected area to make good venous drain and for reduction of pain

 Apply warmth to comfort pain. Warmth usually enhances the blood

 circulation, dilutes the infective agents and quickens the healing process. 

 Control sugar levels in case of diabetes

Take

 Plenty of water to keep good body hydration 

 Fresh fruits and vegetables for healthy living

 Supplements - Vitamins A, C and zinc for better healing 

Avoid 

 Picking or peeling or pinching 

 Fatty/oily foods

 Sugar