Care Plan for Abdominal Abscess

[Esme12, ASN, BSN, RN]

Intra-abdominal abscess

An intra-abdominal abscess is a pocket of infected fluid and pus located inside the belly (abdominal cavity). there may be more than one abscess.

Causes, incidence, and risk factors

An intra-abdominal abscess can be caused by a ruptured appendix, ruptured intestinal diverticulum, inflammatory bowel disease, parasite infection in the intestines (entamoeba histolytica), or other condition.

Risk factors include a history of appendicitis, diverticulitis, perforated ulcer disease, or any surgery that may have infected the abdominal cavity.

Symptoms

depending on the location, symptoms may include:

• abdominal pain and distention
• chills
• diarrhea
• fever
• lack of appetite
• nausea
• rectal tenderness and fullness
• vomiting
• weakness

Signs and tests

A complete blood count may show a higher than normal white blood count. a comprehensive metabolic panel may show liver, kidney, or blood chemistry problems.

A ct scan of the abdomen will usually reveal an intra-abdominal abscess. after the ct scan is done, a needle may be placed through the skin into the abscess cavity to confirm the diagnosis and treat the abscess.

Other tests may include:

• abdominal x-ray
• ultrasound of the abdomen

Treatment

Treatment of an intra-abdominal abscess requires antibiotics (given by an IV) and drainage. Drainage involves placing a needle through the skin in the abscess, usually under x-ray guidance. The drain is then left in place for days or weeks until the abscess goes away.

Occasionally, abscesses cannot be safely drained this way. in such cases, surgery must be done while the patient is under general anesthesia (unconscious and pain-free). a cut is made in the belly area (abdomen), and the abscess is drained and cleaned. a drain is left in the abscess cavity, and remains in place until the infection goes away.

It is always important to identify and treat the cause of the abscess.

Expectations (prognosis)

The outlook depends on the original cause of the abscess and how bad the infection is. generally, drainage is successful in treating intra-abdominal abscesses that have not spread.

Complications

Potential complications include:

• return of the abscess
• rupture of an abscess
• spread of the infection to the bloodstream
• widespread infection in the abdomen

What are they complaining of, what antibiotics are they on? Why are they still there? Care plan basics:

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what NANDA calls defining characteristics.

How does a doctor diagnose? They thoroughly review medical history and perform a physical examination first. Nurses do that too, it's part of step #1 of the nursing process.

Only then, does he use "medical decision making" to ferret out the symptoms the patient is having and determine which medical diagnosis applies in that particular case.

Each medical diagnosis has a defined list of symptoms that the patient's illness must match. Nurses do that too! We call it "critical thinking" and it's part of step #2 of the nursing process. The NANDA taxonomy lists the symptoms that go with each nursing diagnosis.

Nursing Process

1. Assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
3. Planning (write measurable goals/outcomes and nursing interventions)
4. Implementation (initiate the care plan)
5. Evaluation (determine if goals/outcomes have been met)

A care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. The nursing process itself is a problem solving method that was extrapolated from the scientific methods used by the various science disciplines in proving or disproving theories.

[nurseprnRN, BSN, RN]

many nursing students think there is a big list somewhere where column a is the medical diagnosis and column b is the nursing diagnosis. this is wrong-headed for several reasons. one is that nursing diagnoses are made by nurses using the nursing process (which i know you don't have a good handle on yet but we're trying to help), not dependent on a medical diagnostic process. nursing diagnosis is in no way subservient to or inferior to medical diagnosis.

yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.

for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology. i'm pretty sure i will probably see a constellation of nursing diagnoses related to these effects, and i will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. i might find readiness to improve health status, or ineffective coping, or risk for falls, too. these are all things you often see in diabetics who come in with complications. they are all things that nursing treats independently of medicine, via the nursing plan of care, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. but i can't put them in any individual's plan for nursing care until *i* assess for the symptoms that indicate them, the defining characteristics of each.

medical diagnoses, when accurate, can be supporting documentation for a nursing diagnosis, for example, "activity intolerance related to (because the patient has) congestive heart failure/duchenne's muscular dystrophy/chronic pulmonary insufficiency/amputation with leg prosthesis." however, your faculty will then ask you how you know. this is the dread (and often misunderstood) "as evidenced by."

in the case of activity intolerance, how have you been able to make that diagnosis? you will likely have observed something like, "chest pain during physical activity/inability to walk >25 feet due to fatigue/inability to complete am care without frequent rest periods/shortness of breath at rest with desaturation to spo2 85% with turning in bed."

i hope this is helpful to you who are just starting out in this wonderful profession. it's got a great body of knowledge waiting out there to help you do well for and by your patients, and you do need to understand its processes.

[nurseygurlie]

The nursing diagnosis has more to do with the way the disease is affecting the patient, rather than the disease itself. I also want to say there is a difference between Risk for Impaired Skin Integrity and Impaired Tissue Integrity. Impaired tissue means it goes deeper than the skin and it is already affected. I usually use it for cellulitis, infection and abscess.

So the cancer question just depends on how it's affecting him. With a colon resection and abdominal issues I am wondering how his nutrition is? I would ask about intake, albumin levels, nausea and vomiting. What is his fluid status? Can he get up and around? Is there a risk for infection (neutropenic)?

When I am trying to find a diagnosis, i look at the presenting signs and symptoms because that will be your evidence. I figure out what the problem is, what is causing the signs and symptoms at the cellular level. That will lead you to your diagnosis and then you can follow the process :)

[nurseygurlie]

What are his signs and symptoms? Why is he still in the hospital?

I think with an abscess you can almost definitely use Impaired Tissue Integrity?

[sleepysilver]

I was thinking Impaire Tissue Integrity too but I wasn't sure if that was only applicable for a skin abscess because in my nursing diagnosis handbook all the assessments listed have to do with the skin. This patient had colon cancer which was removed with a left hemicolectomy and a subsequent colonostomy 7 months ago. He presented with a fever and leg pain but when I first became his student nurse it was a few days after he was admitted and he no longer had a fever or any pain. He had a biopsy which revealed that the thought abscesses where actually cancerous tumors in his abdomen. Is there a nursing diagnosis for metastatic cancer?

[sleepysilver]

Thank you for the help! Since my patient had been in the hospital for a little while, his vitals and labs were all within normal limits so I was struggling with finding an appropriate diagnosis which is why I was looking for something that had to do with his abscess. I could think of many pyschosocial diagnoses like fear, anxiety, knowledge deficiet, however for this assignment we are only allowed to use one psychosocial diagnosis and we need 3 physiological diagnoses which I was struggling to come up with. Thank you for the advice!