Tissue vs skin integrity in abscess care plan

[WMH RN]

Hello,

I'm a nursing supervisor at our small town hospital. I have been given the responsibility of revising/reviewing all of our careplans that do not appear to have been revised in almost 10 years. So much has changed even in the short period of time since I graduated.

One of my road blocks has been in the abscess care plan. With the new verbiage for impaired tissue integrity and impaired skin integrity I'm unsure what direction to take the generic care plan in. Skin integrity only talks about epidermal and dermal layers being affected. However, I don't see a clear way of including impaired tissue integrity in with abscess as the diagnosis. Or would risk for infection surmise the entire thing and be most appropriate? I'm looking forward to your thoughts on this one.

While I have someone to bounce ideas off of, what are your thoughts on the appropriatness of activity intolerance in a generic abdminal pain care plan?

Thanks so much

[lpnflorida]

https://www.careplans.com/pages/member_app.asp

I found this web site, it does have a yearly fee to join, I noticed many careplans. Perhaps this would be helpful for you

[leslie :-D]

wmh, you would really be much better off posting this in the student forums, where daytonite lives.

she's the master of care planning.

leslie

[Daytonite, BSN, RN]

the use of impaired skin integrity or impaired tissue integrity as a diagnosis when there is a skin abscess is dependent on the medical diagnosis and assessment of the lesion. not all skin lesions extend into the subcutaneous layer which is the defining reason for using impaired tissue integrity. it is unlikely that someone is going to be hospitalized for an i&d of a superficial skin abscess to the level diagnosed as impaired skin integrity. impaired skin integrity is used for stage i and ii decubitus ulcers, sunburns, simple rashes, reddened skin, fungal skin infections, weeping skin, measles. impaired tissue integrity is used for stage iii and iv decubitus ulcers, boils, furuncles, perirectal abscesses where the infestation has invaded into the deeper skin layers. you can't use risk for infection with an abscess because by its very definition an abscess is an infection (a localized collection of pus as a result of pyogenic bacterium--taber's cyclopedic medical dictionary). the related factor attached to a diagnosis is always about how the problem managed to come about. the diagnosis for a deep skin abscess might be impaired tissue integrity r/t bacterial invasion. however, lesions, such as gangrene of the toes in diabetics are due to compromised circulation which then becomes infected. so, the related factor may need to be customized for each instance or you may need to give the nurses choices to pick from. i was trying to find some weblinks on this for you:

• http://apps.uwhealth.org/health/adam/hie/1/001353.htm - abscess
  
• http://apps.uwhealth.org/health/adam/hie/1/000863.htm - skin abscesses
  
• http://www.fpnotebook.com/der/hair/frncls.htm - skin abscess
  
• http://www.fpnotebook.com/gi/rectum/prnlabscs.htm - perirectal abscess
  
• impaired skin integrity
  
• impaired tissue integrity

activity intolerance is used for a hypoxia problem the patient develops during activity. it is generally due to deconditioning and is expected to improve with gradual increases in activity on a daily basis. if that applies to any patient, including someone with abdominal pain, then it is appropriate to use it. however, this diagnosis is most common associated with patients who have chronic cardiac and pulmonary problems. a person with abdominal pain who doesn't want to get up and move is more likely delayed surgical recovery (if they have had surgery) or ineffective health maintenance (for medical patients).

a good cross index for nursing diagnosis suggestions is in the beginning of the nursing diagnosis handbook: a guide to planning care by betty j. ackley and gail b. ladwig. there is also a cross index in the appendix of taber's cyclopedic medical dictionary but the edition and year of printing are important since the diagnoses and wording of them does change. nanda is about to release the 1009-2010 nursing diagnosis taxonomy next month. it can be purchased from them for about $20+. if you want to see skeletons of nursing diagnoses in care plan format, see this website: http://www.rncentral.com/nursing-library/careplans

[WMH RN]

Thanks so much Daytonite! That was exactly what I was looking for. I was leaning the same way on many of those statements and just needed someone else who was well versed in care plans to help validate the thought process. I look forward to bouncing ideas off this site in the future.

[Daytonite, BSN, RN]

I hang out on the student forums. I only find care plan questions on the General Nursing Discussion Forum by doing a search for specific key words relating to care planning. I seldom just hang out here reading threads.

[Aulritto]

Believe it or not, you helped me with write my first official nursing diagnosis for a class! My patient had a really bad sunburn, and I kept trying to decide if it was acute pain R/T sunburn or discomfort R/T sunburn. I was totally wrong.

Thanks again!