Question

The patient is a 56-year-old woman admitted to the hospital after being seen in the physi­cian's office for two large draining abscesses on her back. One was on the left-upper back and the other on the right-lower back. skin. Both lesions were large, actively draining, and showed some necrotic features to the surrounding tissue. These areas on the back were warm to the touch and tender. Because of the size of the lesions, the patient was admitted as an inpatient for surgery. The surgeon performed an incision and drainage on two areas of the back. The right-lower back actually had two areas of abscess with necrotic tissue present. The cavity was widely opened with an incision that connected the two abscesses. Another incision was made in this area because the fluctuance had penetrated deeper down, and the entire area required drain­age and copious irrigation. A Penrose drain was placed to keep the tracks open. The left-upper back had an area of fluctuance of 3 cm x 5 cm. A transverse incision was made deep into the subcutaneous cavity, and all the purulent material was removed from the widely opened area. It was copiously irrigated. Specimens were collected from all these areas for cultures. The fluid cultures grew Methicillin-resistant staphylococcus aureus susceptible to Clindamycin. While in the hospital, the patient received intravenous antibiotics. The patient was continued on this antibiotic orally for one more week. The drain was left in for the surgeon to remove about 3 days after discharge. The patient was known to have hypertension, and it was treated during the hospital stay. The patient had two fasting glucose tests performed in the hospital, and both were significantly elevated at 160 and 180. A hemoglobin Ale was performed with a finding of 9.5. The patient was informed that she had type 2 diabetes, poorly controlled. She had a dietary consultation in the hospital and will attend diabetic education classes after discharge. She was discharged with a glucose monitoring kit and a prescription for oral diabetic medication. She will be seen in the primary care physician's office in 1 week.

4 diagnoses and 1 procedure

Answer 1

•4 Diagnosis are-

1) Impaired skin integrity related to presence of two large draining abscess as evidenced by physical examination.

2) Fatigue related to decreased Haemoglobin level as evidenced by assessing laboratory value.

3) Imbalance nutritional status less than body requirements related to decreased uptake and utilisation of glucose by the tissue as evidenced by assessing gucose level.

4) Impaired haemodynamic status related to Hypertension as evidenced by checking vital signs.

Procedure name: wound dressing.

•Article preparation.

1) A medium tray containing-

• a bowl with normal saline to clean the incision site.

• Knife dish containing gauze pieces for wound dressing.

• Sterile gloves to prevent cross infection.

• Mackintosh to prevent bed soiling.

•kidney dish for collecting liquid waste products.

• Paper bag for collecting solid waste.

Procedure.

• proper position is given to the patient.

• Mackintosh is placed on the bed.

• Hand washing is done.

• Wear gloves.

• Take a piece of gauze and soaked it with normal saline.

• Clean the area from centre to periphery in circular motion.( repeat the process as needed.).

• Discard the gauge pieces in the paper bag.

Termination.

• Remove the gloves and discard it in red bucket.

• Discard gauze pieces in yellow bucket.

• Clean all steel article with running water, soapy water, running water.

Recording.

• Record the time of wound dressing on medicine card of patient.