EMILIO AGUINALDO COLLEGE

Case study
Abrasion in Nasal Area Secondary to Fall

SUBMITTED BY:

Chen wen ting

Eldon Vince Isidro

SUBMITTED TO:
Paul Dayandayan, RN

Submitted on
27/2/2020
TABLE OF CONTENTS

I. Introduction

II. Patient Profile

III. Patient History/ Nursing History

IV. Physical Assessment

V. Anatomy and Physiology

VI. Pathophysiology

VII. Laboratory Results/ Diagnostic Procedures

Vlll. Related Literature

IX.Nursing Care Plan

X.Drug Study

XI.Discharge Planning
 INTRODUCTION
The five types of wounds are abrasion, avulsion, incision, laceration, and puncture.
An abrasion is a wound caused by friction when a body scrapes across a rough
surface. An avulsion is characterized by a flap. An incision is a cut with clean edges. A
laceration is a cut with jagged edges. A puncture is a wound where something passes
through or becomes impaled in the skin.

An abrasion is a partial thickness wound caused by damage to the skin and can be
superficial involving only the epidermis to deep, involving the deep dermis. Abrasions
usually involve minimal bleeding. Mild abrasions, also known as grazes or scrapes, do
not scar or bleed because the dermis is left intact, but deep abrasions that disrupt
the normal dermal structures may lead to the formation of scar tissue. A more
traumatic abrasion that removes all layers of skin is called an avulsion.

Abrasions are classified into three degrees: the first one is called as the first-degree
abrasion, wherein the only involved is the epidermal injury. While the second-degree
abrasion involves the epidermis and a slight part of dermis, and there is slight
bleeding. The third-degree abrasion involves damage in the subcutaneous layer of
the skin and is often called as “avulsion”.

Abrasions can range from mild to severe. Most abrasions are mild and can easily be
tended to at home. Some abrasions, however, may require medical treatment.

First-degree abrasion

A first-degree abrasion involves superficial damage to the epidermis. The epidermis is

the first, or most superficial, layer of skin. A first-degree abrasion is considered mild.
It won’t bleed.

First-degree abrasions are sometimes called scrapes or grazes.

Second-degree abrasion

A second-degree abrasion results in damage to the epidermis as well as the dermis.

The dermis is the second layer of skin, just below the epidermis. A second-degree
abrasion may bleed mildly.

Third-degree abrasion

A third-degree abrasion is a severe abrasion. It’s also known as an avulsion wound. It

involves friction and tearing of the skin to the layer of tissue deeper than the dermis.
An avulsion may bleed heavily and require more intense medical care.

Difference Between Abrasions And Cuts

Cuts and abrasions are both types of skin injuries. They differ mainly in the way they
are caused. Cuts are typically caused when a sharp-edged object such as a blade or
knife cuts or slices across the surface of the skin causing it to split open and bleed.
Cuts can also be caused by accidents and sports injuries.

Abrasions on the other hand are caused by friction of the skin against a rough or
scratchy surface and they do not necessarily bleed.

Do All Abrasions Heal Naturally?

Most abrasions, especially first and second degree abrasions, heal fully within about
7 to 10 days. If the injured area or the area surrounding it continues to remain
swollen, red and warm to the touch or if there is some type of discharge, it may
indicate that an infection has set in. If there is an infection, your doctor may
prescribe antibiotics to treat the infection and heal the injury.

In addition to the severity of your injury, your age, diet and overall health also play
key roles in determining the rate at which your abrasion injury heals. The immune
system and skin need proper nutrition to stay healthy.

Treatment for Abrasion vs. Laceration

Abrasions are the milder form of injury between the two types, typically scraping
away portions of the surface, but not often do they get very deep. Lacerations can
puncture through several layers of fat and muscle.

In an abrasion, healing usually takes place over a few days. These wounds should be
cleaned carefully but thoroughly, and in some cases antibiotics may be needed to
stave off infection.

A laceration, however, will likely take longer to heal. Stitches or skin adhesive may be
needed, and antibiotics may be required to stave off infection. Patients will have to
refrain from strenuous activity while their wound heals, including exercise, sports or
any other high-impact activity. You’ll want to avoid excessive moisture, so you’ll need
to avoid swimming or immersing your wound in water for long periods of time, such
as to do dishes or go swimming.

If you’re experiencing pain and swelling due to a laceration, try keeping the affected
area elevated, and ice it to decrease symptoms. Use the ice for 20 minutes per day,
up to four times per day. It’s important not to apply the ice directly to the wound, but
instead apply it through a resealable bag or washcloth.

If your wound should not improve and show symptoms of worsening, such as:

-Redness or swelling
-Red streaks around the wound
-Wound smells or has drainage
-A fever higher than 100.4 degrees or chills
-Seek medical attention right away to be treated by a healthcare provider.

 PATIENT PROFILE
• Ward : Medical Center Manila Hospital

• Date of admission: Feb,27,2020

• Patient’s name:D,M

• Age:59

• Gender: F

• Religion: Roman Catholic

• Nationality: Filipino

• Civil status: Married

• Reliability: Patient

• NURSING HISTORY:

Past Health History

Cholecystectomy in 2015
Diabetes

Family Health History

According to mrs x she has no family history of any disease

Social Health History

Allergies: (-)
Smoking: (-)
Alcohol Consumption:(-)

PERSONAL/ SOCIAL HISTORY

Patient has no history of substance abuse. She doesn’t have any specific diet or
exercise. Employment history is not shown.

A. General Survey

Patient was seen in ER conscious and coherent, with no ongoing iv.

fluid

B. Vital Signs:

Temperature 36c axillary

Cardiac Rate: 114bpm

Blood preassure: 160/110

Respiratory rate: 20

spo2:97%
C.Review of Systems:
Area assessed Normal Findings Actual findings Analysis/
inference
Eyes Parallel and evenly slightly palpable Normal
placed, conjunctive, anicteric
symmetrical, not sclerae
protruding
Ears Intact tympanic Intact tympanic Normal
membrane, membrane
parallel, not
protruding
Nose midline septum, Presence of abrasion Abnormal
normal turbinate
Neck No lumps and supple, no palpable Normal
masses lymph nodes
Throat Symmetry no tonsillopharyngeal Normal
congestion
Chest/ lung Chest walls move symmetrical Normal
symmetrically, expansion, clear
clear breath breath sounds no
sounds rales
Heart A dynamic A dynamic Normal
precordium, precordium, normal
normal rate, rate, regular rhythm,
regular rhythm, no no murmurs
murmurs
Abdomen No pain, Normal Symmetrical, no Normal
bowel movement abnormalities
 • ANATOMY & PHYSIOLOGY

Soft Tissues of the Nose

The tissues covering the nasal frame vary significantly in thickness from the cephalic
to the caudal portion.

These tissues are thick cephalically and caudally, and become thinner in the center.
It is for this reason that a nose frame that is totally straight on profile most likely will
not induce an optimal dorsal outline.

The soft tissue components of the nose include skin, muscles, nerves, and the
vascular elements. In general, the nose has more sebaceous glands than most other
parts of the face and body.
Therefore the skin of the nose will re-epithelialize faster than other types of skin
following procedures such as dermabrasion, chemical peel, and laser abrasion.
The sebaceous glands are more abundant in the caudal third of the nose skin than
the middle and cephalic portions.

The thickness of the cephalic portion of the nose skin is related more to components
such as the procerus muscle and adipose tissue than to a thick dermis and sebaceous
glands.

Skin

One of the key determining factors in the outcome of the rhinoplasty is the quality
of the nasal skin. The skin color, consistency, thickness, and porous nature vary from
patient to patient, on different parts of the same patient’s nose and at different
stages of life.

The skin is thicker at the radix than the central portion. However, in some patients
the supratip area is even thicker than the radix and contains more sebaceous glands.
Lessard & Daniel have determined that the average skin thickness is greatest at the
radix (measuring 1.25 mm) and the least at the rhinion (approaching 0.6 mm)
( Figure 1.5 ).

The lower third of the nose, especially the supratip area, has an abundance of
sebaceous glands which range in activity from time to time and race to race. In men,
especially teenagers, there is a vast number of these glands within the tip and
supratip area that renders achievement of an optimal tip definition difficult.
A varying degree of rosacea may alter the skin surface color, causing some redness in
the mid-vault area, or more commonly, in the caudal half of the nose, especially the
supratip area.

This redness commonly extends to the cheek area.

The thickness of the skin is reduced dramatically in the columella and mid-alar area,
while it thickens in the alar base area.

As much as thick skin is problematic in achieving an ideal nasal definition, thin skin
may also adversely affect the outcome of rhinoplasty by revealing harshness of the
underlying frame and any existing iatrogenic or residual minor flaws, which would
not be discernible in a patient with thicker skin.

The alar base area contains more fibrous bands, which is the reason for its rigidity.
The vestibule is the cavity just inside the external nares bounded by the
membranous septum and the columella medially and the side wall of the ala
laterally, the latter being covered with hair (vibrissae).

Medical Diagnosis:
Acute pain

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DRUG STUDY:
Ciprofloxacin
NAME OF MECHAN INDICATI CONTRAINDICA ADVER NURSING
DRUG ISM OF ONS TIONS SE CONSIDERA
ACTION EFFEC TION
T

Generic Inhibits Ciprofloxac Contraindicated in Seizures Assess for

name: bacterial in is used to hypersensitivity, infection prior
Ciprofloxaci DNA treat cross- sensitivity dizzines to and during
n synthesis infections among agents may s, therapy.
by of the skin, occur. drowsin
Brand name: inhibiting lungs, ess, Caution patient
Cipro DNA airways, headach that this may

gyrase. bones, and e, cause dizziness

Classificatio insomni and drowsiness
joints
n: Anti- Therapeuti a, acute
caused by
infectives c Effects: agitation
susceptible
Death of bacteria. ,
Antibiotic
susceptible confusio
Class:
bacteria. n,
Fluoroquinol
ones Spectrum:
Broad
Dose: 500
activity
mg
includes
many
Route: PO gram-
positive
Frequency: pathogens.
Q12

DISCHARGE PLAN:

MEDICATION
•Instructed the patient to continue home medications with the right time, dose,
frequency, route, it’s possible side effects and its expected effect.
-Ciprofloxacin 500mg 1tab every 12hours
-Salinase Nasal Spray2 sprays 2x a day
EXERCISE
•Avoid strenuous activities and encouraged rest periods between activities.

TREATMENT
•Emphasized compliance with the medications and attend follow up check-up.

HYGIENE
•Instructed to maintain hygienic measures such as taking a bath every day and
ensure proper had washing.
•Instruct proper perineal hygiene

DIET
•Instruct to increase oral fluid intake to maintain proper hydration.

Spiritual
•Never lose faith in God
•Stay positive always