NWT Clinical Practice Guidelines for Primary Community Care Nursing - The Integumentary System
Furuncle And Carbuncle Definition Complications Furuncle or boil: an acute, tender perifollicular • Scarring inflammatory nodule • Spread of infection (e.g. lymphangitis, lymphadenitis) Carbuncle: a cluster of furuncles, generally larger • Abscess and deeper • Recurrence
Causes Diagnostic Tests • Staphylococcal infection of several hair follicles • Swab discharge for culture and sensitivity • Predisposing factors: obesity, diabetes mellitus, • Determine blood glucose level if infection is poor hygiene, excessive friction or perspiration, recurrent or if symptoms suggestive of diabetes seborrhea, local trauma (e.g. from plucking mellitus are present hairs), use of systemic steroids Management History Goals of Treatment • Usually found on the neck, axilla, breasts, face • Control infection and buttocks • Prevent recurrence • Local redness, swelling, pain, tenderness • Identify predisposing underlying conditions • Begins as a small nodule, quickly becomes a (e.g. diabetes mellitus) large pustule • If poked, purulent, sanguineous material drains Appropriate Consultation • May occur singly or in groups Consult physician if a large furuncle or carbuncle • May be recurrent is present, as surgical drainage may be needed. • Fever absent Nonpharmacologic Interventions Physical Findings • Apply warm saline compresses to area at least • Nodule or pustule 5-30 mm in diameter qid. This may lead to resolution or spontaneous • Deep red in colour drainage if the lesion or lesions are mild. • Central area may spontaneously drain pus • Cover area with a sterile, non-adherent dressing • Carbuncle may present as red mass with • If area is fluctuant and pointing, incise lesion multiple draining sinuses in area of thick, with a single stab wound and allow pus to drain. inelastic tissue (e.g. posterior neck, back, thigh) • Lesion(s) warm, tender to touch Client Education • May be fluctuant • Counsel client about appropriate use of • Regional lymph nodes usually not enlarged or medications (dose, frequency) tender • Encourage proper hygiene of the area • Stress importance of regular skin cleansing to Differential Diagnosis prevent future infection • Cellulitis • Recommend that client avoid picking or • Abscess squeezing the lesions • Impetigo • Instruct clients with recurrent disease to bathe • Insect bites area bid with a mild antiseptic soap to help prevent recurrences
September 2004 Furuncle And Carbuncle - Adult 1 NWT Clinical Practice Guidelines for Primary Community Care Nursing - The Integumentary System
Pharmacologic Interventions Monitoring and Follow-Up Antibiotics if infection is moderate or severe: • Follow up in 2 days and at 7-10 days cloxacillin (A class drug), 250 mg PO qid for • Instruct client to return immediately for 7-10 days reassessment if lesion becomes fluctuant, if pain increases or if fever develops For clients with allergy to penicillin: erythromycin (A class drug), 250 mg PO qid for Referral 7-10 days Arrange elective follow-up with physician if infections recur.
September 2004 Furuncle And Carbuncle - Adult 2