An abscess is a walled-off pocket of pus inside a cavity created by tissue destruction, most often caused by Staphylococcus aureus entering through a break in the skin. The nursing diagnoses used most often are Impaired Tissue Integrity, Acute Pain, Risk for Infection, and Deficient Knowledge — and one fact drives all four: an abscess has to be drained, because antibiotics cannot reach the inside of a walled-off cavity of pus.
At a glance
- Defining sign
- Fluctuance — a soft, movable centre under tense skin. That is what separates an abscess from cellulitis.
- Definitive treatment
- Incision and drainage. Antibiotics are an adjunct, not a substitute.
- Usual organism
- Staphylococcus aureus, including MRSA in community-acquired abscesses.
- Never do this
- Squeeze, pop, or express it. Pressure drives bacteria into surrounding tissue and the bloodstream.
- Escalate for
- Fever, tachycardia, spreading or streaking redness, confusion, or pain out of proportion to the findings.
Pathophysiology in one pass
Bacteria breach the skin barrier through a cut, bite, injection, hair follicle, or surgical wound. Neutrophils arrive, kill bacteria, and die in the process, and the mixture of dead neutrophils, bacteria, and liquefied tissue becomes pus. The body then walls the collection off with a fibrin capsule — the pyogenic membrane — which is a reasonable defence and a serious problem at the same time.
That capsule keeps the infection contained, but it also keeps everything else out. There is no blood supply inside the cavity, so systemic antibiotics arrive at low concentration or not at all, and the low pH and low oxygen inside impair the few neutrophils that do reach it. This is the whole reason drainage is the treatment and antibiotics alone commonly fail. Meanwhile pressure builds inside the fixed space, which produces the throbbing pain, and if the capsule gives way inward the contents spread into surrounding tissue and the bloodstream.
Risk rises with diabetes, obesity, immunosuppression or corticosteroid therapy, injection drug use, prior MRSA infection, shaving or waxing, and any retained foreign material in a wound.
Nursing assessment
Subjective data
- Throbbing pain that is worse with pressure, movement, or a dependent position
- A lump the client describes as having “come to a head,” and how many days it has been there
- Fever, chills, malaise, loss of appetite
- History of a cut, bite, injection, ingrown hair, or recent surgery at the site
- Previous abscesses or a known MRSA history, in the client or in the household
- Diabetes, immunosuppressant or corticosteroid use, chemotherapy, injection drug use
Objective data
- Erythema, warmth, oedema, and induration, with a tender central area that is fluctuant
- A central punctum, or spontaneous purulent drainage
- Drainage colour, amount, consistency, and odour
- Measured size of the lesion, and the border of erythema marked on the skin with the date and time
- Regional lymphadenopathy and any red streaking toward the nodes
- Temperature, heart rate, respiratory rate, blood pressure, and mental status
- White cell count, blood glucose, and culture of the pus itself once it is drained
- Bedside ultrasound findings when the examination is uncertain
Abscess or cellulitis?
| Feature | Cellulitis | Abscess |
|---|---|---|
| Borders | Diffuse, spreading, poorly defined | Localised, with a defined centre |
| Fluctuance | Absent — firm and indurated | Present — the key finding |
| Drainage | None | Purulent, spontaneous or on incision |
| Treatment | Antibiotics | Drainage, with antibiotics if indicated |
The two frequently coexist, and an abscess can hide under an area that looks like plain cellulitis. When the examination is equivocal, point-of-care ultrasound is what settles it — not a longer trial of antibiotics.
Nursing diagnoses used with an abscess
- Impaired Tissue Integrity — the cavity and the wound itself
- Acute Pain — from pressure inside a closed space and from dressing changes
- Risk for Infection — spread to deeper tissue, a second site, or the bloodstream
- Hyperthermia — when a systemic response is present
- Deficient Knowledge — wound care, transmission, and preventing recurrence
- Impaired Skin Integrity — where the break in the skin is the presenting problem
Worked care plans
Four plans in the same ADPIE shape. The scenario is a 46-year-old client with type 2 diabetes admitted with a 5 cm fluctuant abscess of the left forearm, drained at the bedside this morning.
1. Impaired Tissue Integrity
Problem-focusedSubjective: Reports the lump started as a scratch at work five days ago and has been growing.
Objective: Open drained cavity 5 cm by 3 cm on the left forearm, moderate thick yellow drainage, surrounding erythema marked at 8 cm, blood glucose 244 mg/dL.
Impaired Tissue Integrity related to bacterial invasion with liquefactive necrosis and surgical drainage, as evidenced by an open 5 cm wound cavity with purulent drainage and surrounding erythema.
- Wound shows granulation tissue at the base and no increase in cavity size by day three
- Erythema does not extend beyond the marked border
- Drainage decreases in amount and changes from purulent to serosanguineous
- Measure length, width, and depth at each dressing change and probe gently for undermining
- Re-mark the erythema border with the date at every shift
- Perform the dressing change and packing exactly as ordered, using sterile technique
- Document drainage colour, amount, consistency, and odour
- Report the culture result and check that the ordered antibiotic still matches it
- Support healing: protein and fluid intake, and glycaemic management per the orders
By day three the cavity measures 4 cm by 2 cm with pink granulation at the base, drainage is scant and serosanguineous, and erythema is inside the marked line. Goal met.
2. Acute Pain
Problem-focusedSubjective: Reports constant throbbing pain of 7/10, rising to 9/10 when the packing is removed.
Objective: Guards the left arm, holds it flexed against the chest, grimaces and withdraws during the dressing change.
Acute Pain related to inflammation and pressure within a closed tissue space and to wound care procedures, as evidenced by self-report of 7/10 throbbing pain, guarding, and grimacing during dressing changes.
- Client reports pain at or below the stated comfort-function goal within an hour of analgesia
- Client tolerates the dressing change without pain above the agreed limit
- Client uses the affected arm for light activity and sleeps through the night
- Give the ordered analgesia in time for peak effect at the dressing change, not afterwards
- Moisten the packing with sterile saline before removal if that is permitted by the order
- Elevate the arm on a pillow to reduce throbbing from dependent oedema
- Apply warm compresses only if ordered, and never with pressure on the site
- Warn the client that pain increasing after the second day is a finding to report, not something to endure
- Reassess and document after each dose and each procedure
Pain reported at 3/10 at rest and 5/10 at its worst during the dressing change, and the client slept without waking. Goal met.
3. Risk for Infection
Risk diagnosis- Open drained wound cavity with a break in the primary skin barrier
- Hyperglycaemia, which impairs neutrophil function and healing
- Invasive devices and repeated dressing changes
- Staphylococcus aureus colonisation, with MRSA suspected
No “as evidenced by” — this names the spread that has not happened yet.
Risk for Infection related to an open drained wound, impaired glycaemic control, and staphylococcal colonisation.
- Client remains free of fever, tachycardia, and change in mental status
- No new lesions and no extension of erythema beyond the marked border
- Blood glucose stays within the range set in the orders
- Assess temperature, heart rate, respiratory rate, and mentation each shift and with any change
- Hand hygiene before and after every contact, and contact precautions per facility policy
- Culture the pus at drainage, before antibiotics are started where the order allows
- Give antibiotics on schedule and check that coverage matches the culture and sensitivity result
- Monitor glucose and treat per the ordered protocol
- Inspect other sites — axillae, groin, buttocks — for new lesions
Afebrile with stable vital signs, alert and oriented, erythema inside the marked line, no new lesions, glucose within the ordered range. Risk not realised; continue plan.
4. Deficient Knowledge
Problem-focusedSubjective: States he tried to squeeze the lump for two days and asks whether he can stop the antibiotic once the wound closes over.
Objective: Third abscess in eighteen months. Shares razors at home. Cannot describe how to change the dressing.
Deficient Knowledge related to no previous instruction on wound care and transmission, as evidenced by attempting to express the abscess, a plan to stop antibiotics early, and inability to describe a dressing change.
- Client demonstrates a dressing change using teach-back before discharge
- Client names three findings that require a call to the provider
- Client states why the antibiotic course is finished and why the abscess is not squeezed
- Explain that squeezing forces bacteria into surrounding tissue and the bloodstream
- Teach the dressing change with the client’s own supplies and confirm by return demonstration
- Cover household transmission: no shared razors, towels, or bedding; hot wash and dry of linens
- Write the warning signs down, large and plain, rather than reciting them
- Confirm the follow-up appointment for packing removal or wound check
- Link glycaemic control to healing and to why this keeps recurring
Client changed the dressing correctly with prompting on one step, named fever, spreading redness, and increasing pain as reasons to call, and stated he will not squeeze the site. Goal met.
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NCLEX Readiness Diagnostic
Fifty questions with a written rationale on every option, scored by section so you can see which content area is weakest. Sent as a PDF.
Interventions and rationales
Client teaching
- Do not squeeze, pop, or dig at an abscess — pressure spreads the infection instead of releasing it
- Keep the wound covered with a clean, dry dressing, and wash hands before and after touching it
- Finish the whole antibiotic course if one is prescribed, even after the wound looks healed
- Do not share razors, towels, washcloths, or bedding, and wash and dry linens on a hot cycle
- Keep the follow-up appointment for packing removal or the wound check, even if it feels better
- Call for fever, chills, redness spreading past the marked line, red streaks, new drainage, or pain that increases after the second day
- Manage blood sugar — high glucose slows healing and is a common reason abscesses come back
- See a provider for a new lump rather than waiting for it to burst on its own
NurseStudyPrep.com
You’ve read the care plan. Now answer one.
A real item from the Safety and Infection Control section. Every option gets a written rationale — including the three that are wrong.
A nurse is assigned four clients with skin and soft tissue infections. Which client should the nurse assess first?
Why C. Pain far out of proportion to the visible findings, with dusky discolouration, is the classic early presentation of a necrotising soft tissue infection — a surgical emergency where delay costs limb and life. The other three are stable, expected, or already improving. Prep also explains why each wrong option looks defensible.
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Frequently asked questions
Why won’t antibiotics alone cure an abscess?
Because the fibrin capsule that walls off an abscess has no blood supply running through it. Systemic antibiotics travel in blood, so they reach the edge of the cavity and stop, and the acidic, low-oxygen interior disables the immune cells that do get in. Drainage removes the collection and lets everything else work. Antibiotics are added based on systemic signs, host defences, and the response to drainage.
What is the priority nursing diagnosis for a client with an abscess?
It depends on the data in front of you. With systemic signs — fever, tachycardia, spreading erythema, change in mental status — the priority shifts to the risk of spread and sepsis. Without them, Impaired Tissue Integrity is usually the priority, with Acute Pain close behind. Actual problems outrank risk diagnoses, and anything threatening airway, breathing, or circulation outranks both.
How do you tell an abscess from cellulitis?
Fluctuance. An abscess has a soft, movable centre under tense skin because there is fluid in it; cellulitis is firm, indurated, and diffuse with no drainable collection. The distinction changes the treatment — drainage versus antibiotics — and the two often occur together. When the examination is uncertain, bedside ultrasound is the answer rather than a longer course of antibiotics.
Should an abscess be packed after drainage?
Sometimes. Packing keeps the skin edges apart so the cavity heals from the base upward rather than sealing over and refilling, and it is common for larger cavities. For small abscesses a plain dry dressing is often used instead, and the evidence for routine packing is not strong. This is a decision made by the provider, so follow the written order and the facility’s wound care standard.
Are warm compresses helpful?
Moist heat can increase local blood flow, help a small lesion localise, and ease discomfort, and it is frequently ordered. What it cannot do is drain an abscess, so it is never a reason to delay evaluation. Apply it without pressure, protect the skin, and follow the order — particularly in clients with diabetes or neuropathy, who may not feel a burn.
When does an abscess become an emergency?
When the infection stops being local. Fever with tachycardia, spreading redness or red streaking, confusion, hypotension, or new or worsening pain after the second day all need a provider now. Pain out of proportion to the findings, dusky skin, blisters, or crepitus suggest a necrotising infection and are surgical emergencies.
References
- Stevens, D. L., et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2).
- Duane, T. M., et al. Surgical Infection Society 2020 Updated Guidelines on the Management of Complicated Skin and Soft Tissue Infections. Surgical Infections, 22(4).
- Centers for Disease Control and Prevention. MRSA: information for healthcare professionals and for patients.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. Thieme.
- Wound, Ostomy and Continence Nurses Society. Wound assessment and documentation guidance.
Wound care protocols, packing practice, antibiotic choice, and glycaemic targets vary by facility and by client. Follow the provider’s written orders and your own institution’s standards. This page supports study and does not replace course instruction or clinical judgement.
