I.

Introduction
The skin is the body's outer covering. It protects us against heat and light,
injury, and infection. In fact, the skin is an essential part of our body's defense
against infection from microbes in our environment. The skin also regulates body
temperature and stores water, fat, and vitamin D. weighing about 6 pounds, the
skin is the body's largest organ. It is made up of two main layers the outer
epidermis and the inner dermis.
!tab wounds are wounds where the depth of injury is greater than the
length. They penetrate more deeply than the slash wounds and tend to come into
contact with vital organs in the chest and abdomen. !tabbing is the most
common mode of homicide in the "#, due to the strict control of gums. !tab
wounds are caused most obviously by knives, but are also caused by bayonets
and swords, as well as scissors and even blunter instruments such as
screwdrivers. !tab wounds are usually slit$like, but when the object is removed
the skin contracts slightly, leaving a wound that is slightly shorter than the blade
width. The center of the wound often widens. %ost operative wound infection
delays recovery and often increases length of slay and produce lasting scars and
re&uire e'tra resources for investigations, management and nursing care.
Therefore, its prevention or reduction is relevant to &uality patient care.
!tudies support the concept that reduction in post operative wound
infection is directly relate influenced to increased education and awareness of its
causes its prevention is greatly aided by critically evaluated infection control
practice. !urveillance for wound infection is a useful tool to demonstrate the
magnitude of the problem. (ombined with a regular feedback to the surgeon it
has been shown to decrease the infection rate. It is important to reali)e that
surveillance alone cannot act as a substitute for action and prevention.
II. SIGNIFICANCE OF THE STUDY
*iven the tremendous increase in the crime rate in the %hilippines, it is
very important for health care providers to learn the basic concept of initial
assessment and stabili)ation of severely injured patients. Trauma is one of the
major leading causes of death for +ilipinos under forty and the initial assessment
and stabili)ation of the patient strongly influences the ultimate outcome for the
severely traumati)ed patient. ,ost jurisdictions re&uire that injuries arising from
acts of violence such as gunshot wounds, stab wounds be reported to the local
police. - fundamental point to remember regarding blunt and penetrating trauma
is that a patient who has been stabbed may also have been beaten and kicked
and subse&uently has sustained both blunt and penetrating injury to the body.
This could be a tool so that we can be a help for those patient.s in need of
care like patients who are in pain from having stab wounds. -nd be able to
understanding those parts of the body affected from the wound.

III. OBJECTIVES OF THE SUDY
This study provides information for the patient.s condition and gives
understanding in providing comfort of the patient while he is in pain and having
some discomfort in his recovery from the stab wounds and surgical wounds. This
could student nurses to be more caring and to manage a patient who have the
same condition like ,r. /amerel +ajanilag.
-ll the given care to the patient while he is admmited in the male surgical
ward is reflected in this study in the two day of the duty. This could be a help for
further study about the patient.s condition and be able to upgrade skills in
handling patient having the incident of multiple stab wounds in patient.s
abdomen.

IV. PATIENT PROFILE
/amerel +ajanilag, a 01 year old male, single, 2oman (atholic, living in 3aloy,
Tablon, admitted for the first time at 4orthern ,indanao ,edical (enter 54,,(6
with an initial diagnosis of acute abdomen secondary to stab wounds. 7e had no
known allergy. "pon admission, he had a blood pressure of 189:;9 mm7g, heart
rate of 191 bpm, respiratory rate of 86 cpm, and a temperature of 8<.=> (.
V. HISTORY OF PRESENT ILLNESS
- case of /amerel +ajanilag admitted at 4orthern ,indanao ,edical
(enter with multiple stab wounds at lower abdomen and left upper &uadrant with
the use of kitchen knife done by his companions in Tablon due to
misunderstanding and in layman.s term ?bikil@. The patient was stabbed
unconscious because he being hit in the head by a paddle from his back. Then at
that time he didn.t know what happened ne't, all he knew he felt someone
stabbed him.
VI. DEVELOPMENTAL TAS
Aur personality traits come in opposites. Be think of ourselves as
optimistic or pessimistic, independent or dependent, emotional or unemotional,
adventurous or cautious, leader or follower, aggressive or passive. ,any of these
are inborn temperament traits, but other characteristics, such as feeling either
competent or inferior, appear to be learned, based on the challenges and support
we receive in growing up.
In Crik Crickson.s developmental stages, the patient, /amerel +ajanilag
belong to the young adulthood stage 51<$8= years old6 in which the ego
development outcome is Intimacy and Solidarity vs. Isolation and its basic
strengths are -ffiliation and Dove. In the initial stage of being an adult a person
seek one or more companions and love. -s one try to find mutually satisfying
relationships, primarily through marriage and friends, he generally also begin to
start a family, though this age has been pushed back for many couples who
today don't start their families until their late thirties. If negotiating this stage is
successful, one can e'perience intimacy on a deep level. If one we're not
successful, isolation and distance from others may occur. -nd when a person
doesn.t find it easy to create satisfying relationships, their world can begin to
shrink as, in defense, one can feel superior to others. In this stage the significant
relationships are with marital partners and friends.
In /ean %iaget.s theory of cognitive development, the patient belongs to
the formal operational stage. It begins in most people at age twelve and
continues into adulthood. This stage produces a new kind of thinking that is
abstract, formal, and logical. Thinking is no longer tied to events that can be
observed. It is thought that not all individuals reach this level of thinking. The
ability to generate abstract propositions, multiple hypotheses and their possible
outcomes is evident. Thinking becomes less tied to concrete reality.
VII. ANATOMY AND PHYSIOLOGY
An!to"# o$ t%& '(in
S(in Structur&
The skin is the largest human organ. It covers between 1.= and 0 m
0
, comprising
about one si'th of total body weight.
Function o$ S(in
The skin performs a comple' role in human physiologyE
serves as a barrier to the environment, and some glands 5sebaceous6 may
have weak anti$infective properties.
acts as a channel for communication to the outside world.
protects us from water loss, friction wounds, and impact wounds.
uses speciali)ed pigment cells to protect us from ultraviolet rays of the
sun.
produces vitamin D in the epidermal layer, when it is e'posed to the sun's
rays.
helps regulate body temperature through sweat glands.
helps regulate metabolism.
has esthetic and beauty &ualities.
The skin consists of three functional layersE
E)id&r"i'
D&r"i' or corium
Su*cuti' 5hypodermis6
T%& E)id&r"i'
-s the outermost skin layer, the epidermis forms the actual protective
covering against environmental influences. Its thickness averages 9.1 mm. An
the face it is only 9.90 mm, while on the soles of the feet between 1 and = mm.
Though paper thin, the epidermis is composed of many layers of cells. In
the basal layer 5the living epidermis6, new cells are constantly being reproduced,
pushing older cells to the surface. -s skin cells move farther away from their
source of nourishment, they flatten and shrink. They lose their nuclei, move out
of the basal layer to the horny layer 5the dead epidermis6, and turn into a lifeless
protein called keratin. -fter serving a brief protective function, the keratinocytes
are imperceptibly sloughed off. This process of a living cell's evolution, called
keratini)ation, takes about F weeks.
The epidermis consists of up to ;9 percent keratinocytes, the actual
epidermal cells or dead skin cells, that are held together by what are called
desmosomes. #eratinocytes function as a barrier, keeping harmful substances
out and preventing water and other essential substances from escaping the body.
The other 19 percent of epidermal cells are melanocytes, which manufacture and
distribute melanin, the protein that adds pigment to skin and protects the body
from ultraviolet rays. !kin color is determined by the amount of protein produced
by these cells, not by the number of melanocytes, which is fairly constant in all
races.
7air and nails are speciali)ed keratin structures and are considered part of
the epidermis. Bhile animals use fur and claws for protection and defense, these
corresponding structures are largely cosmetic in humans. The skin, however, is
uni&uely human, since it can betray emotion by blushing 5embarrassment6,
turning red 5anger6, blanching 5fear6, sweating 5tension6, and forming goose
bumps 5terror6.
An the skin surface are the sweat gland pores 5199$099:cm
0
6 and the
openings of the sebaceous glands 5=9$199:cm
0
6. Their secretions ensure skin
moisture and oiliness, and thus maintain the hydro lipid film. The epidermis itself
has no blood vessels, so the nutrients are supplied through the fine blood
vessels in the dermal papillae.
The epidermis is differentiated into five layersE
7orny layer 5stratum corneum6
(lear layer 5stratum lucidum6
*ranular layer 5stratum granulosum6
%rickle$cell layer 5stratum spinosum6
3asal layer 5stratum basale6
T%& D&r"i'
The dermis forms a well$defined border with the epidermis 5scarf skin6 and
a more fluid border with the subcutis 5subcutaneous fatty tissue6.
The dermis, or the Gtrue skin,G is composed of gel$like and elastic
materials, water, and, primarily, collagen. Cmbedded in this layer are systems
and structures common to other organs such as lymph channels, blood vessels,
nerve fibers, and muscle cells, but uni&ue to the dermis are hair follicles,
sebaceous glands, and sweat glands.
Str!tu" )!)i++!r& !nd 'tr!tu" r&ticu+!r&
The stratum reticulare 5reticular H net$like:Dat.6 makes up the lower part of
the dermis and shows a continuous transition to subcutis. The stratum papillare
5papillae H protuberance:Dat.6 is the upper layer which is clearly demarcated from
the epidermis by an undulated border. The wave$like structure increases the
contact area with the epidermis, thus ensuring optimal nourishment of the
deepest layer of the epidermis $ the basal cells $ by way of the blood vessels
running through the papillae.
T%& conn&cti,& ti''u& o$ t%& d&r"i'
The main constituent of the dermis is the proteinous connective tissue
made up of arc$shaped, elastic fibres and undulated, nearly inelastic collagen
fibres. These are responsible for the high elasticity and tensile strength of the
dermis.
Ioung collagen fibre $ glycosaminoglycan $ can bind large amounts of water and
so determine the high intrinsic tension of young skin. -s the skin ages, the
interweaving of the collagen fibres increases and the water$binding capacity
diminishes. The skin tends to wrinkle. 54oteE *lycosaminoglycans
5mucopolysaccharides6 bind with the proteinous connective tissue matri' to form
proteoglycans. These form a gel$like mass that can absorb and e'pel water like a
sponge.6
Conn&cti,& ti''u&- .+#co'!"ino.+#c!n& !nd /!t&r0*indin. c!)!cit#
The space within the dermal meshwork contains a sort of GfillingG made of
long chains of sugar molecules 5polysaccharides poly H many, sacchar H
sugar:*k.6. These are known as glycosaminoglycans 5also
mucopolysaccharides6. Bith the help of fibronectins a type of GglueG, they bind to
the proteinous connective tissue matri' to form proteoglycans, which can bind
water molecules. This gel$like mass functions like a sponge. "nder pressure it
can e'pel the bound water and in a reverse process take it up again. This
process is the probable route of nourishment for the dermis. 7yaluronic acid
5hyalo H glass:*k.6 belongs to the group of glycosaminoglycans and so
contributes to the water$binding whole. *lycosaminoglycans are subject to a
continuous wa'ing and waning. In contrast, the collagen fibres are only renewed
when necessary, such as when injury is sustained.
Ather constituents of the dermis are various types of cells such as
fibroblasts, mast cells and other tissue cells, as well as a multitude of blood and
lymph vessels, nerve endings, hot and cold receptors as well as tactile sensory
organs.
Dike the epidermis, the hair follicle manufactures a keratin structure, hair.
These follicles are found everywhere on the body e'cept for the palms and soles,
though most of the hairs produced are fine, light hairs that, &uite unlike the hair of
the scalp, are scarcely visible to the naked eye. The sebaceous glands are
attached to the hair follicles and through the follicles e'crete an oily substance
called sebum, which both lubricates and protects the skin. An most of the skin
surface sebum appears constantly and imperceptibly, but in areas with a higher
concentration of sebaceous glands, such as the face and back, there are wide
variations in the amount of sebum produced.
There are two distinctive sweat$producing glands, the apocrine and the
eccrine. The apocrine gland is best known for producing body odor but otherwise
has no known physiological function and is apparently a holdover from times
past. In the ear it forms a portion of what we see as earwa'. It is also present
under the arms, around the nipples and navel, and in the anal$genital area.
The eccrine glands are an advanced and e'tensive system of temperature
control. !everal million of these glands are distributed over the entire body, with
the highest concentration in the palms, soles, forehead, and underarms.
!weat, a dilute salt solution, evaporates from the skin's surface to cool the
body. C'cessive sweating without replacement of lost water can cause heat
stroke. Cccrine glands sweat in response to physical activity and hot
environments, but emotional stress and eating spicy foods can also cause
perspiring.
The dermis also regulates heat through a network of tiny blood vessels. In
hot weather these vessels dilate to give off heat, causing the skin to flush. In cold
weather, they constrict, conserving heat, causing pallor. The blood in these
vessels nourishes the skin and provides protection for the cellular and fluid
systems. Dike the eccrine glands, blood vessels in the dermis are responsive to
emotional stress, causing the color changes mentioned previously.
4erve endings in the dermis are the source of the body's sense of touch.
They sense heat, cold, and pressure, providing both pain and pleasure.
T%& Su*cuti' 1H#)od&r"i'2
The subcutis 5sub H under cutis H skin:Dat.6 refers to the fat tissue below
the skin. It consists of spongy connective tissue interspersed with energy$storing
adipocytes 5fat cells6.
F!t c&++ c+u't&r'
+at cells are grouped together in large cushion$like clusters held in place
by collagen fibres called connective tissue septa or sheaths.
Nouri'%"&nt- in'u+!tion !nd )!ddin.
The subcutis is heavily interlaced with blood vessels, ensuring a &uick
delivery of stored nutrients as needed. The functions carried out by the
subcutaneous fatty tissue, beside the storage of nutrients in the form of li&uid
fats, include the insulation of the body from cold and shock absorption. An the
palms of the hand, the soles of the feet and the buttocks, fat padding serves
almost e'clusively for shock absorption. 54oteE +ats, also triglycerides or
acylglycerins, are the most plentiful and simplest fatty acid$containing lipids. They
are esters of the triol alcohol, glycerine with three saturated and:or unsaturated
fatty acids. +ats make up the main component of the fat depots.6
F!t di'tri*ution in "&n !nd /o"&n
The fat content of the subcutis is not the same in all body regions. -lso
men and women differ in the distribution of subcutaneous fat. -n e'ample is
cellulite $ it is characteri)ed by a special arrangement of the subcutaneous fat
tissue septa and predisposes to fat deposition on the hips, thighs and buttocks $
which occurs mostly in women. ,en on the other hand tend to store fat on the
torso.
T%& 'tructur& o$ %u"!n !*do"&n
The human abdomen 5from the Datin word meaning GbellyG6 is the part of
the body between the pelvis and the thora'. -natomically, the abdomen stretches
from the thora' at the thoracic diaphragm to the pelvis at the pelvic brim. The
pelvic brim stretches from the lumbosacral angle 5the intervertebral disk between
D= and !16 to the pubic symphysis and is the edge of the pelvic inlet. The space
above this inlet and under the thoracic diaphragm is termed the abdominal cavity.
The boundary of the abdominal cavity is the abdominal wall in the front and the
peritoneal surface at the rear.
+unctionally, the human abdomen is where most of the alimentary tract is
placed and so most of the absorption and digestion of food occurs here. The
alimentary tract in the abdomen consists of the lower esophagus, the stomach,
the duodenum, the jejunum, ileum, the cecum and the appendi', the ascending,
transverse and descending colons, the sigmoid colon and the rectum. Ather vital
organs inside the abdomen include the liver, the kidneys, the pancreas and the
spleen.
A*do"in!+ or.!n'
The abdomen contains most of the tubelike organs of the digestive tract,
as well as several solid organs. 7ollow abdominal organs include the stomach,
the small intestine, and the colon with its attached appendi'. Argans such as the
liver, its attached gallbladder, and the pancreas function in close association with
the digestive tract and communicate with it via ducts. The spleen, kidneys, and
adrenal glands also lie within the abdomen, along with many blood vessels
including the aorta and inferior vena cava. -natomists may consider the urinary
bladder, uterus, fallopian tubes, and ovaries as either abdominal organs or as
pelvic organs. +inally, the abdomen contains an e'tensive membrane called the
peritoneum. - fold of peritoneum may completely cover certain organs, whereas
it may cover only one side of organs that usually lie closer to the abdominal wall.
-natomists call the latter type of organs retroperitoneal.
VIII. P!t%o)%#'io+o.#
%erforation of a bowel segment. Cvisceration of
bowel content through a penetrating injury. Injury to
the kidneys and ureters. %ancreatic injury, %elvic
organ injury
- stab wound to the abdomen fre&uently leads to
hemorrhage from the penetration of major vessels or
solid organs, such as the liver or spleen.
The signs and symptoms depend upon which part of
the body is involved
The victim usually presents with aktered mental
status, hypo'ia, paralysis, une&ual pupils, shock, or
major bleeding
Injury results in a hemorrhage from the penetration to
a major vessel or solid organ
%enetrating injury to the body
P&n&tr!tin. in3ur# to t%& !*do"&n
- stab wound to the abdomen fre&uently leads to hemorrhage from the
penetration of major vessels or solid organs, such as the liver or spleen.
%erforation of a bowel segment.
Cvisceration of bowel content through a penetrating injury.
Injury to the kidneys and ureters.
%ancreatic injury.
%elvic organ injury.
I4. MEDICAL MANAGEMENT
Doctor5' Ord&r
1:J:9<
,ay have soft diet this am D-T this pm
IK+ to follow D=D2 1D L09 gtts:min
%lease regulate %4!! IK+ for volume: volume replacement
Terminate all IK medicines
(hange dressing
-mbulate
1:<:9<
D-T
D:( IK+
,*7
+ollow up with surgery A%D 1:1=:9<, Dr. 2ocha
7ome meds
o (efuro'ime =99 mg 1 cap TID
o ,etronida)ole =99 mg 1 tab TID
o Cteroco'ib 1 cap AD
o ,KM +e a cap AD
L!*or!tor# t&'t
1:1:9<
7ematology
2esults are within normal
1:0:9<
3lood (hemistry
(reatinine 8.J; mg:dD ref. value 59.69$1.096
1:F:9<
7ematology
7emoglobin 19.= g:dD ref. value 510.9$16.96
7amatocrit 81.6 N ref. value 58J.9$FJ.96
3lood (hemistry
(reatinine 0.9F ref. value 59.69$1.096
4. NURSING MANAGEMENT
Id&!+ nur'in. "!n!.&"&nt
%ost op care includesE
Immediate rapid assessment, then review all systems
K! and assessments every 1= minutes 'F, &89m ' F, &1hr'F, &Fh until 0F
hrs has elapsed.
Temperature:Infection. Don.t change first dressing, that.s the surgeon.s
prerogative. 2einforce only.
+luid intake:output 5usually until oral intake reestablished6
!afetyE ready e&uipment, raise side rails, call bell, assist AA3, etc.
(omfort and rest
%ulmonary (OD3, early ambulation
o Its okay to feel sorry for them, but dont let it get to your head"
Drains are soft rubber tubular structures placed in wounds to
remove fluid 5blood, pus6
prevent deep wound infections in areas that may contain purulent material
obliterate dead spaces
Discharge TeachingE
Individuali)e to the needs of the patient
o diet
o activity
o prescriptions
o elimination
o complications
o se'ual activity
o special e'ercises
o visit with the surgeon
o removal of sutures or staples
o care of the incision
Actu!+ nur'in. "!n!.&"&nt
6. Cu&'
Su*3&cti,&
7Init akong paminaw na ug hawoy kayo akong lawas@, as verbali)ed by
the patient.
O*3&cti,&
TemperatureE 8<.0>(, warm skin, moist skin, tachypnea
Di!.no'i'
7yperthermia related to dehydration as evidence by flushed skin and
warm to touch
O*3&cti,&'
-t the end of 89 minutes, the patient will be able toE
1. maintain core temperature within normal range
0. demonstrate behaviors to monitor and promote normothermia
Int&r,&ntion'
Independent
promote surface cooling by means of tepid sponge bath
maintain bed rest
increase fluid intake 5%A6
(ollaborative
administer antipyretic 5paracetamol6 as ordered
E,!+u!tion
-t the end of 89 minutes, patient.s temperature was rechecked and it
lowered down from 8<.0>( to 8J.6>(. Tepid sponge bath was successful in
lowering the patient.s fever.
8. Cu&'
Su*3&cti,&
73asa lage kayo akong tae bai, kapila nko nalibang karon nga buntag na@,
as verbali)ed by the patient.
O*3&cti,&
Doose bowel movement, F' defecated with loose watery stool
Di!.no'i'
7igh risk for fluid volume deficit related to e'cessive losses through
normal routes 5diarrhea6
O*3&cti,&'
-t the end of < hours, the patient will be able toE
1. control diarrhea
0. have replacement for fluid loss
Int&r,&ntion'
Independent
encourage oral intake
provide supplement fluid, volume: volume replacement
monitor Intake and Autput
asses skin turgor
(ollaborative
-dminister medication as indicated 5anti$diarrheals6
E,!+u!tion
-t the end of the shift, patient was asked If how was his feeling, and he
said ?murag paminaw nku nag arang$arang bya@, as verbali)ed by the patient.
The manifested some degree of progress in the span of care during the shift.
9. Cu&'
Su*3&cti,&
7Daghan lage kayo ni akoa samad bai na, puro ni dunggab, way kaluoy
ang nag$buhat@, as verbali)ed by the patient.
O*3&cti,&
Damage or destroyed tissue at lower and left upper &uadrant, presence of
wound dressings
Di!.no'i'
Impaired tissue integrity related to surgery secondary to stabbed wound
O*3&cti,&'
-t the every shift, the patient will be able toE
1. verbali)e understanding of condition
0. note progressive improvement in wound: or promote healing
process
Int&r,&ntion'
Independent
promote good nutrition with increase protein
monitor wound for changes 5signs of infection6
provide devices to aid in comfort 5wound dressing6
practice aseptic techni&ue for cleansing: dressing wound
(ollaborative
-dminister medication as indicated 5anti$infectives6
E,!+u!tion
-t the end of every shift, the patient understood the importance of good
nutrition and the purpose of ambulatory in the healing process of the wound and
also the importance of deep breathing e'ercises.
XI. REFERRALS AND FOLLOW UP
-fter the patient had discharged from the hospital, he was suggested to
return to his physician Dr. 2ocha on /anuary 1=, 099< for follow up check$up,
change of dressing and for further evaluation, instructions and care.
The recovery of patient.s wounds and post surgical wounds depends on
medications and treatment regimen if it was followed religiously as ordered by his
physician.
4II. NURSING IMPLICATION
This study will serve as a reference material in rendering and competent
care to our patient especially those with similar conditions. Through this, we will
be able to develop our knowledge as well as our skills and attitudes in applying
the prescribed procedures to improve the health status of the patient.
This study will act as a baseline data as well as guide for coming up with a
good, reliable, accurate and comprehensive research paper dealing with issues
commonly e'perienced by patients in the hospital setting. This may aid the
researchers to widen the scope of the study in relation to more or less similar
cases.
The case study paved the way for the researchers to identify and
determine issues related to stab wounds. Through this, the importance of proper
aseptic and sterile techni&ue must be at all times be e'ercised to prevent
occurrence of possible complications on the wound. This study provided the
researchers with the essential information on disease and infection prevention,
health promotion and health maintenance.
4III. BIBLIOGRAPHY
o httpE::en.wikipedia.org
o www. kidshealth.org
o 4urse.s pocket guide F
th
edition
3y ,arilynn C. Doenges and ,ary +rances ,oorhouse
o www.udmercy.edu