BACTERIAL INFECTIONS-CELLULITIS
Definition
Cellulitis is a common, potentially serious bacterial skin infection. The affected skin appears swollen and red and is typically painful and warm to the touch. Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas.
Signs and Symptoms
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Red area of skin that tends to expand
Swelling
Tenderness
Pain
Warmth
Fever
Red spots
Blisters
Skin dimpling
Causes
Cellulitis occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in your skin.
Risk Factors
Injury. Any cut, fracture, burn or scrape gives bacteria an entry point.
Weakened immune system. Conditions that weaken your immune system — such as diabetes, leukemia and HIV/AIDS — leave you more susceptible to infections. Certain medications also can weaken your immune system
Skin conditions. Conditions such as eczema, athlete's foot and shingles can cause breaks in the skin, which give bacteria an entry point.
Chronic swelling of your arms or legs (lymphedema). This condition sometimes follows surgery.
History of cellulitis. Having had cellulitis before makes you prone to develop it again.
Obesity. Being overweight or obese increases your risk of developing cellulitis.
Health Education
Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
Apply a protective cream or ointment. For most surface wounds, an over-the-counter ointment (Vaseline, Polysporin, others) provides adequate protection.
Cover your wound with a bandage. Change bandages at least daily.
Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.
Medical Treatment
For Pain
Ibuprofen oral 400mg 8hrly with meals or Paracetamol 1000mg 4-6 Hrly PRN
Antibiotic Therapy
Flucloxacillin Oral 500mg QUID For severe penicillin allergy Clindamycin Oral 450mg 8 Hrly
Surgical Management
Rarely, severe cases may need surgery. For example, doctors may need to open and drain an abscess or pus that has collected in the tissue. They may also need to cut away dead tissue to allow healing
Diagnostic Tests
Clinical examination.
Nursing Management
Bed rest is necessary - passive exercise can reduce the associated complications.
Limb elevation is important to reduce oedema
Pressure area care.
Patient education once the condition has resolved. Advise on:basic skin care and avoidance of predisposing factors where possibleavoidance of skin damage by wearing appropriate protective equipment when taking part in work or sport;cleaning any skin breaks carefully and monitoring for signs of infection;and good general health in fighting potential infection.
Blood cultures
Pathophysiology
Cellulitis usually follows a breach in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. In some cases, there is no obvious portal of entry and the breach may be due to microscopic changes in the skin or invasive qualities of certain bacteria. Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis
Nursing Care Plan
Wound culture.
Ultrasound
Risk For Impaired Skin Integrity
Goals And Outcomes
Patient’s skin remains intact, as evidenced by the absence of redness over bony prominences and capillary refill less than 6 seconds over areas of redness.
Assessment
Assess the overall condition of the skin.
Check on bony prominences such as the sacrum, trochanters, scapulae, elbows, heels, inner and outer malleolus, inner and outer knees, back of head).
Evaluate the patient’s awareness of the sensation of pressure
Nursing Intervention
Discourage the patient or caregiver from elevating the head of bed repeatedly. Encourage the use of lifting devices like trapeze or bed linen to move the patient in bed.
Encourage the patient to change position every 15 minutes and change chair-bound positions every hour.
Encourage the implementation of pressure-relieving devices commensurate with degree of risk for skin impairment
Encourage adequate nutrition and hydration
Disturbed Body Image
Goals and Outcomes
Patient incorporatess changes into self-concept without negating self-esteem.
Patient verbalizes acceptance of self in situation.
Patient discusses with family/SO about situation, changes that have occurred.
Patient develops realistic goals/plans for the future.
Nursing Intervention
Nursing Assessment
Assess meaning of loss or change to patient and SO, including future expectations and impact of cultural or religious beliefs.
Assess the perceived impact of change in ADLs, social participation, personal relationships, and occupational activities
Assess the result of body image disturbance in relation to the patient’s developmental stage.
Evaluate the patient’s verbal remarks about the actual or perceived change in body part or function.
Acknowledge and accept expression of feelings of frustration, dependency, anger, grief, and hostility. Note withdrawn behavior and use of denial.
Recognize the normalcy of response to the actual or perceived change in body structure or function.
Set limits on maladaptive behavior. Maintain nonjudgmental attitude while giving care, and help patient identify positive behaviors that will aid in recovery.