CD, 28 y/o male w/
cellulitis in r. hand d/t
IVDU and AKI from
vancomycin use in
hospital.
Pathophysiology
Secondary Dx:
Acute kidney injury
Assessment
Pertinent labs,
diagnostic tests
Symptoms
Complications
Nursing Interventions
and Treatments
Numbness, tingling in r. hand,
potentially nerve damage from
constriction from bandage. Also
potentially from cellulitis.
Bowel tones normoactive on 3/3.
Hyperactive on 3/4. Last BM 2/29 and 3/3.
Constipation d/t
opioid usage.
Encourage PO fluids and activity to
reduce constipation symptoms.
Monitor fingers and RUE for
changes in sensation and temp.
Cellulitis is an infection that develops on the skin from bacteria entering the tissues beneath the outer layers. The most common cause of cellulitis is staph bacteria. IV drug users are more susceptible to contracting cellulitis because of the constant puncturing of the skin with potentially dirty and used needles. Using the same location for needle sticks also raises the chance for bacteria to enter the vessels and the tissue beneath the skin. CD likely contracted his cellulitis from his recent IV drug usage, which he uses as a coping mechanism.
To treat the cellulitis, CD had been receiving
IV vancomycin. Vacno is a nephrotoxic drug
and can be damaging to the kidneys if used
in high dosages. The high dose resulted in acute
kidney injury, requiring the use of another
antibiotic to treat the cellulitis.
Pt is awake, alert, Ox4. Edema: +1 in
LLE and RLE; +2 in RUE. Breathing non-labored,
clear bilat all fields. Skin is warm with abrasions on face. Otherwise dry and intact. Fingers are warm and blanchable. Incision covered with gauze bandage. Swelling in fingers.
Decreased kidney function from
AKI, caused by vancomycin usage.
Loss of finger function from
compression of nerves with
tight bandage.
Spreading of infection
to other parts of the body
if not properly controlled with
antibiotic and antiviral treatment.
Apply sequential compression
devices while CD in bed to prevent
potential blood clot.
Consult social work to find
drug rehab placement after DC,
as pt has expressed interest in
getting clean from IV drugs.
WBC
Hemoglobin
Day 1: 8.13; Day 2: 6.69; Day 3: 7.3
Day 1: 9.8; Day 2: 10.5; Day 3: 9.7
Hematocrit
Day 1: 29.9; Day 2: 32.2; Day 3: 29.7
Creatinine
Day 1: 2.74; Day 2: 2.59; Day 3: 2.49
Elevated d/t AKI
Decreased d/t fluid retention
Levels WDL
Decreased d/t AKI