Nursing Intervention for Cellulitis

Cellulitis

Nursing Intervention for Cellulitis

The following guide is about cellulitis and nursing intervention for cellulitis. It can be utilized to create nursing interventions for educational purposes only.

What is Cellulitis? 

Nursing Intervention for Cellulitis
What is Cellulitis?

Cellulitis (sel-u-LIE-tis) 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. With cellulitis, the bacteria enter the skin. Cellulitis may spread rapidly. Affected skin appears swollen and red and may be hot and tender. Without treatment with an antibiotic, cellulitis can be life-threatening.

Cellulitis spreads rapidly all over the body, yet cannot spread from one person to another.

  • Cellulitis is a common, potentially serious bacterial skin infection.
  • It indicates a non-necrotizing inflammation of the skin and subcutaneous tissues derived from acute infection.
  • Cellulitis may appear as a swollen, red area of skin that feels hot and tender.

Pathophysiology

Cellulitis mostly arises from breaks in the skin that are not covered or cleaned well.

Nursing Intervention for Cellulitis
Pathophysiology
  • Weak defense. Cellulitis usually follows a break in the skin like puncture wounds, fissures, or lacerations.
  • Entry. Organisms in the skin gain entrance to the dermis and multiply to cause cellulitis.
  • Inflammation. The infected skin would get swollen, red, and tender, and fever may accompany these symptoms.
  • Invasion. If cellulitis is left untreated, the infection could reach the inner layers of the skin and enter the lymph nodes and bloodstream and spread throughout the body.

Statistics & Epidemiology

Since cellulitis is not a reportable disease, the exact prevalence is uncertain; however, it is a relatively common infection affecting all racial and ethnic groups.

  • There is a higher incidence of cellulitis in individuals older than 45 years old.
  • There is an incidence rate of 24.6 cases per 1000 persons for cellulitis.
  • In a large epidemiologic study about skin, soft tissue, joint and bone infections, 37.3% of patients were identified as having cellulitis.
  • There are 32.1 to 48.1 visits per 1000 population for skin and soft tissue infections.
  • Visits for abscess and cellulitis increased from 17.3 to 32.5 visits per 1000 population.
  • Cellulitis was found to account for approximately 3% of emergency medical consultations in a general hospital in the United Kingdom.

Causes

What is the main cause of cellulitis?

Cellulitis is usually caused when bacteria enter a wound or area where there is no skin. The most common bacteria that cause cellulitis include: Group A ß – hemolytic streptococcus (Strep) Streptococcus pneumoniae (Strep)

Certain factors can increase the risk of developing cellulitis and these are:

  • Weak immune system. Bacteria easily lodges to a person who has a weak immune system.
  • Breaks in the skin. Eczema and athlete’s foot, for example, causes breaks in the skin wherein bacteria can enter and cause cellulitis.
  • Intravenous drug use. The insertion site is also a break in the skin that could become the entry point of pathogens.
  • Diabetes. Patients with diabetes experience slow wound healing, and long exposure of wounds could cause infection from pathogens.

Clinical Manifestations

What are the common assessment findings signs and symptoms of cellulitis?

The signs and symptoms of cellulitis are mostly observable and present on the skin tissues.

  • Tenderness at the affected site. Pain is felt at the site of a developing cellulitis.
  • Inflammation of the skin. As the infection spreads into the inner layer of the skin, inflammation occurs.
  • Skin sore or rash that spread quickly. Due to the invasion of pathogens, the skin develops rashes over the affected site.
  • Tight, glossy appearance of the skin. The skin stretches and becomes taut and shiny-looking due to the swelling.
  • Abscess with pus formation. As the infection worsens, pus and abscess starts to form.
  • Fever. Fever generates as the body fights off the infection.

Prevention

How can you prevent cellulitis?

Preventing cellulitis is more favorable than trying to treat one. Here are some tips on how to prevent cellulitis from occurring.

  • Clean thoroughly. Clean the break in your skin immediately and apply antibiotic ointment aseptically.
  • Covering. Cover the wound with a clean bandage and change it regularly until a scab form.
  • Observe. Watch the affected site for signs of wound infection such as tenderness, discharges, and pain.

Complications

Cellulitis, if left untreated, could result in more severe complications such as the following.

  • Blood infection. The blood could become contaminated because of the pathogens that enter the bloodstream and affect the surrounding tissues.
  • Bone infection. The infection may burrow through the layers of the skin and reach the bones.
  • An inflammation of lymph vessels. When there is infection, the lymph nodes may become inflamed and infected as well.
  • Gangrene. The worst-case scenario in cellulitis is if it develops to be gangrene because of the lack of oxygen in the tissues.

Assessment and Diagnostic Findings for Cellulitis

Nursing Intervention for Cellulitis
Assessment and Diagnostic Findings for Cellulitis

Determining the extent of cellulitis is important so that the treatment would be appropriate.

  • Blood tests. The physician may order a blood test to rule out systemic or blood infection.
  • Wound culture. A wound culture would be performed to determine the causative factor of the infection.
  • Ultrasound. Ultrasound may play a role in the detection of the abscess and how to treat it.

Medical Management

The management of cellulitis focuses mainly in the eradication of the infection.

  • Antibiotic therapy. Antibiotics are effective in more than 90% of the patients and treatment may last from 10 to 21 days, depending on the severity of the condition.
  • Drainage. Abscess need drainage for resolution whatever the pathogen is.
  • Analgesics. Pain relievers are prescribed in some cases.
  • Rest. Rest is necessary until symptoms improve, and while resting, the affected area should be raised higher than the heart to reduce swelling.

Surgical Management

When the tissue affected by cellulitis has reached the worst condition, surgical arrangements may be necessary.

  • Amputation. Amputation would only be required if the affected area becomes gangrenous or necrotic.

Nursing Management

Management of cellulitis depends on the severity of the affected area.

Nursing Assessment

Assessment would be performed to check the etiology and the cause of cellulitis.

  • Past medical history. The nurse may assess the presence of comorbid conditions that may increase the risk of cellulitis.
  • Surgical history. If there is a history of surgery, that procedure may have resulted in wound infection.
  • Physical examination. Physical exam should focus on the area affected.

Diagnosis

According to the baseline data gathered, the following diagnoses are achieved:

  • Impaired skin integrity related to altered primary defenses.
  • Disturbed sensory perception related to impaired nerve stimulation.
  • Risk for situational low self esteem related to disturbed body image.

Nursing Care Planning & Goals

Desired outcomes must be achieved for the effectiveness of the treatment. The patient will:

  • Display timely healing of wounds without complication.
  • Maintain optimal nutrition and physical well-being.
  • Participate in prevention measures and treatment program.
  • Verbalize feelings of increased self-esteem.

Nursing Interventions 

The care for a patient with cellulitis mainly rests on the antibiotic regimen.

  • Secure specimen. Obtain specimen from draining wounds as indicated to determine appropriate therapy.
  • Monitor complications. Observe for complications to monitor progress of wound healing.
  • Clean the area. Keep the area clean and dry and carefully dress wounds to assist body’s natural process of repair.
  • Wound care. Use appropriate barrier dressings and wound covering to protect the wound and surrounding tissues.
  • Create a care plan. Consult with wound specialist as indicated to assist with developing plan of care for potentially serious wounds.

Evaluation

The treatment is deemed effective according to the evaluation.

  • Patient displayed timely healing of wounds without complication.
  • Patient maintained optimal nutrition and physical well-being.
  • Patient participated in prevention measures and treatment program.
  • Patient verbalized feelings of increased self-esteem.

Discharge and Home Care Guidelines

Care should continue at home as assisted by the significant others.

  • Assist the client and the significant others in understanding and following medical regimen.
  • Assist the client to learn stress-reduction to deal with the situation.
  • Emphasize importance of proper fit of clothing and shoes to avoid reduced sensation or circulation.

Documentation Guidelines

Every nursing intervention must be documented for legal and medical purposes. For these reasons, the following must be documented:

  • Characteristic of the wound.
  • Causative factors.
  • Impact of condition on personal image or lifestyle.
  • Plan of care and those involved in the planning.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress towards desired outcomes.
  • Modifications to plan of care.

Nursing Intervention for Cellulitis Examples

Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to cellulitis, as evidenced by erythema, warmth and swelling of the affected leg

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for cellulitis.

Intervention Rationale
Assess the patient’s skin on his/her whole body. To determine the severity of cellulitis and any affected areas that require special attention or wound care.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician. Cellulitis is generally treated through the use of antibiotic therapy. •           For mild cases, cellulitis can be treated on an outpatient basis with prescriptions for oral 1st class penicillin. Macrolides may be used as alternatives for patients with Penicillin allergies. Fluoroquinolones may be used but are only warranted for gram-negative organisms to avoid resistance. •           For severe forms of cellulitis, intravenous administrations of higher class of antibiotics are given. 3rd class penicillin is the drug of choice for severe sepsis. However, IV lincosomides and IV Glycopeptides may be given for patients allergic to penicillin’s. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
 Apply corticosteroids over the affected skin as prescribed by the physician. Application is usually twice a day and is done thinly over the inflamed skin. It is applied for a maximum if 14 days. Topical corticosteroids promote the reduction of skin inflammation in the affected area. Mild cellulitis may benefit from over-the-counter topical corticosteroid preparations, but severe cellulitis requires prescription ones.
Prevent the use of occlusive dressing over the affected site. Occlusive dressing potentiates the systemic absorption of the corticosteroid cream or ointment.
Prepare the patient for surgery as indicated. Incision and drainage. This is used for simple cellulitis with presence of pus or abscess to the infected tissue. This treatment is followed with a course of antibiotics to treat remaining infection otherwise not drained from the procedure. Surgical resection. In severe forms of cellulitis, deep tissues like the muscle and bone may be infected and would require surgical removal of the necrotized and dead tissues.
Educate the patient and caregiver about proper skin hygiene through washing the skin with soap and water. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water.

Nursing Care Plan 2

Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will prevent spread of infection to the rest of the body, by following treatment regimen for cellulitis.

Intervention Rationale
Assess the patient’s skin on his/her whole body. To determine the severity of cellulitis and any affected areas that require special attention or wound care.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
Educate the patient and caregiver about proper skin hygiene through washing it with soap and water. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas. Long fingernails tend to harbor more bacteria.
Using a skin marker, mark the edges of the cellulitic area and observe for its shrinkage or spread. This method can help determine whether the antibiotics are effective, or if there is a need to change the antibiotic used.

 

Nursing Intervention for Cellulitis

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