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Concept Map of Cellulitis Predisposing factors: Obesity Alcoholism Diabetes Low socio-economic status: highly densely populated areas Poor nutrition: low protein and Vit C intake Lymphadema Conditions that compromise the function of the immune system (for example, HIV/AIDS or those receiving chemotherapy or drugs that depress the immune system) Intravenous drug use History of cellulitis peripheral vascular disease Precipitating factor: Breaks in the skin (cut, graze, burn, animal/insect bite, puncture wound, skin ulcer) Pre-existing skin infection, such as athlete's foot (tinea pedis) impetigo, chickenpox and shingles Exposure of bacteria (group A streptococcus or staphylococcus aureus bacteria) It overwhelms the defensive cells (neutrophils, eosinophils, and mast cells) Bacteria releases toxins in the subcutaneous tissues Entry of bacteria (usually strep or staph) through skin impairment These cells normally breakdown cellular components, localize inflammation Increase capillary permeability Vasodilation Exudation of plasma proteins Rubor (redness) Increase blood flow Leukocytosis Headache High Fever, chills, diaphoresis Malaise Muscle aches/pain
MEDICAL MANAGEMENT:
Mild cases of cellulitis can be treated on an outpatient basis with oral antibiotic therapy. If the cellulitis is severe, the patient is treated with IV antibiotics. The key to preventing recurrent episodes of cellulitis lies in adequate antibiotic therapy for the initial event and in identifying the site of bacterial entry. Cracks and fissures that occur in the skin between the toes must be examined as potential sites of bacterial entry. (Other locations include
drug use injection sites, contusions, abrasions)
Precipitating Factors Predisposing Factor s Disease process Signs/Symptoms Nursing Dx /Intervention Diagnostic Test Medical Management Tumor (swelling) Calor (heat) Dolor (pain) Edema ACUTE PAIN A. Elevate head of bed at intervals. Turn client from side to side. B. The patient is instructed to elevate the affected area above heart level and apply warm, moist packs to the site every 2 to 4 hours C. Encourage use of relaxation techniques, such as deep- breathing exercises, guided imagery, and visualization. Provide divertsonal activities.
IMPAIRED COMFORT
A. Provide comfort through therapeutic touch. B. Instruct deep breathing exercising every 15 minutes for 2 hours. C. Place on high backrest. D. Encourage verbalization of feelings to minimize discomfort. DIAGNOSTIC TESTS: Doctors often diagnose through looking at the symptoms. In most cases, there is no need for further testing. Sometimes UTZ will be used to make sure there is no blood clot in a deep vein. A CT Scan or an MRI may also be done to rule out other problems. If the initial treatment with antibiotics is not effective, your doctor ay take samples of your blood and skin to identify specific bacteria present and select a more effective antibiotic.
Sources: Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins. http://www.google.com.ph/imgres?imgurl=&imgrefurl=http%3A%2F%2Fbrights-thoughts.blogspot.com http://medical-dictionary.thefreedictionary.com/cellulitis http://www.tonybullard.com/2008/02/ Retrieved on Sept 23, 2013 10:25PM
