Pathophysiology
Where in the body does cellulitis usually occur?
Lower legs (or a limb) (usually unilaterally)
How does localized cellulitis present?
Redness, warmth, tenderness, and swelling to the affected area
What is the first clinical step in diagnosing cellulitis?
Performing a physical assessment of the skin
The nurse understands the most important task in infection prevention is to...?
Wash hands (especially prior to and after touching wound)
Cellulitis is typically treated with..?
Oral antibiotics such as Penicillins (penicillin G or flucloxacillin) and Cephalosporins (such as ceftriaxone, cefotaxime or cefazolin)
What two bacteria are responsible for causing cellulitis?
Streptococcus and Staphylococcus
List at least 3 systemic manifestations of cellulitis
- fever and chills
- shakes (rigors)
- fatigue/malaise
- nausea and vomiting
- muscle aches
- joint stiffness
What will be the findings of a physical assessment in a client with cellulitis?
How often should bandages be changed?
Daily
Why would the nurse educate the importance of finishing a course of antibiotics, even if the client feels better?
To prevent antibiotic resistances (especially important in preventing MRSA)
How does a client become infected with the bacteria that is responsible for cellulitis?
The bacteria enter through a break or crack in the skin (such as an injury or surgical wound)
Untreated cellulitis can lead to this infection characterized by bacteria in the bloodstream:
Sepsis
Why would a culture & sensitivity be obtained?
To determine the causative bacteria and effective treatment
Why should the nurse mark the edge of the involved area of swelling in a client with cellulitis?
To monitor for progression or regression of the infection
Why would IV antibiotics be necessary for the treatment of cellulitis?
(Name at least one of these)
- signs and symptoms aren't improving with oral antibiotics
- signs and symptoms are extensive (systemic effects)
- client has a high fever
- immunocompromised client
Which layer(s) of skin are affected in cellulitis?
Dermis and subcutaneous tissue
Recurrent cellulitis can lead to damage of what system?
Lymphatic system (causes chronic edema of the affected limb as it does not drain the way it should)
Name two labs that would be drawn on a client who is suspected to have cellulitis.
- CBC w/ differential (looking for elevated WBC)
- C-Reactive Protein (elevated result indicates inflammatory/infectious process)
Why would the nurse educate a client to moisture their skin regularly?
Lubricating skin can prevent cracking and peeling and thus prevent a portal of entry for bacteria
Severe cellulitis with systemic effects should be treated with?
IV antibiotics, oxygen, and fluids
List at least 2 factors that puts a client at an increased risk for cellulitis?
- injury: any cut, burn, fracture, or scrape gives the bacteria a portal of entry
- weakened immune system: conditions such as diabetes and HIV makes a client more susceptible to infection
- personal history of cellulitis: client more likely to develop cellulitis if they've has it previously
- obesity
- skin conditions: chronic skin conditions such as eczema, athlete's foot, and shingles can cause breaks in the skin which give the bacteria a portal of entry
- history of peripheral vascular disease
- chronic swelling of limbs (lymphedema)
Rarely, cellulitis can spread to the deep layer of skin and cause infection in the fascial lining. Name this condition.
Necrotizing fasciitis (medical emergency that requires prompt intervention and surgery)
Why would imaging be ordered for a client with cellulitis?
To further assess systemic affects:
- chest xray in case of HF or pneumonia
- MRI in case of necrotizing fasciitis
- Ultrasound to look for blood clots
List 3 interventions to reduce pain and/or swelling in a client with cellulitis
- elevate extremity
- apply cool, damp cloth on the affected area
- take OTC analgesics
- rest
- manage comorbidities such as venous eczema or tinea pedis (athlete's foot)
Name 2 antibiotics that are used when a client has an allergy to Penicillins or Cephalosporins?
- Clindamycin (Cleocin)
- Sulfamethoxazole-trimethoprim (Bactrim)
- Doxycycline
- Vancomycin
*these are also utilized in client with suspected MRSA infection