Cellulitis is an infection of the skin and connected soft tissues. See. I must conduct nursing assessments with the knowledge of the several risk factors which make the individual more susceptible to other infections, such as chronic illnesses and compromised immune systems. Obtain specimens for culture and sensitivity testing, Administration of prescribed antibiotics and pain medications, Patient family education on condition and management at home, Danger signs and symptoms of infection (such as, very high grade fever, confusion or disorientation, severe pain, dyspnea), Immunocompromised health status due to comorbidities such as HIV/AIDS, diabetes, and cancer. Getting medical attention right away for any deep cuts or puncture wounds. Poorly managed wounds are one of the Should only be used for 2-3 weeks, -Moisture management for moderate- high exudate, -Absorbs fluid to form a gel (can be mistaken for slough), -To fill irregular shaped wounds e.g. It is important to note that these bacteria naturally occur on the skin and mucous tissues of the mouth and nose in healthy people. Get useful, helpful and relevant health + wellness information. Cellulitis most frequently affects the periorbital area and limbs where the skin is damaged by blisters, surgical incisions, cuts, insect bites, or burns. 1 Cellulitis presents as a painful, skin integrity linked to infection of the skin ancillary to cellulitis, as shown by erythema, warmness, and swelling of the infected leg. Copyright 2023 The Cochrane Collaboration. WebThis review looks at interventions for the skin infections 'cellulitis' and 'erysipelas'. WebAntihistamine drugs should be administered 1.Patient who have cellulitis develop a cycle of itch- scratch and the scratching worsens the itching (Nazik et al., 2020). Skin breaks, lymphedema, venous insufficiency, tinea pedis and obesity have been associated with an increased risk of lower limb cellulitis in case control studies.911, Assessment of baseline liver and renal function may be useful for assessing end-organ dysfunction in patients with sepsis and for dosing of antimicrobials. WebDoctors typically diagnose cellulitis by looking at the affected skin during a physical examination. If the WBC and CRP continue increasing, it indicates a worsening infection. Effective wound management requires a collaborative approach between the nursing team and treating medical team. by practicing good personal hygiene, washing hands regularly, applying lotion and moisturizers on dry and fractured skin, using gloves when managing cuts, and always wearing protective footwear. Only two studies investigated treatments for severe cellulitis and these selected different antibiotics for their comparisons, so we cannot make firm conclusions. Severe cellulitis is a medical emergency, and treatment must be sought promptly. Cellulitis nursing management and patient teaching are all included. https://digital.nhs.uk/catalogue/PUB19124 [Accessed 9 April 2017]. Nursing management for Cellulitis Assess for pain, noting quality, characteristics, location, swelling, redness, increased body temperature. 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, standard aseptic technique or surgical aseptic technique, RCH Procedure Skin and surgical antisepsis, Parkville EMR | Nursing Documenting Wound Assessments (phs.org.au), Clinical Images- Photography Videography Audio Recordings policy, Pain Assessment and Management Nursing Guideline, Procedural Pain Management Nursing Guideline, Infection Control RCH Policies and Procedures, Pressure injury prevention and management, evidence table for this guideline can be viewed here, The goal of wound management: to stop bleeding, The goal of wound management: to clean debris and prevent infection, The goal of wound management: to promote tissue growth and protect the wound, The goal of wound management: to protect new epithelial tissue, Cellulitis: redness, swelling, pain or infection, Macerated: soft, broken skin caused by increased moisture, Wound management practices and moisture balance (e.g. Dressings that have direct contact with the wound and have the ability to change the wound (e.g. However, if cellulitis is left untreated it can cause life-threatening complications such as sepsis. However, we aim to publish precise and current information. This nursing care plan we are developing will increase the patients knowledge of preventive measures, treatment plans, and nursing interventions that will help alleviate the cellulitis infection and relieve pain. WebPediculosis Capitis (Head Lice) NCLEX Review and Nursing Care Plans Pediculosis capitis, commonly known as head lice, is a common contagious infection due to human head lice. Bacterial Infections. I must conduct nursing assessments with the knowledge that cellulitis infections sometimes look like common skin infections. It is important to note that these bacteria naturally occur on the skin and mucous tissues of the mouth and nose in healthy people. Your health care provider will likely be able to diagnose cellulitis by looking at your skin. 1. Hospital Episode Statistics for England 201415, Mandell, Douglas, and Bennett's principles and practice of infectious diseases, Use of cultures in cellulitis: when, how, and why, Erysipelas, a large retrospective study of aetiology and clinical presentation, Erysipelas: clinical and bacteriologic spectrum and serological aspects, Improvement of a clinical score for necrotizing fasciitis: Pain out of proportion and high CRP levels aid the diagnosis, Distinguishing cellulitis from its mimics, Risk factors for erysipelas of the leg (cellulitis): case-control study, Risk factors for acute cellulitis of the lower limb: a prospective case-control study, Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples, Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America, Costs and consequences associated with misdiagnosed lower extremity cellulitis, Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care, Managing skin and soft tissue infections: expert panel recommendations on key decision points, Guidelines on the management of cellulitis in adults, Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients, A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study, National Institute for Health and Care Excellence, Sepsis: recognition, diagnosis and early management, Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial, Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial, Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis, Early response in cellulitis: A prospective study of dynamics and predictors, Gilchrist DM. Chills and fever as the body fights off the infection, A feeling of warmness around the affected area, pain is felt at the site of developing cellulitis, A red, painful rash with coatings and sores that spread rapidly due to the invasion of pathogens, Swollen glands and lymph nodes from the infection, Swelling of the skin in the tender area as infections spread to the inner layer of the skin, Tender skin accompanied by an aching, dull pain, Red lines from the original location of the cellulitis, Tight, polished appearance of the skin. RCH Procedure Skin and surgical antisepsis. They produce a variety of products such as jams, jellies, marmalades, sauces, condiments, teas, and other gourmet foods. Needs to be bigger than the wound as it will shrink in size, Continue to use until there is low- nil exudate, -Protects the wound base and prevents trauma to the wound on removal, Can be left on for up to 14 days (for orthopaedic wounds), -Protective dressing for low- moderate exudate, -Can adhere to the wound bed and cause trauma on removal (consider the use of an atraumatic dressing/ impregnated gauze), Stop using when exudate is too high or the wound has healed, -Moisture donation for low-moderate exudate, -Forms a gel when exudate present (white bubbles), -Can be used as a primary or secondary dressing, -Iodine is only be used in acute superficial wounds as it can damage granulating tissue so should be used with caution, -Has antifungal and antibacterial properties, -Moisture donation for low- moderate exudate, -Used on dry/ necrotic wounds as it hydrates the wound bed and promotes autolytic debridement, Change every 3-7 days depending on exudate, -Protective dressing for nil-low exudate, -Allows for inspection through dressings, -Protective dressing for low- heavy exudate, -Absorbs moisture and distributes pressure (good for pressure injuries), -Atraumatic to the wound and surrounding skin, -Same as silicone foam but includes adhesive film, -For infected, contaminated or malodorous wounds as it promotes autolytic debridement, -For moderate-high exudate or hypergranulation tissue, -Used for moist necrotic wounds and draining infected wounds, For best results change frequently (more than once daily). Use incision and drainage procedures to clean the wound area. Cleveland Clinic Children's is dedicated to the medical, surgical and rehabilitative care of infants, children and adolescents. Apply corticosteroids over the affected skin twice a day for two weeks, To prevent further damage to the skin as they reduce inflammation, Do not use occlusive dressing over the affected site, Occlusive dressing absorbs the corticosteroid cream and ointment making treatment ineffective, Prepare the patient for surgery as indicated. This nursing care plan is grounded on evidence-based practices as it accurately records prevailing subjective and objective data while identifying any possible needs and risks involved. Nursing Interventions For Risk of infection. In: Loscalzo J, Fauci A, Kasper D, et al., eds. Refraining from touching or rubbing your affected areas. See RCH Our writers have earned advanced degrees We do not endorse non-Cleveland Clinic products or services. Macrolides/streptogramins were found to be more effective than penicillin antibiotics (Risk ratio (RR) 0.84, 95% CI 0.73 to 0.97). Cochrane Database of Systematic Reviews 2010, Issue 6. No. Untreated cellulitis can lead to life-threatening conditions such as sepsis and gangrene. Clinical Images- Photography Videography Audio Recordings policy for more information regarding collection of clinical images. It is now evident the Nursing care plans for the risk of. In some cases of cellulitis, the entry point may not be evident as the entry may involve minute skin changes or intrusive qualities of some infectious bacteria. I recommend the following nursing interventions in the tables below to reduce the risk of cellulitis. Perform hand hygiene and change gloves if required, 14. Stevens, DL, Bryant AE. We selected randomised controlled trials comparing two or more different interventions for cellulitis. Encourage and assist patient to assume a position of comfort. Is all the appropriate equipment available or does this need to be sourced from a different area? Diverticulitis Pathophysiology for nursing students and nursing school, 20 NANDA nursing diagnosis for Chronic Kidney Disease (CKD), 5 Stages of Bone Healing Process |Fracture classification |5 Ps, 19 NANDA Nursing Diagnosis for Fracture |Nursing Priorities & Management, 25 NANDA Nursing Diagnosis for Breast Cancer, 9 NANDA nursing diagnosis for Cellulitis |Management |Patho |Pt education, Trauma, surgical incision, thermal injury, insect bites. Oral antibiotics may include dicloxacillin or cephalexin. Nursing Diagnosis: Risk for infection related to a decrease in immune function, non-adherence to antibiotic treatment, broken skin barriers, chronic illnesses, malnutrition, and poor hygiene practices. Debridement can be enzymatic (using cleansing solutions), autolytic (using dressings) or surgical. Though rare, you may be able to contract cellulitis if you have an open wound and have skin-to-skin contact with an infected persons open wound. The skin is the bodys largest organ and is responsible for protection, sensation, thermoregulation, metabolism, excretion and cosmetic. It stands for Tissue, Infection or Inflammation, Moisture balance and Edges of the wound or Epithelial advancement. They include; The following is an illustration of cellulitis infection on the legs. Treatment includes antibiotics. Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43). Macrolides are used for patients with an allergic reaction to penicillin Fluoroquinolones are approved for gram-harmful bacteria to prevent resistance to severe cellulitis. If you notice symptoms of cellulitis, talk to your healthcare provider right away. Nursing outcomes ad goals for people at risk of cellulitis. Technique. No, cellulitis doesnt itch. No two trials examined the same drugs, therefore we grouped similar types of drugs together. Patients with three to four episodes of cellulitis per year despite addressing predisposing factors could be considered for prophylactic antimicrobial therapy so long as those factors persist.12 A randomised controlled trial of phenoxymethylpenicillin prophylaxis in patients with a history of recurrent cellulitis showed a reduced rate of recurrence in the treatment group (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.350.86, p=0.001). Patients with severe or necrotising infections should have initial broad spectrum antimicrobial cover to include staphylococci, streptococci, Gram-negative organisms and also an agent with activity against toxin production in group A streptococci, such as clindamycin or linezolid.12,15 Treatment with an agent active against methicillin-resistant S aureus (MRSA) should be considered in patients with a known history of, or risk factors for, MRSA colonisation as well as in those with suspected necrotising fasciitis.12 Recent prospective trials in the USA have suggested that empiric use of agents active against MRSA may not be warranted in the treatment of non-purulent cellulitis.20, There is little evidence to support the historical practice of adding benzylpenicillin to flucloxacillin in the treatment of cellulitis.21 In a randomised double-blinded trial comparing flucloxacillin and clindamycin with flucloxacillin alone, there was no difference in clinical improvement or the resumption of normal daily activities, but there was increased diarrhoea in the clindamycin group.22 Brunn et al found that early antimicrobial escalation (during the first 3days of therapy) did not result in improved outcomes and addressing non-antibiotic factors such as limb elevation and treatment of comorbidities should be considered as an integrated part of the clinical management of cellulitis.23, Outpatient parenteral antimicrobial therapy has become an increasingly important means of delivering ambulatory care. Antibiotics given by injection into a muscle were as effective as when given into a vein, with a lower incidence of adverse events. This will ensure the healthcare teams have the information to deliver safe and effective patient care for cellulitis infections. Hinkle, J., & Cheever, K. (2018). Management should include limb elevation and continuing narrow-spectrum antimicrobial therapy alongside treatment of comorbid conditions exacerbating the cellulitis (oedema, diabetes, vascular disease), Outpatient parenteral antimicrobial therapy (OPAT) (including ambulatory care) is often appropriate in patients requiring intravenous therapy, but presents challenges in terms of antimicrobial agents used. WebNursing intervention care for patients at risk of cellulitis. A range of antibiotic treatments are suggested in guidelines. While recommendations regarding specific antimicrobial agents will vary depending on local practice and resistance rates, suggested empiric regimens are outlined in Table2. Cellulitis is a bacterial infection of your skin and the tissue beneath your skin. For more information follow the We know the importance of nursing assessment in identifying factors that may increase the risk of cellulitis. We had insufficient data to give meaningful results for adverse events. Having the knowledge, skills and resources to assess a wound will result in positive outcomes, regardless of product accessibility. Documentation of wound assessment and management is completed in the EMR under the Flowsheet activity (utilising the LDA tab or Avatar activity), on the Rover device, hub, or planned for in the Orders tab. Infections of the Skin, Muscles, and Soft Tissues. Cleveland Clinic is a non-profit academic medical center. Contact us Hypertension (HTN) is a chronic disease that requires long-term, To use turmeric for leg cellulitis treatment, thoroughly mix a teaspoon of turmeric powder with 1 tablespoon of raw organic honey to make a paste. RCP members and fellows (using their login details for the main RCP website) are able toaccess the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:https://cme.rcplondon.ac.uk, Copyright 2021 by the Royal College of Physicians, DOI: https://doi.org/10.7861/clinmedicine.18-2-160, Sign In to Email Alerts with your Email Address, Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol, NHS Digital. Clean any wounds with water and antibacterial soap and cover them with a clean bandage to reduce your risk of infection. The infection most commonly affects the skin of the lower leg but can infect the skin in any part of the body, usually following an injury to the skin. Need Help with Nursing assignment We Have Experts in Every Field! Policy. The program will also give information on managing any complications that may arise. This plan aims to lower blood pressure levels and reduce the risk of illness or injury from high blood pressure-related events such as stroke or heart attack. WebNarrow spectrum penicillins targeting streptococci and staphylococci (in the case of purulent infection) should be the mainstay of antimicrobial therapy The natural history of cellulitis In: Kelly A, Taylor SC, Lim HW, et al., eds. As a nurse, I will assess subjective and objective data when assessing the patient for disease risk. The evidence table for this guideline can be viewed here. The patient will prevent the spread of infection to the rest of the bodyby following a treatment regimen for cellulitis. Patients with mild to moderate cellulitis should be treated with an agent active against streptococci. Dressings that cover/ compliment primary dressings and support the surrounding skin. Many people who get cellulitis again usually have skin conditions that dont go away without treatment, such as athletes foot or impetigo. Intravenous agents should be used for those with evidence of systemic infection (Dundee class III and IV) or those who do not respond to initial oral therapy. A wound is a disruption to the integrity of the skin that leaves the body vulnerable to pain and infection. The SEWS is a standardised form of early warning score, calculated from the patient's routine clinical observations, with a threshold score of 4 selected to indicate the most severely unwell patients (class IV) in whom a clinical review was mandated at the site where the study was undertaken. Scratching the skin and rubbing it in response to the itchiness makes the irritation to the skin to increase. EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG. Transmission based precautions. It appears as a reddened, swollen area of the skin and is usually easily diagnosable through inspection. Art. The community nurse may be involved in dressing leg ulcers and may refer a patient with Meshkov LS, Nijhawan RI, Weinberg JM. If you are not familiar with wound assessment/debridement confer with a senior/expert nurse. Marwick et al used a modified version of the Eron classification (the Dundee classification) to separate patients into distinct groups based on the presence or absence of defined systemic features of sepsis, the presence or absence of significant comorbidities and their Standardised Early Warning Score (SEWS).17 The markers of sepsis selected (see Box2) were in line with the internationally recognised definition of the Systemic Inflammatory Response Syndrome (SIRS) at the time. Covering your skin will help it heal. Nursing Care Plan and Diagnosis for Cellulitis Ineffective These findings suggest the currently used severity scoring system is not a robust means of guiding empirical therapy. Elsevier. See also The opportunistic infections from cellulitis can affect the brain as its contaminants circulate the body through infected blood, Endocarditis or the infection of the heart and adjacent tissues, Lymphangitis, an infection of lymph nodes and vessels. Assess the skin. If there is a history of surgical procedures, it is most likely the policies may have resulted in wound infection, I will analyze results from blood and skin tests to confirm the type of bacteria that is present, I will analyze bacteria culture results to know the type of bacteria as this will guide treatment in knowing the most effective antibiotic against the bacteria identified, I will physically assess the patient for open wounds, cuts, or any other injuries and evaluate the skin for redness, swelling, blisters, and other physical signs of cellulitis.