Included In This Lesson
Study Tools
Outline
Pathophysiology
Cellulitis is a common deep bacterial skin infection that causes redness, swelling, and pain in the affected area of the skin (usually the arms and legs). If untreated, can spread and cause serious health problems.
Etiology
Cellulitis is usually caused by bacteria that enters into a wound, bruise, burn, surgical cut, bite, or an ulcer. Group A strep (streptococcal) being the most common cause.
Desired Outcome
Patient will re-establish healthy skin integrity and be free from infection
Subjective Data
- Pain
- Tenderness
- Weakness
Objective Data
- Redness (tends to expand)
- Swelling
- Warm to the touch
- Fever/chills
- Red spots
- Blisters
- Skin dimpling
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Full skin assessment/mark edges with skin marker (note color, swelling, blisters) | to determine the severity of cellulitis. Marking the border of cellulitis can determine if it continues to spread and/or if antibiotic therapy is working |
| Antibiotic Therapy/Pain medication | Many cellulitis cases are treated with PO antibiotics, but more serious cases may need to be treated in hospital with IV antibiotics
NOTE: patient should take full course of antibiotics Pain meds- assess pt’s pain level and give pain medication as needed |
| Elevation of affected extremity | elevating the affected extremity helps decrease swelling and speeds up recovery |
| Assess VS/Labs/CT/MRI imaging possible | VS- patient can develop a fever
Labs- CBC (WBC), Creatinine, CRP CT/MRI- if necrotizing fasciitis is a concern |
| Proper Wound Care-Corticosteroid cream,
Keeping the wound clean/dry with occlusive dressings Proper hand hygiene Clipping toenails |
Corticosteroid cream-helps with inflammation
Keeping the wound clean/dry and dressed with occlusive dressing avoids further infection Note Toenails harbor bacteria |
| Educating the patient/family | throughout therapy, it is important to always educate the patient on cellulitis, medications, and any interventions being done. |
A Nursing Care Plan (NCP) for Cellulitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.
References
https://my.clevelandclinic.org/health/diseases/15071-cellulitis
https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&v%3Asources=medlineplus-bundle&query=Cellulitis
https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762
https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html
Transcript
Hi everyone. Today, we are going to be creating a nursing care plan for cellulitis. So let’s get started. First, we’re going to go over the pathophysiology. Cellulitis is a common, deep bacterial skin infection that causes redness, swelling, and pain in the affected area of the skin. Usually it’s the arms and the legs. Some nursing considerations. You want to do a full skin assessment, vital signs, administering medications, wound care, labs, and educating the patient on treatment and prevention. Some desired outcomes: the patient’s going to reestablish healthy skin integrity and be free from infection. And here’s just a little photo to show you guys of what cellulitis looks like. You’ll notice that there’s some redness, all in the lower part of the leg here. Maybe some swelling, usually pretty warm to the touch. You can feel as you get closer, that heat that comes.
We’ll go right ahead to the care plan here. So we’re going to write down some subjective data and some objective data. So what are we going to see, or what is the patient going to tell you? One of the main things with the patients is that they’re going to be complaining of pain and also some tenderness in that area. Some of the objective that you’re going to see that is the hallmark is redness or swelling. You can also see some blisters, Some other things that you’re going to see, they’ll complain of some weakness in that extremity. There’ll be some swelling, warmness to the touch. The patient can have fever or chills, red spots, and maybe some skin dimpling.
One of the interventions we really want to make sure that we’re doing is a full skin assessment. Assessment is usually one of the main things we do for pretty much anything. And we want to make sure we’re marking the border. And you’re probably wondering, well, Kristen, why would we mark the border? So we want to assess it. We want to see if there’s any swelling, any blisters, have the blisters broken, the color if it’s like real deep red. You want to determine the severity of the cellulitis and by marking the border, you’re going to determine if it continues to spread further and or if you’ve started antibiotic therapy, is it working. Another intervention that we’re going to be doing is we’re going to be giving antibiotics and pain medication. Many cellulitis cases are treated with PO or by mouth antibiotics, but more serious cases may need to be treated in the hospital with IV antibiotics. You want to note that patients should take a full course of antibiotics. They do not want to take or stop up taking antibiotics, even if they feel better or that it looks better. And with pain medication, you want to make sure you’re assessing the patient’s pain level and giving pain medication as needed. Another intervention we’re going to be doing for the patient. You want them to elevate that extremity. So you want to elevate the affected leg or arm just to decrease the swelling. And it speeds up the recovery process. Now intervention, obviously we’re going to make sure we’re checking the vital signs and doing any sort of labs or CT or MRI. So the vital signs; patients can develop that fever. They may also have chills. Labs. We want to make sure we’re checking for CBC for that white blood count. We’re going to be checked in for their creatinine for the kidney function and for the infection. CT or MRI will be done if the physician believes the possibility of necrotizing fasciitis. Okay, another intervention we’re going to do for this patient, we want to make sure we’re doing proper wound care, whether that is by you or by the wound care nurse that comes and sees the patient. You want to keep that wound very clean and very dry with any sort of occlusive dressing. You want to make sure you’re doing proper hand hygiene prior to doing any sort of wound care and after so you’re not spreading the bacteria. I want to make sure that you’re clipping the toenails as harbor bacteria and can cause spread of the infection. You can apply some corticosteroids, topically if ordered, and that helps with the inflammation. Another intervention. We also just want to make sure we’re educating, educating, educating. Very important. We’re letting the patient know what we’re doing, why we’re doing it, any medications that we’re giving and any wound care that we’re doing.
So we’re going to go over some key points now. So cellulitis, it’s a common deep bacterial infection usually caused by bacteria that enters in by wound by a bruise, burn, surgical cuts, a bite, or an ulcer. Typically group a strep is the most common cause. Subjective and objective: you’re going to patients going to complain of tenderness in that area. Weakness, redness (very common), swelling (very common), warm to touch fever, chills, red spots, blisters, and skin dimpling. You want to do a thorough skin assessment, give any medications, make sure you’re noting the color, swelling, any blisters that might be there. Checking vital signs, antibiotic therapy and pain management, wound care, corticosteroid cream, keeping the wound dry and intact, applying any occlusive dressings, and proper hand hygiene to prevent any sort of spreading of the bacteria. And there you have a completed care plan.
We love you guys. Go out, be your best self today and as always happy nursing.
Miriam Wahrman, MSN/Ed, RNC-MNN 
Nichole Weaver, MSN/Ed, RN, CCRN 
