The spectrum of severity ranges from localised erythema in a systemically well patient to the rapidly spreading erythema and fulminant sepsis seen with necrotising fasciitis. Nursing interventions are centered on an antibiotic regimen while practicing proper wound care to prevent complications. following is an illustration of cellulitis infection on the legs. Individuals can protect themselves from cellulitis 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. Healthy people can develop cellulitis after a cut or a break in the skin. It is essential for optimal healing to address these factors. Having the knowledge, skills and resources to assess a wound will result in positive outcomes, regardless of product accessibility. Scratching the skin and rubbing it in response to the itchiness makes the irritation to the skin to increase. The patient will prevent the spread of infection to the rest of the bodyby following a treatment regimen for cellulitis. It is important to note that these bacteria naturally occur on the skin and mucous tissues of the mouth and nose in healthy people. Handbook of nursing diagnosis. Most cases of uncomplicated cellulitis are traditionally treated with 12weeks of antimicrobial therapy.15However, evidence now exists to suggest that such prolonged courses may be unnecessary, and that 5days treatment may be sufficient in cases of uncomplicated cellulitis.26 Provided there are no concerns about absorption and there has been some clinical improvement, most patients with uncomplicated SSTIs can be safely switched to oral antibiotics after 14days of parenteral therapy.15,16 The CREST guidance suggests settling pyrexia, stable comorbidities, less intense erythema and falling inflammatory markers as criteria for an oral switch.16 Any predisposing factors (eg tinea pedis, lymphoedema etc) should be addressed to reduce the risk of recurrent cellulitis. Cellulitis presents as redness and swelling initially. Nursing interventions are centered on an antibiotic regimen while practicing proper wound care to prevent complications. Its very important to take cellulitis seriously and get treatment right away. The goal of wound management is to understand the different stages of wound healing and treat the wound accordingly. Cellulitis is an infection that occurs when bacteria enter the skin, causing a dented appearance attributed to fatty deposits. Standard Precautions and I will assess and monitor closely for signs of deteriorating infection. Does the patient need pain management or procedural support? Let it sit for about 30 minutes, and then rinse it off with clean water. Cellulitis is an infection of the skin and connected soft tissues. Royal College of Physicians 2018. Which OTC pain relievers do you recommend? All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. 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). Cleaning and trimming your fingernails and toenails. ), mouth, anus, and belly. As a nurse, I will assess subjective and objective data when assessing the patient for cellulitis. For complex wounds any new need for debridement must be discussed with the treating medical team. No two trials examined the same drugs, therefore we grouped similar types of drugs together. Normal skin can be affected by cellulitis after an injury that causes the skin to break, such as shock and surgical procedures. Nursing Interventions for the Risk of Impaired skin integrity linked to cellulitis. In addition, it may also affect areas around the eyes (Periorbital cellulitis), mouth, anus, and belly. For example, use odor-eliminating spray, and avoid strong scents such as perfume. They include; The following is an illustration of cellulitis infection on the legs. Making the correct diagnosis is key to management. This article will focus on cellulitis of the lower limb. WebCellulitis is an acute, painful, and potentially serious infection of the skin and underlying tissue affecting approximately 1 in 40 people per year. cavities, -Ideal for bleeding wounds due to haemostatic properties, Change every 1-7 days depending on exudate. Scissors should be cleaned with an alcohol or disinfectant wipe before and after use. Many people who get cellulitis again usually have skin conditions that dont go away without treatment, such as athletes foot or impetigo. Assess the patient's skin on the whole body to identify the affected skin areas, To determine the severity of cellulitis and any affected areas that need special consideration during wound care, Administer antibiotics as recommended and ensure the patient completes the course of antibiotics approved by the physician. The patient must finish the dose even if the symptoms heal, Educate the patient on appropriate skin sanitation. Log In See Table 1 for cellulitis severity classification. You may require hospitalization and intravenous (IV) antibiotics your healthcare provider will use a small needle and tube to deliver the antibiotics directly into a vein. Nursing interventions are aimed at prevention. Perform hand hygiene and change gloves if required, 14. We identified 25 randomised controlled trials. Monitor pain closely and report promptly increases in severity. 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. Cellulitis and erysipelas are now usually considered manifestations of the same condition, a skin infection associated with severe pain and systemic symptoms. Services Seek immediate medical care if you show signs of infection, such as a fever, drainage from a sore, a sore that smells bad, changes in skin color, warmth or swelling around a sore. Pain can occur from the disease process, surgery, trauma, infection or as a result of dressing changes and poor wound management practices. Wound or tissue cultures are negative in up to 70% cases,3 with S aureus, group A streptococci and group G streptococci being the most common isolates from wound cultures.4 Serological studies suggest group A streptococcal infection is an important cause of culture negative cellulitis.5 Skin infection with pus is strongly associated with S aureus.6, Animal bites can be associated with cellulitis due to Gram-negatives such as Pasteurella and Capnocytophaga. If you notice symptoms of cellulitis, talk to your healthcare provider right away. All rights reserved. See Box 1 for key points in history taking. We know the importance of nursing assessment in identifying factors that may increase the risk of infection. Last reviewed by a Cleveland Clinic medical professional on 04/18/2022. This nursing care plan will provide the nursing care team with sufficiently treating impaired skin integrity related to cellulitis, ensuring the patient's well-being. Simply fill out the form, click the button and have no worries. Perform hand hygiene, use gloves where appropriate, 7. National OPAT Conference, 2015 Apr 13; Business Design Centre, London, Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections, Comparison of short-course (5days) and standard (10days) treatment for uncomplicated cellulitis, Penicillin to prevent recurrent leg cellulitis, CME Infectious diseases (113044) self-assessment questionnaire. Cellulitis is a frequently encountered condition, but remains a challenging clinical entity. Surprisingly, oral antibiotics appeared to be more effective than antibiotics given into a vein for moderate and severe cellulitis. If you do this yourself, you will: Remove the old bandage and packing. Dressings that have direct contact with the wound and have the ability to change the wound (e.g. Your pain will decrease, swelling will go down and any discoloration will begin to fade. Your healthcare provider will typically prescribe antibiotics taken by mouth (oral antibiotics) to treat your cellulitis. To analyze the effectiveness of interventions and to offer patient-centered care. See also Nursing intervention care for patients at risk of cellulitis. This merits further study. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Stop using once wound bed is dry, -Used for granulating and epithelializing wounds as it provides protection, -Can be used in conjunction with other dressings to increase absorption and prevent maceration, Change every 1-7 days depending on exudate, -To fill irregular shaped wounds e.g. Your symptoms dont go away a few days after starting antibiotics. 1 Cellulitis presents as a painful, Cellulitis is a bacterial infection of your skin and the tissues beneath your skin. http://bsac.org.uk/meetings/2015-national-opat-conference-2/. wound dehydration or maceration), Medications (including immunotherapy, chemotherapy, radiation or NSAIDs), Mental health (including stress, anxiety or depression), Patient knowledge, understanding or compliance, Frequency of dressing changes is led by the treating team or indicated by product manufacturers, Consider less frequent dressing changes in the paediatric population to promote wound healing and prevent unnecessary pain and trauma, It is advised that wounds are reviewed at least every 7 days to monitor wound healing and reassess goals of wound management. Accurate assessment of pain is essential when selecting dressings to prevent unnecessary pain, fear and anxiety associated with dressing changes. I have listed the following factors that predispose individuals to cellulitis, A weak immune system allows bacteria to easily lodge in a person who is unable to fight off the infection, People with breaks in the skin, such as athlete's foot and eczema, provide points of entry for cellulitis-causing bacteria, Intravenous drug use also provides a break in the skin that could be an entry point for pathogens, Patients living with diabetes have sluggish wound healing, and extended exposure to wounds predisposes them to bacterial infections, History of cellulitis in the family or the patient, Lymphedema, a chronic localized swelling of the upper and lower extremities, Widespread tissue damage and tissue death( gangrene), Infection can spread to other body parts such as blood, bones, lymph system, heart, and nervous system, leading to shock and sometimes death ( sepsis), Septic shock-untreated cellulitis can cause unwarranted stress to body organs, causing numerous organ failure, Meningitis is an infection of the exterior cover of the brain. 3. Inflammatory process, circulating toxins, secondary to exogenous bacteria infiltration, Verbal reports of pain, facial grimace, guarding behavior, changes in vital signs, restlessness, Compromised blood flow to tissues secondary to cellulitis, Reduced sensation in extremities, acute pain, prolonged wound healing, swelling, redness, Inflammatory process, response to circulatory toxins secondary to cellulitis, Increased body temperature above normal range, tachycardia, tachypnea, warm skin, flushed, New disease process, lack of understanding of the condition/treatment, Lack of adherence with treatment regimen and follow up, worsening of the condition, poor management of other risk factors, Changes in health status, prolonged wound healing, Expression of worry and concerns, irritability, apprehension, muscle tension, inadequate knowledge to avoid exposure to pathogens. Anyone can get cellulitis. Under and overtreatment with antimicrobials frequently occurs and mimics cloud the diagnosis. We are going to prepare FIVE nursing care plans and diagnoses for patients with Cellulitis, namely: Nursing diagnosis: Impaired skin integrity linked to infection of the skin ancillary to cellulitis as shown by erythema, warmness, and swelling of the infected leg. A warm compress, elevation, compression and NSAIDs also help relieve your symptoms. Signs and symptoms include redness and swelling. Specific situations, such as infections associated with human or animal bites, may require broader spectrum antimicrobial cover and should be discussed with an infection specialist, as should cellulitis involving atypical sites such as the face, torso and upper limb. Cellulitis is a bacterial infection of your skin and the tissue beneath your skin. Many different bacteria can cause cellulitis. (2021). We selected randomised controlled trials comparing two or more different interventions for cellulitis. Anyone can get cellulitis, but the risk is higher if you have a skin wound that allows bacteria to enter your body easily or a weakened immune system. Cellulitis is most common in places (limbs)where the skin was broken before by blisters, surgical wounds, cuts, insect bites or burns. The fastest way to get rid of cellulitis is to take your full course of antibiotics. Cleaning your wounds or sores with antibacterial soap and water. Remove dressings, discard, and perform hand hygiene, 8. These findings suggest the currently used severity scoring system is not a robust means of guiding empirical therapy. It also commonly appears on your face, arms, hands and fingers. 1. Skin surface looks lumpy or pitted, like an orange skin. Non-infectious conditions should be considered, Narrow spectrum penicillins targeting streptococci and staphylococci (in the case of purulent infection) should be the mainstay of antimicrobial therapy, The natural history of cellulitis is one of slow resolution. 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. Pain out of proportion to the clinical signs, in particular, if accompanied by a history of rapid progression should prompt consideration of a necrotising fasciitis.7 Timing and evolution of the skin findings may differentiate cellulitis from some of the common mimics with more chronic clinical course. The guideline aims to provide information to assess and manage a wound in paediatric patients. Typical presentation, microbiology and management approaches are discussed. I will evaluate any ultrasound, CT scans, and MRI results to detect abscesses, The patient should show opportune healing of wounds without any problems, Patient should be able to preserve ideal diet and physical well being, Person should partake in prevention measures and treatment programs, Patient should articulate feelings of increased self-esteem. Assess the patients awareness of infection treatment, potential complications, the extent of cellulitis, and tissue perfusion. The bacteria that cause cellulitis are. As a nurse, I will assess subjective and objective data when assessing the patient for disease risk. Antibiotics given by injection into a muscle were as effective as when given into a vein, with a lower incidence of adverse events. Impaired skin integrity linked to infection of the skin ancillary to cellulitis, as shown by erythema, warmness, and swelling of the infected leg. A cellulitis infection may cause flu-like symptoms, including a fever higher than 100 degrees Fahrenheit (38 degrees Celsius), chills, sweats, body aches and fatigue. To assess the efficacy and safety of interventions for non-surgically-acquired cellulitis. 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. help promote faster skin healing while preventing complications. Blood or other lab tests are usually not needed. Inflammation is an essential part of wound healing; however, infection causes tissue damage and impedes wound healing. I present the illustration to differentiate between normal skin and skin affected by cellulitis. Copyright 2023 The Cochrane Collaboration. I present the illustration to differentiate between normal skin and skin affected by cellulitis. Applying an antibiotic ointment on your wounds or sores. Assess the treatment and management plans are documented clearly and comprehensively. There is a need for trials to evaluate the efficacy of oral antibiotics against intravenous antibiotics in the community setting as there are service implications for cost and comfort. 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. You may learn to do this yourself, or nurses may do it for you. Cellulitis usually affects the arms and legs. Technique. Refraining from touching or rubbing your affected areas. Cellulitis. Erysipelas classically refers to a more superficial cellulitis of the face or extremities with lymphatic involvement, classically due to streptococcal infection. Daily review and early switch to oral therapies is optimal, In patients with recurrent episodes of cellulitis, risk factors should be addressed and consideration given to prophylaxis. There was no significant difference in antimicrobial therapy or treatment outcomes between class I and II severity patients, suggesting that these two groups could be merged, further simplifying the classification. We know the importance of nursing assessment in identifying factors that may increase the risk of cellulitis. Poorly controlled diabetes may also contribute to repeat instances of cellulitis. While recommendations regarding specific antimicrobial agents will vary depending on local practice and resistance rates, suggested empiric regimens are outlined in Table2. Poorly managed wounds are one of the Our primary outcome 'symptoms rated by participant or medical practitioner or proportion symptom-free' was commonly reported. Some of the online platforms that offer MHF4U Canadore College in Canada offers a program in Supply Chain Management. The following are the patient goals and anticipated outcomes for patients with Cellulitis. We do not endorse non-Cleveland Clinic products or services. Patients sensitive to penicillin are prescribed.IV Lincosomides and IV glycopeptides. When you first get cellulitis, your skin looks slightly discolored. Our expert physicians and surgeons provide a full range of dermatologic, reconstructive and aesthetic treatments options at Cleveland Clinic. https://digital.nhs.uk/catalogue/PUB19124 [Accessed 9 April 2017]. These two terms are now considered different presentations of the same condition by most experts, so they are considered together for this review. We know the importance of nursing assessment in identifying factors that may increase the risk of infection. Open wound site, drainage of pus and lesions. As a nurse, I will assess subjective and objective data when assessing the patient for cellulitis. It is important to select a dressing that is suitable for the wound, goals of wound management, the patient and the environment. 1 Between 13.9% and 17% 1-3 of patients seen in the ED with cellulitis are admitted, accounting for 10% of all infectious disease-related US hospitalizations. Please go to the home page and simply click on the edition that you wish to read. 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.