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Cellulitis Case Study

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by

Eric Ceasar Lopez

on 8 August 2013

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Transcript of Cellulitis Case Study

Cellulitis
History of Present Illness
Signs/Symptoms
• Skin erythema
• Edema
• Warmth
• Raised lesions above the level of the skin
• Clear line that indicates where infected area stops
• Drainage, pus (if purulent cellulitis)

Diagnostics
• Bacterial culture (needle/lance)
• Blood culture
• Punch biopsy
• Radiographic examination (differentiates cellulitis vs. osteomyelitis)

Management/Treatment
• Pharmacological:
o Antibiotic (Broad-spectrum initially used)
 Selection depends if cellulitis is purulent or non-purulent
• Nonpharmacological:
o Elevation of the affected area
o Sufficient hydration
• Surgical removal, debridement

Conclusion
Questions?
Cellulitis
Skin infection that is caused by a breach of bacteria through the skin barrier
Caused by infection by Staphylococcus and Streptococcus bacteria
Methicillin-resistant Staphylococcus aureus is beginning to become the common cause of cellulitis
There are two types of cellulitis: purulent cellulitis and nonpurulent cellulitis
Patient is a 56-year old female admitted to Long Beach Memorial on July 10, 2013, with complaints of difficulty breathing, left foot pain, fever, swelling, chills
Diagnosed with cellulitis in LLE due to open diabetic foot ulcer on the left foot
Contact isolation due to MRSA & VRE
Bacterial culture of foot ulcer was positive with MRSA
Patient was generally uncooperative
Poorly controlled type 1 diabetes mellitus
Switched from insulin infusion pump to SQ insulin due to noncompliance
Severe renal insufficiency due to congenital single kidney
Lab Tests
Hgb A1c = 8.6
RBC = 3.47
RDW = 19.6
Hgb = 9.6
Hct = 29.8

Risk Factors
Compromised skin barrier
Skin trauma, abrasions, use of injection drugs, penetrating wounds
Inflammation
Eczema, radiation therapy
Pre-existing skin infection
Impetigo, tinea pedis
Varicella
Edema
Venous insufficiency
Co-Morbidities
• Disc disorder (Cervical), 05/2010
o Epidural injection, C6-7
o Degenerative joint disease (Cervical, thoracic, lumbosacral)
• Carpal tunnel syndrome (Right), 1996
o Ulnar surgery
• Humerus fracture (Right), 1997
o Plate inserted
• Diabetes mellitus, type 1
o Polyneuropathy, peripheral neuropathy
o Nephropathy
o S/P multiple toe amputations

Absent kidney, congenital (Left)
o Severe renal insufficiency
o Recurrent UTI
• Hx of bladder repair surgery, 2009
• Gout
• Pressure ulcer (Right heel, left foot)
• Hypertension
• Peripheral artery disease
• Cardiac arrhythmia
o Implantable pulse generator (Left chest), 2003
• Asthma
• Chronic obstructive pulmonary disease
• Sleep apnea
• MRSA infection
• VRE infection
• Appendectomy, 1984
• Implantable pulse generator (currently “nonfunctional”)
• Dialysis (x6 wks), 03/2009
• Hx of falls
BUN = 31
Cr = 1.54
Glucose = 168
Nursing Diagnoses
1. Impaired skin integrity related to excessive mechanical pressure secondary to cellulitis as evidenced by the presence of inflammation secondary to infection, exposure of deep tissue layers, swelling/edema at infected site, imbalanced nutritional state secondary to diabetes mellitus type 1, hypertension, and peripheral artery disease, and presence diabetic foot ulcers on the left foot and right heel.
2. Ineffective health maintenance related to inability to make appropriate judgments as evidenced by history of poorly managed diabetes mellitus, report of change from insulin infusion pump to subcutaneous insulin secondary to noncompliance and poor reliability, persistent request of pain medications to sleep through the hospital stay, and a history of noncompliance. (Bloom & Olinzock, 2014)
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