Cellulitis Flashcards
What is the most common infectious cause of limb swelling?
cellulitis
Cellulitis is caused by a deeper bacterial infection of the ___,___, and ___,
dermis, subcutaneous tissue, and possibly muscle tissue
What are the most common bacteria to cause cellulitis?
streptococcus and staphylococcus
What are the ways the bacteria can invade the skin and cause cellulitis? (4)
- wounds
- animal or insect bites
- trauma
- IV drug use
What are the s/s of inflammation? (5)
- warm
- erthyema
- edema
- tenderness
- pain
Risk factors of cellulitis (6)
- pre-existing skin disorders (i.e. dermatitis)
- obesity
- Immunocompromised
- diabetes
- peripheral vascular disorders
- fungal infection
steps of inflammation
vascular response –> cellular response –> formation of exudate –> healing
vascular response –> think of what
blood vessels
Vascular response steps
injury occurs –> local vasoconstriction –> release of kinins, histamines, and prostaglandins –> local vasodilation and hyperemia –> increased capillary pressure and permeability –> fluid exudate from capillaries to tissue spaces leading to edema
Cellular response –> think of what
think WBCs
Cellular phase steps
chemotaxis begins –> WBCs rush in to help –> neutrophils and monocytes migrate through capillary walls to the site of injury –> macrophages signal the immune response
What other cells may be released during inflammation?
- eosinophils
- lymphocytes
- basophils
when are eosinophils released?
allergic response
What do lymphocytes do?
help develop immunity
What do basophils do?
carry histamine and heparin
Cellulitis clinical manifestations (4)
- acute onset swelling
- localized redness and pain
- possible regional lymph nodes tenderness and swelling
- systemic s/s (not always present): fever, chills and sweating
How to treat mild cellulitis
- tx with oral antibiotics
- outpatient tx
how to treat moderate to severe cellulitis
- hospitalized
- treat with IV antibiotics
What is the key to treatment of cellulitis?
- identify site of bacterial entry
- complete full course of antibiotics
Cellulitis nursing management (8)
- elevate affected area 3-6 inches above the heart
- cool, moist packs to site every 2-4 hours until inflammation is resolved
- transition to warm moist packs (caution in patients with sensory and circulatory deficits [diabetics])
- assess area
- administer antibiotics
- monitor lab results
- prevention of recurrent infection
- Identify site of entry
What is skin marking?
the infection is outlined to see if it gets worse at all
Cellulitis patient education (5)
- complete antibiotic treatment
- prevention of recurrence
- self skin and foot care for PVD and diabetic patients
- IV substance abusers: referral and support
- notify provider for worsening s/s
Quick risk for sepsis assessment (10 signs of infection)
- increased RR
- Increased HR
- decreased BP
- decreased output
- possible increase/decrease bowel sounds
- possible increase/decrease temperature
- Increased neutrophils
- possible increase or decrease WBC
- decreased O2 sat
- altered mental status
qSOFA score what is measured?
- systolic blood pressure at or below 100 mmHg
- respiratory rate at or above 22
- any change in mental status
What qSOFA score is an increased risk of mortality or extended ICU stay? What lab level?
score of 2 or 3
serum lactate level > 2 suggests hypoperfusion
What is the current clinical criteria for septic shock?
persistent hypoperfusion after fluid resuscitation requiring vasopressors to maintain MAP > 65 mmHg and/or serum lactate level > 2mmol/L
If the sepsis wheel or qSOFA indicate clinical deterioration possible related to infection what does the nurse do?
- call for help (CAT, RRT)- transfer to tele or ICU
- NS bolus to quickly improve BP
- broad spectrum ABx
Diagnosis for DKA
- glucose >250 mg/dL
- pH < 7.30
- bicarb level 18 mEq/L or less
How to help DKA pt while waiting for help (6)
- maintain airway
- hourly monitoring of serum glucose, kidney function, and electrolytes
- fluids (lower serum Glucose and improve metabolic acidosis)
- IV regular insulin drip (5-7 units/hour)
- K+ supplementation during drip
- bicarb IV if pH < 7
cardinal signs of inflammation (5)
- heat
- redness
- swelling
- pain
- loss of function
