Cellulitis Flashcards
Cellulitis
Bacterial infection involving the skin and underlying subcutaneous tissue following a break in the skin
Deep inflammation in the subcutaneous tissue occurs from the enzymes produced by bacteria
Most common causative bacteria
Staphylococcus aureus and streptococci (gram-positive bacteria) are the most common causative bacteria
Diagnostic studies
Careful history
Physical examination
Inspection of individual lesions
Risk Factors for Cellulitis
Damaged skin
Poor circulation
Diabetes mellitus – higher risk for polymicrobial infections necessitating more aggressive, broad coverage antibiotic treatment
Insect bites – i.e. hikes, walk in tall grass, farmers etc
Use of corticosteroids
Wound Cultures
A wound culture may be ordered if there is uncertainty about the causative organism
Swabs should always be collected after the wound is cleansed
How to collect Aerobic cultures
collected by swabbing the surface of the wound or area of fresh drainage
How to collect Anaerobic cultures
collected using aspirates, swabs and tissue samples
Methicillin Resistance in Saph. Aureus
Major public health concern
Mutation of penicillin-binding protein causes resistance to several antibiotics including methicillin, tetracyclines, macrolides, and aminoglycosides
MRSA risk factors
recent hospitalization, recent antibiotic use, invasive procedures, new admission to a nursing home, long-term use of indwelling medical devices
empiric therapy
Patient’s may be started on empiric therapy (treatment based on the most likely antibiotic to work) while waiting for C&S results – treatment adjusted if bacteria is resistant to the treatment
Nursing Assessment Prior to Antibiotic Initiation
Baseline vitals
Review bloodwork – WBC
Wound assessment
Patient history, comorbidities, allergies, past abx use
Signs and symptoms of sepsis
Treatment of Cellulitis
Medication therapy
Antibiotics – oral or IV
Corticosteroids – oral or IV
Pain management – oral, IV, topical – administer analgesia prior to dressing changes
Complications of Cellulitis
Sepsis – hypotension, fever, tachypnea, tachycardia, confusion, disorientation
Bacteremia – infection in bloodstream
Endocarditis – infection spreads to inner lining of heart chambers and valves
Osteomyelitis – infection spreads to bone, bone marrow, and surrounding soft tissue (highest risk in wounds overlying joints)
Teaching for the Patient on Antibiotics
Instruct patients to finish the full course of abx even in their condition improves
Alcohol should be avoided while taking abx
Notify healthcare provider immediately if negative side effects occur – vomiting, rash
Seek immediate medical attention if signs of allergic reaction occur – hives, difficulty breathing, lip and tongue swelling etc.
Patient Teaching – Cellulitis Prevention and Risk Factors
apply sunscreen and insect repellant when outdoors
Don’t pick or scratch skin
Don’t walk around barefoot
Keep skin moisturized
Avoid hot tubs and open bodies of water when you have an open wound
Manage modifiable risk factors: obesity, diabetes, lymphedema, injectable drugs, skin breakdown
