Nursing Management 1

CELLULITIS IN THE MEDIAL ASPECT OF THE RIGHT THIGH

Nursing Management of a Patient Having Cellulitis in the Medial Aspect of the Right Thigh

Balcobero, Kristal Jade D. Our Lady of Fatima University, Quezon City

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Nursing Management of a Patient Having Cellulitis in the Medial Aspect of the Right Thigh Patient G. D. P. a 5 year old male, Roman Catholic, lives in 99 St. Abra Bago Bantay Quezon City. Patient slipped and fell on his inner thigh pubic area and pain, swelling and tenderness was present. It was self-medicated with topical ointment and 3 days prior to admission; he developed undocumented fever and was self-medicated with biogesic which is an analgesic and antipyretics which provided temporary relief. A few hours later, patient has persistence of symptoms and was brought to Philippine Orthopedic Center where consultation was done. Subsequently, patient was admitted and with initial diagnosis of cellulitis medial aspect of the right thigh. Often patients with Cellulitis exhibits pain accompanied by swelling and tenderness and should be assessed for impaired skin integrity. Patient with cellulitis usually occur anywhere on the body, most often on the legs, face, or arms, Parks (2007). Pathophysiology The symptoms of cellulitis include tenderness, pain, swelling and redness at the site of the infection. If the infections spread, fever and chills may develop along with swollen lymph nodes. Cellulitis usually occurs anywhere in the body, most often in the legs, face and arms. In some cases it can spread quickly causing more intense symptoms. There are some reasons for having cellulitis such as animal bites, insects bites and cuts or wounds. When bacteria are inside the body they start slowly invading the inner layer of the skin and produces enzymes that destroy the cells in the particular area of the body. The bacteria responsible for the development of Cellulitis are usually of the Staphylococcus or Streptococcus group. Staphylococcus aureus is essentially a non-harmful bacterium. This type ofbacteria can be normally found on the skin surface. Its presence does not cause any disease at all. The cellulitis disease cycle normally ends with local infection or inflammation. However, when the body cannot compensate or if the infection becomes too much for the body to handle, the body also suffers. This could sometimes lead to systemic infections that spread via the blood or cellulitis that affects the vital organs. This type of reaction happens in people with very weak immune systems. It affects people with AIDS, individuals taking immunosuppressant medications and those with other illnesses. It can stop cellulitis from becoming full blown through taking the necessary means of treating local and simple cellulitis.

Nursing Management 3 History Patient G. D. P. a 5 year old male, Roman Catholic, lives in 99 St. Abra Bago Bantay Quezon City. Patient slipped and fell on his inner thigh pubic area and pain, swelling and tenderness was present. It was self-medicated with topical ointment and 3 days prior to admission; he developed undocumented fever and was self-medicated with biogesic which is an analgesic and antipyretics which provided temporary relief. A few hours later, patient has persistence of symptoms and was brought to Philippine Orthopedic Center where consultation was done. Subsequently, patient was admitted and with initial diagnosis of cellulitis medial aspect of the right thigh.

Nursing Physical Assessment

Patient G.D.P was alert and oriented to person, time and place. In, 16 March, 2012, 12:30 pm, patients vital signs were as follows: temperature 35.5 Degree Celsius, respiratory rate of 22 cycles per minute and pulse pressure of 97 beats per minute. The patient has an intravenous fluid in his left arm. Hair is consistently distributed and had variable amount of body hair. He had productive cough and mouth was in color regularity. Upon assessment, right medial aspect of the thigh noted redness, tenderness and swelling and the patient reported feeling of pain scale of 3. The patients skin is light brown in color and upon auscultation wheezing was noted. Patient had no edema and fever and bowel movement is normal.

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Related Treatments The patient was admitted on 10 March, 2012 at 10:40 pm. The doctor ordered Cefuroxime 700 gram through intravenous route for 12 hours, Clindamycin 75 milligram/ 5 millilliter by 2 weeks 3 times a day and a D5 0.3 NaCl 500 to be infuse in 10 hours. Vital signs should be monitored and recorded. There is generally a lack of evidence from placebo controlled trials to support the effectiveness of antibiotics in the treatment of cellulitis, but limited evidence from comparative trials indicates that the appropriate antibiotic will successfully treat cellulitis in about 85% of cases [Jones, 2002]. The Physician ordered Clindamycin as an option recommended by the Health Protection Authority for the treatment of cellulitis in people who are allergic to penicillin. However, it has a worse adverse effect profile than the macrolides [BNF 55, 2008], so should be considered second-line. The diagnostic procedure undergone by the patient was chest x-ray. Chest x-ray is the most commonly performed diagmostic examination that shows the images of the heart, lungs, airways, blood vessels and the bones. Complete blood count was also done to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood.

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Nursing Care Plan Assessment Subjective: masakit po ang sugat ko sa hita as verbalized by the patient. Diagnosis Planning Intervention Assess skin, note the color Rationale To establish baseline data and to assess for infection Evaluation After interventions were rendered the patient was able to demonstrate improvement:

Impaired skin integrity related to inflammatory response secondary to infection ( Cellulitis)

Short Term: After 3 days of rendering interventions, the patient will be able to demonstrate wound healing and decreased pain scale of 3 to 2.

Intructs to maintain clean, dry clothes

To minimize irritation and risk for infection

Minimized presence of wounds

Maintain clean and dry skin Provides barrier to infection and minimize microorganism

Objectives: Disruption of skin in the right medial thigh Wound is 5mm indiameter. Localized erythema Purulent discharge (+) pruritus on thesite of the wound. (+) pain scale of 3

Minimized erythema

Long Term:

Emphasized the importance of adequate nutrition and fluid intake

Some wounds have dried up To improve skin condition Minimized itchiness

Vital signs T- 35.5 P- 97 R- 22

After rendering all the interventions, patient was able to demonstrate absence of pain and normal skin integrity

Instruct for dry wound dressing

Demonstrate skin hygiene , proper handwashing Instruct parents to clipped and file nails regularly

To protect the wound for infections

-minimize risk for infection

-to decrease the risk for skin injury due to scratching

Nursing Management 6 Recommendations The patient should have continuous compliance to what physicians prescribed to optimize treatment and have continues medication for his situation. Patient should also monitor and report to the physician if signs of worsening cellulitis and infection are present. Patient will also have to continue his therapeutic lifestyle changes such as washing hands before examining a wound or abrasions to minimize infections. Patient can do exercises but not strenuous activity. Educate the patient about preventing recurrent episodes of cellulitis which can include keeping skin clean, moisturizing skin, properly cleaning any wounds, covering wounds with a bandage and changing wound dressings as needed. Patient was recommended to increase consumption of foods high in vitamin C to help treat cellulitis. Such foods include citrus fruits, broccoli and peppers. Snack on oranges and grapefruit in the afternoon and raw broccoli and a variety of colorful peppers to to help get extra vitamin C into the system. Snack rich in vitamin E that can boost natural healing power and help in treating cellulitis and improve any skin conditions, Ehow (2011).

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References:

Brunner and suddarths, (2006) Ehow (2011) Nurses pocket guide Doenges, Moorhouse, Murr Parks (2007)