Arellano University

College of Nursing

Case Presentation
Of
Cellulitis
&
Urinary Tract Infection (suspect)

Prepared by :
SALAMANCA, JEFFREY
STA.ANA, STEPHANIE ANNE
MACAYA, EMERLITA
MAANO, CARISSA
LORENZO, DENICA
TRAQUENA, JENNIFER
VERGARA, MAYLANIE
YABUT, BRYAN LOUIS

Submitted to:
Mr. Rowel L Lucina
INTRODUCTION
Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.
Cellulitis usually begins as a small area of tenderness, swelling, and redness. As this red area
begins to enlarge, the person may develop a fever, sometimes with chills and sweats, and swollen
lymph nodes ("swollen glands") near the area of infected skin.

Cellulitis may occur anywhere on the body, but the leg is the most common site of the
infection (particularly in the area of the tibia or shinbone and in the foot), followed by the arm,
and then the head and neck areas. In special circumstances, such as following surgery or trauma
wounds, cellulitis can develop in the abdomen or chest areas. People with morbid obesity can
also develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designated
by the location of the infection. Examples include periorbital (around the eye socket) cellulitis,
buccal (cheek) cellulitis, and perianal cellulitis.

The majority of cellulitis infections are caused by either staph (Staphylococcus) or strep
(Streptococcus) bacteria. Staph (Staphylococcus aureus) is the most common bacteria that causes
cellulitis. There is a growing incidence of community-acquired infections due to methicillin-
resistant S. aureus (MRSA), a particularly dangerous form of these bacteria that is resistant to
many antibiotics and is more difficult to treat.

Strep (Streptococcus) is also a common cause of cellulitis. A form of rather superficial

cellulitis caused by strep is called erysipelas; it is characterized by spreading hot, bright red
circumscribed area on the skin with a sharp raised border. The so-called “flesh eating bacteria"
are, in fact, also a strain of strep that can sometimes rapidly destroy tissues.

Cellulitis can be caused by many other types of bacteria. In children under 6 years of age,
H. flu (Hemophilus influenza) bacteria can cause cellulitis, especially on the face, arms, and
upper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurella
multocida bacteria, which has a very short incubation period of only four to 24 hours.
Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis that
develops after exposure to freshwater or seawater. Pseudomonas aeruginosa is another type of
bacteria that can cause cellulitis, typically after a puncture wound.
 Cellulitis can affect anyone of any age; cellulitis of the face is more common in children
and adults over age 50 (Cunningham). The actual incidence of cellulitis is unknown because
cases are seldom reported. Orbital cellulitis is uncommon but potentially very serious.

The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) and

other antibiotic-resistant bacteria has increased dramatically in recent years (Mayo Clinic Staff).
Infection by these organisms is much more serious.

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary
tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not
have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they
cause a UTI. The most common type of UTI is a bladder infection which is also often called
cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more
serious.

Urinary tract infections are caused when bacteria like E. coli enter the urinary system and
attach to the urinary lining. Most infections are ascending, which means they enter through the
urethra and work their way up. In very rare cases, an infection may be descending, starting in the
kidneys and working its way down. When you have contracted a urinary tract infection, you may
notice that you have the urge to urinate more often, even if little or no urine comes out. You may
also experience burning or pain in your lower back, pelvis or groin. Your urine may also be dark,
cloudy or even bloody.

Prevalence and incidence:

The most common skin problems in the children in our study were infected scabies (22.2%),
impetigo (20.2%), non-infected scabies (9.7%) and abscess or localized cellulitis (8.1%). Other
skin problems not included in the algorithm accounted for 11.3% of all skin problems.
General objectives:
To gain more information and enough understanding about Cellulites and Urinary Tract
Infection. This will help to prepare ourselves if in case we encounter same case in the future. The
study of cellulites and urinary tract infection will help us to embark information to clients to help
them understand the cause and risks of having this disease, and also to know the proper nursing
management that we should render.

Specific objective:
 To know the information about such diseases, how does it occur, how it is being
treated and its extent.
 To let ourselves be familiarize about the medical procedure on managing such
diseases.
 To gain more knowledge that we can use in giving health teaching to our client.
THEORETICAL FRAMEWORK
Nightingale's Environmental Theory

Environmental effects

She stated in her nursing notes that nursing "is an act of utilizing the environment of the
patient to assist him in his recovery" (Nightingale 1860/1969), that it involves the nurse's
initiative to configure environmental settings appropriate for the gradual restoration of the
patient's health, and that external factors associated with the patient's surroundings affect life or
biologic and physiologic processes, and his development.

Environmental factors affecting health

Adequate ventilation has also been regarded as a factor contributing to changes of the
patient's process of illness recovery

Defined in her environmental theory are the following factors present in the patient's
environment:

 Pure or fresh air

 Pure water
 Sufficient food supplies
 Efficient drainage
 Cleanliness
 Light (especially direct sunlight)

Any deficiency in one or more of these factors could lead to impaired functioning of life
processes or diminished health status.
NURSING HISTORY
Name: Ms. RL Age: 1 4/12

Address: Barangka ibaba, Mandaluyong City

Birthday: June 15, 2009

Birthplace: Mandaluyong City Medical Center

Nationality: Filipino

Sex: Female

Religion: Roman Catholic

Status: Single

Chief complaint: Swelling and Redness of the Right thigh

History of present illness:

1 day PTA, the mother went to the hospital complaining of swelling on the right thigh of
her baby, (+) on redness. No medication taken at home, laboratory exam done was urinalysis and
CBC.

History of past illness:

Client was fully immunized, has no history of hospitalization and no known injury or
surgery in the past. Client usually experienced cough and colds and fever and not yet
experienced severe diseases. She has no known allergies on foods or drugs.

Family health history:

Client father has hypertension. Family has no known history of asthma, DM, or other
CVD.
GORDON’S 11 FUNCTIONAL HEALTH PATTERN
Health perception pattern

According to the mother when she or her family not feeling well they go to Mandaluyong
City Medical Center.

Nutritional Metabolic pattern

According to the mother RL is breastfeeding and she said that “pinapakain ko din sya ng
kanin na may sabaw at minsan pinapatikim ko din sya ng soft drinks”

Elimination pattern

RL usually voids every two days, before she hospitalized the color of her urine is yellow,
during hospitalization the color of her urine become dark yellow, as stated by the mother

Activity exercise pattern

“nakakapaglakad na paunti unti ang anak ko” as stated by the mother. RL also play some
toys with her sister.

Sleep rest pattern

“Nakakatulog ang anak ko ng mga isang oras lang kasi maingay sa bahay’ as stated by
the mother. During hospitalization RL sleeping pattern does not change, still she sleeps within 1
hour because of noise and environment.

Cognitive perceptual

RL cries when someone touches her aside from her mother. She gets interested and
observed new object and tries to touch it.

Self perception

“umiiyak at natatakot ang anak ko kapag nilalapitan sya ng nurse at ng doktor” as stated
by the mother. RL also cry when there is procedure done.
Role relationship pattern

According to the mother RL is the youngest and she is the favorite child among their 4
children.

Values belief pattern

“Naniniwala ako na kapag palaging naliligo sa gabi ito ay nakakapagpababa ng dugo at

pwedeng magkaanemia”as stated by the mother. We did health teachings and explain that low
blood pressure is different from anemia.
PHYSICAL ASSESSMENT
1. General appearance

 Client is conscious and well-groomed

2. Skin

 With scar

 With lesions

3. Skull

 Rounded, proportional to the size of the body

 Symmetrical in all planes

 Gently curved

 Smooth and no masses

4. Scalp

 It is white and clean

 Free from masses, lumps, scars, lies, flakes and lesion

 No areas of tenderness

5. Hair

 Black evenly distributed and covers the whole scalp

 Thin, shiny and free from split ends

6. Face

 Oblong, symmetrical nasolobial fold

 Free from wrinkles

 No involuntary muscle movement

7. Eyes

 Parallel and evenly place

 Symmetrical, non protruding

 Both eyes are bright and clear

8. Eyebrows

 Black, symmetrical, thick

 Evenly distributed, parallel with each other

9. Eyelashes

 Black, symmetrical, thick

 Distributed and parallel with each other

10. Conjunctiva

 Smooth and pink

 Shiny

11. Sclera

 Sclera is white and clear

12. Cornea

 Transparent, shining and smooth

13. Pupils

 Round equal in size

 Black reacts to light and accommodation

 Constricts when light is painted

14. Iris

 Round, brown symmetrical

15. Ears

 Parallel, symmetrical, proportional to the size of the head

 Firm cartilage

16. Nose

 In middle lie symmetrical and with discharge

 Internal nacres is pinkish

17. Mouth

 Lips are pinkish, symmetrical with well defined

 Lips is smooth moist

 Gums has no swelling

 Tongue is pink, slightly rough on top and freelyrovable

18. Neck

 Proportion to the size of the body and the head

 Symmetrical and straight

 No palpable, lumps, masses or areas of tenderness

 Freely movable without difficulty

19. Thorax and lungs

 Spine vertically aligned

 No retractions, wall intact

 Clear breath sound heard

20. Abdomen

 Uniform in color and rounded

 Umbilicus centrally located

 Auscultation: audible bowel sound presence

 Percussion: tympany was noted on air

 Palpation: abdomen is relaxed with smooth tension no tenderness

21. Upper extremities

 Fingers are equal in member, symmetrical and no abnormalities

 With blister and scars

22. Lower extremities

 Skin has so many scars, blister and lesion

 Swelling erythema.
ANATOMY AND PHYSIOLOGY OF SKIN

The dermis is a layer of skin between the epidermis (with which it makes up the cutis)
and subcutaneous tissues, and is composed of two layers, the papillary and reticular dermis.
Structural components of the dermis are collagen, elastic fibers, and extrafibrillar matrix
(previously called ground substance

The epidermis is the outer layer of the skin , which together with the dermis forms the
cutis. The epidermis is a stratified squamous epithelium, composed of proliferating basal and
differentiated suprabasal keratinocytes. The epidermis acts as the body's major barrier against an
inhospitable environment.

The hypodermis, also called the hypoderm, subcutaneous tissue, or superficial fascia is
the lowermost layer of the integumentary system in vertebrates. Types of cells that are found in
the hypodermis are fibroblasts, adipose cells, and macrophages. It is derived from the mesoderm,
but unlike the dermis, it is not derived from the dermatome region of the mesoderm. In
arthropods, the hypodermis is an epidermal layer of cells that secretes the chitinous cuticle.
ANATOMY & PHYSIOLOGY OF URINARY SYSTEM

How does the urinary system work?

 The body takes nutrients from food and converts them to energy. After the body has
taken the food that it needs, waste products are left behind in the bowel and in the blood.

 The urinary system keeps the chemicals and water in balance by removing a type of
waste called urea, from the blood. Urea is produced when foods containing protein, such
as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in
the
bloodstream to the kidneys.
 Urinary system parts and their functions:

 Two kidneys - a pair of purplish-brown organs located below the ribs toward the middle
of the back.

Their function is to:

> Remove liquid waste from the blood in the form of urine.
> Keep a stable balance of salts and other substances in the blood.
> Produce erythropoietin, a hormone that aids the formation of red blood cells.

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each
nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small
tube called a renal tubule. Urea, together with water and other waste substances, forms the urine
as it passes through the nephrons and down the renal tubules of the kidney.

 Two ureters - narrow tubes that carry urine from the kidneys to the bladder.
Muscles in the ureters walls continually tighten and relax forcing urine downward, away
from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can
develop. About every 10 to 15 seconds, small amounts of urine are emptied into the
bladder from the ureters.

 Bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is

held in place by ligaments that are attached to other organs and the pelvic bones. The
bladder's walls relax and expand to store urine, and contract and flatten to empty urine
through the urethra. The typical healthy adult bladder can store up to two cups of urine
for two to five hours.

 Two sphincter muscles - circular muscles that help keep urine from leaking by
closing tightly like a rubber band around the opening of the bladder.

 Nerves in the bladder - alert a person when it is time to urinate, or empty the
bladder.

 Urethra - the tube that allows urine to pass outside the body. The brain signals
the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time,
 the brain signals the sphincter muscles to relax to let urine exit the bladder through the
urethra. When all the signals occur in the correct order, normal urination occurs.

PATHOPHYSIOLOGY OF CELLULITIS

Contributing factors

superficial infection
((
(lesions and blisters)

Etiologic agent

Staphylococcus
aureus
Streptococcus

Dermis

Common site

lower extremities

Signs & symptoms

Redness, swelling, warm to touch, erythema, skin tightness & accompanied by fever, malaise, chills &
headache

Cellulitis
 PATHOPHYSIOLOGY OF URINARY TRACT
INFECTION

Modifiable factor
Non – modifiable factor
 Avoidance of the urge to
Age – UTI is the prevalence disease
void
among children.  Inadequate fluid intake

Bacterial invasion (E.coli)

Multiplication of the bacteria

– causing UTI in any part of
the urinary tract.

Interruption in the normal

homeostatic environment of
the urinary tract.

Change in
Fever urine color.
DRUG STUDY

NAME MECHAN DOSAG INDICATI CONTRAINDIC ADVE NURSING

OF ISM OF E ON ATION RSE CONSIDERA
DRUG ACTION EFFEC TION
T

Paraceta Antipyreti PO or >Analgesic >contraindicated Headac Do not exceed

mol c: reduces PR -antipyretic with allergy to he, recommended
fever by in patients paracetamol. chest dose; do not
(Tempra acting Doses with aspirin pain, take for longer
) directly on may be allergy, dyspnea than 10 days.
the repeated hemostatic , hepatic
4-5 > Use cautiously Take the drug
hypothala disturbance with impaired toxicity
mic heat- times a s, bleeding and only for
day; do hepatic fun, complaints
regulating diatheses, chronic failure,
center to not upper GI rash, indicated; it is
exceed alcoholism, not an anti-
cause disease, pregnancy, fever.
vasodilatat five gouty inflammatory
doses in lactation. agent.
ion and arthritis.
sweating 24hr,
>Arthritis Avoid the use
which give PO other over the
helps &
or by rheumatic counter
dissipate preparations.
heat. supposit disorders
involving They may
ory. contain
Analgesic: musculoske
site and letal pain paracetamol
mechanis (but lacks and serious
m of clinically overdose can
actions significant occur. If you
unclear. antirheumat need an over
ic & anti- the counter
inflammato preparation,
ry effects). consult your
health care
> provider.
Common
cold, flu Report rash,
other viral unusual
and bleeding or
bruising,
 bacterial yellowing of
infections skin or eyes,
with pain changes in
and fever. voiding
patterns.

NAME MECHANIS DOSAGE INDICATION CONTRAINDICATION ADVERSE NURSING

OF DRUG M OF EFFECT CONSIDERATION
ACTION

Cloxacilli Bactericidal 170 mg .Treatment of Contraindicated with Upset Take this drug
n action against infections allergies to penicillin’s, stomach, around the clock.
sensitive caused by cephalosporins, or other nausea and
organisms; susceptible allergies. vomiting, Take the full course
inhibits strains of diarrhea, of therapy; do not
synthesis of shigella, Use cautiously with pink & stop taking the drug
bacterial cell salmonella, E. renal disorders. dark urine, if you feel better.
wall, causing coli, H. Take the oral drug
cell death. influenza, Sore
throat, on an empty
gram positive stomach, 1hr before
organisms. muscles
ache, or 2hr after meals;
Meningitis nephritis. the oral solution in
caused by stable for 7days at
neisseria room temperature.
meningitidis. This antibiotic is
specific to your
problem and should
not used to self-
treat other
infections.

You may
experience these
side effects; nausea,
vomiting, GI upset
(eat frequent small
meals) diarrhea.
 Report pain or
discomfort at sites,
unusual bleeding or
bruising, mouth
sores, rash, hives,
fever, itching,
severe diarrhea,
difficulty of
breathing.

LABORATORY EXAMINATION

Hematology Report

Hematology Normal Values Result

Hemoglobin 12.0 - 16.0 g/dL 11.5 g/ dL
Hematocrit 36-46 36
Erythrocyte 5-7 4.46
Leukocyte 20- 40 17.5
Lymphocyte 0.20-0.40 0.32
Thrombocyte 150-140 190

Urinalysis Report

Color- dark yellow

Ph acidic- (6.0)

Chemical Exam

Albumin - trace (-)

 Sugar – negative

Microscopic Exam

PUS/ WBC  – 10-12 g/ dL

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNIG INTERVENTION EVALUATION

S : “Namamaga Impaired skin SHORT TERM INDEPENDENT : After 4 hours of

at namumula integrity GOAL : >Identify underlying rendering nursing
ang kanang hita related to After 4 hours of cause/condition involved. intervention, the
ng anak ko.” As bacterial rendering nursing R : To assess client’s mother
verbalized by infection as intervention, causative/contributing participated in
the mother. manifested by client’s mother factors. preventive
the swelling of will be able to >Note changes in skin measures and
O: the right thigh. participate in color, texture and turgor. treatment
-swelling of the preventive R : To assess extent of programs for her
right thigh measures and involvement/injury. child.
-skin redness treatment >Determine depth of
-skin lesions program. injury/damage to Goal met.
-crying integumentary system.
R : To assess extent of
involvement/injury.
>Inspect skin on a daily
basis, describing lesions
and changes observed.
R : To assist with
correcting/minimizing
condition and promote
optimal healing.
>Keep the area clean/dry,
prevent infection, and
stimulate circulation to
surrounding areas.
R : To assist body’s natural
process of repair.
>Review importance of
skin and measures to
maintain proper skin
functioning.
R : To promote wellness.
 >Discuss importance of
early detection of skin
changes and/or
complications.
R : To promote wellness.
>Assist client’s mother in
understanding and
following medical regimen
and developing program of
preventive care and daily
maintenance.
R : Enhances commitment
to plan, optimizing
outcomes.

DEPEDENT :
>Give cloxacillin IV as
indicated.
R : To relieve
inflammation.

ASSESSMENT DIAGNOSIS PLANNIG INTERVENTION EVALUATION

S : “Sumasakit Acute pain After 1 hour of INDEPENDENT : After 1 hour of

yung hita ng related to rendering >Determine possible rendering
anak ko.” As inflammation nursing pathophysiological causes of nursing
verbalized by of connective intervention, pain. intervention, the
the mother. tissue as the client’s pain R: To assess etiology. client’s pain was
manifested by will be >Perform pain assessment controlled as
Pain scale : facial grimace relieve/control. each time pain occurs. evidenced by
moderate (7- and expressive Pain scale of 7-8 R: To evaluate client’s pain scale from
8) behavior. becomes 2. response to pain. 7-8 becomes 2.
>Monitor vital signs.
O: R: usually altered in acute Goal met.
-facial grimace pain.
-irritability >Provide comfort measures
-expressive such as use of heat/cold.
behavior R: To provide
(crying) nonpharmacological pain
management.
>Encourage diversional
activities such as portable dvd
and toys.
R: To assist client to explore
methods for
alleviation/control of pain.

DEPENDENT :
>Administer paracetamol 10 -
 15 mg/kg by mouth every 4 -
6 hours as indicated.
R : To maintain acceptable
level of pain.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

S : “Natatakot Fear related to After 8 hours INDEPENDENT : After 8 hours of

ang anak ko unfamiliarity of rendering >Note degree of rendering nursing
kapag with nursing incapacitation. intervention,
nilalapitan siya environmental intervention, R: To assess degree of fear and client’s fear has
ng nurse o experiences as the client will reality of threat perceived by lessened.
kaya ng evidenced by lessen her the client.
doctor.” As increased fear. >Measure vital Goal met.
verbalized by alertness. signs/physiological responses
the mother. to situation.
R: To assess degree of fear and
-increased reality of threat perceived by
pulse rate the client.
-increased >Stay with the client or make
respiratory arrangements to have
rate someone else be there.
-increased
alertness R: sense of abandonment can
-v/s taken as exacerbate fear.
follows : >Identify client’s mother
P : 125 bpm responsibility for the solutions.
R : 36 cpm R: enhances sense of control.
>Instruct mother in use of
relaxation/visualization and
guided imagery skills.
 Discharge Planning
 Get plenty of rest. This gives your body a chance to fight the infection.
 Raise the area of the body involved as high as possible. This will ease the pain, help
drainage and reduce swelling.
 Take painkillers such as paracetamol. Please check the label for how much to take and
how often. The pain eases once the infection starts getting better.
 Be sure to take the full course of antibiotics.
 You may be advised to make a follow-up appointment with your doctor to make sure the
cellulitis is improving. Don’t forget to do this.