CELLULITIS

Elmundo, Cristina Lu V.
Reporter
Cellulitis (Bacterial Skin infection)
an acute inflammation of the
connective tissue of the skin, caused
by infection with staphylococcus,
streptococcus or other bacteria.
Cellulitis is most common on the
lower legs and the arms or hands,
although other areas of the body may
sometimes be involved. If it involves
the face (erysipelas), medical
attention is urgent.
Risk factors for cellulitis

Insect bites and stings , animal bite,

or human bite
Injury or trauma with a break in the
skin (skin wounds)
History of peripheral vascular
disease
Diabetes -related or ischemic ulcers
Cracks or peeling skin between the
toes
Use of immunosuppressive or
corticosteroid medications
Symptoms

Localized skin redness or inflammation

that increases in size as the infection
spreads
Tight, glossy, "stretched" appearance of
the skin
Pain or tenderness of the area
Skin lesion or rash (macule)
Warmth over the area of redness
Fever
Other signs of infection:
o Chills, shaking
o Warm skin, sweating
o Fatigue
o Muscle aches , pains (myalgias)
o General ill feeling (malaise)
DIAGNOSTIC TESTS
CBC
blood culture
Culture and sensitivity of the
drainage from the lesion
Treatment
 
may require hospitalization if it is
severe enough
warrant intravenous antibiotics and
close observation
oral antibiotics and close outpatient
follow-up
Antibiotics are given to control
infection, and analgesics may be
needed to control pain.
Elevate the infected area, usually
higher than the heart, to minimize
swelling. Rest until symptoms
improve.
Expectations (prognosis)
 
Cure is possible with 7 to 10 days of
treatment. Cellulitis may be more
severe in people with chronic
diseases and people who are
susceptible to infection
(immunosuppressed).
Complications
 
Tissue death (gangrene)
Sepsis , generalized infection and
shock
Meningitis (if cellulitis is on the face)
Lymphangitis (inflammation of the
lymph vessels)
Prevention
 
Avoid skin damage by wearing
appropriate protective equipment
when participating in work or sports.
Clean any breaks in the skin
carefully and watch for redness, pain,
drainage, or other signs of infection
Maintain good general health and
control chronic medical conditions. A
body that is healthy can more easily
fight bacteria before they multiply
and cause infection, while a body that
is run down has lessprotection against
infection.
Nursing Care
  Nursing care focuses on preventing of the
spread of infection and restoring normal
skin integrity. Nursing interventions
includes:
Practice good hand washing
Assess client for increase in infection
Place the client in isolation precaution
Cover draining lesion with sterile
dressing
Health teachings

Importance of maintaining good

nutrition
Maintaining cleanliness thru hand
washing
Proper handling and disposal of
wastes
Preventing spread of infection at
home by changing linens and towels
regularly or washing clothes with hot
water
Bathing daily using antibacterial
soap
Warm compress applied to affected
to prevent from swelling
PYOMYOSITIS
Pyomyositis usually due to S.
aureus 
Tropical areas
No known portal of entry
 Infection remains localized unless
organisms produce toxic shock
syndrome toxin 1 due to S. pyogens
may induce primary myositis:
streptococcal necrotizing myositis
Diagnostic tests
soft tissue radiography
CT
MR
aspiration of the leading edge or
punch biopsy with frozen section
open surgical inspection with
debridement
 
Osteomyelitis
A common condition usually caused
by staphylococcus aureus and
occasionally by other organisms such
as streptococcus, pneumococcus,
salmonella and Escherichia. An
infection of the bone which can be
one in three modes
Extension of soft tissue infection
Direct bone contamination from
bone surgery, open fracture or
traumatic injury such as gunshot
wound
Hematogenous (blood-home) spread
from other sites of infection
Clinical Manifestations
Acute onset with high fever and
malaise
Pain which is usually localized to
the metaphyseal region of the bone
Localized tenderness and heat over
the site of infection
In later cases, if not controlled by
antibiotics, edema develops over the
site of pus formation.
 Swelling of nearby joints is usually
due to a ‘sympathetic effusion. If the
metaphysic is intracapsular, the joint
itself may become infected.
Additional symptoms

Chills
Excessive sweating
Low back pain
Swelling of the ankles, feet, and legs
Risk factors

Sex
Male-to-female ratio is
approximately 2:1.
Age
In general, osteomyelitis has a
bimodal age distribution
Exams and Tests
A physical examination shows bone
tenderness and possibly swelling and
redness
Tests may include:
Blood cultures
Bone biopsy (which is then cultured)
Bone scan
C-reactive protein (CRP)
Erythrocyte sedimentation rate
(ESR)
MRI
Needle aspiration of the area around
affected bones
Surgery
If there are metal plates near the
infection, they may be removed
bone graft or packing material
Expectation (Prognosis)

When treatment is received, the

outcome for acute osteomyelitis is
usually good.
The outlook is worse for those with
long-term (chronic) osteomyelitis,
even with surgery.
Amputation may be needed,
especially in those with diabetes or
poor blood circulation.
The outlook is guarded in those who
have an infection of a prosthesis.
Possible Complications
Abscess
chronic osteomyelitis
Other complications include:
Need for amputation
Reduced limb or joint function
Spread of infection
Medical and surgical management
 Blood culture must be done
Combination of antistaphylococcal
and broad spectrum antibiotic is
started.
 Fucidin and erythromycin can be
given in combination may be
parenterally for a child who is too ill
to take oral medication.
The limb should be splinted as in
Thomas’ splint, sling or plaster back-
slab
Debridement
Sequestrectomy
Medications: 
Nafcillin
Ciprofloxacin
Ceftriaxone
Nursing management

Your major concerns are to control

infection, protect the bone from
injury, and offer meticulous
supportive care.
Use strict aseptic technique
technique when changing dressings
and irrigating wounds.
If the patient is in skeletal traction
for compound fractures, cover
insertion points of pin tracks with
small, dry dressings, and tell him not
to touch the skin around the pins and
wires.
Assess vital signs and wound
appearance daily, and monitor daily
for new pain
Carefully monitor sunctioning
equipment.
Support the affected limb with firm
pillows. Keep the limb level with the
body.
Provide good skin care
Provide good cast care
Check circulation and drainage.
Watch for any enlargement.
Protect the patient from mishaps,
such as jerky movements and falls
Be alert for sudden pain, crepitus or
deformity.
Provide emotional support and
appropriate diversions.
Teach the patient how to protect and
clean the wound and how to
recognize infections.
Possible nursing diagnosis

Activity intolerance
Anxiety
Fear
Fluid volume excess
High risk for infection
High risk for injury
Impaired physical mobility
Impaired tissue integrity
Knowledge deficit
Pain
Health teachings

Teach infection control for drains

and wounds
Discuss the nutritional requirement
and the dietary sources
Discuss technique to manage pain.
Teach the client to monitor
a.) fever
b.) increasing pain
c.) visible bone deformity
d.) swelling
e.) exudates
 
 The end
Thank you!