/
Nursing Care Plan (NCP) for Cellulitis

Nursing Care Plan (NCP) for Cellulitis

Watch More! Unlock the full videos with a FREE trial
START FREE TRIAL
Master
To Master a topic you must score > 80% on the lesson quiz.
Take Quiz

Included In This Lesson

Study Tools
Outline
Transcript
Additional Lessons

Study Tools For Nursing Care Plan (NCP) for Cellulitis

Example Care Plan_Cellulitis (Cheatsheet)
Blank Nursing Care Plan_CS (Cheatsheet)

Outline

Lesson Objective for Nursing Care Plan for Cellulitis

What is Cellulitis?

 

Cellulitis is a skin infection that happens when bacteria, usually through a cut or crack in your skin, get inside and start to spread. It’s like if you had a small hole in a wall, and water got in and started to make the area soggy and damaged.

 

How Does it Look?

 

The skin where the bacteria have entered gets red, swollen, and painful. Sometimes it can feel warm and look like it’s spreading.

 

Where Can It Happen?

 

It usually occurs on the legs, but it can happen on any part of the body.

 

Symptoms:

 

  • Red, swollen, and tender area on the skin.
  • Might feel warm and look like a rash.
  • Some people also get a fever or feel tired.

 

Upon completion of this care plan, nursing students will be able to:

  • Demonstrate an understanding of the pathophysiology of Cellulitis, including the role of bacterial infection and its impact on the skin and subcutaneous tissues.
  • Conduct a thorough nursing assessment of a patient with Cellulitis, identifying risk factors, signs, and symptoms, and differentiating cellulitis from other skin conditions.
  • Formulate and prioritize nursing diagnoses based on the individualized needs of the patient, addressing issues such as impaired skin integrity, pain, and potential complications.
  • Develop evidence-based nursing interventions to manage Cellulitis, including antibiotic therapy, wound care, and pain management.
  • Implement effective communication strategies to educate patients on preventive measures, self-care, and the importance of completing prescribed medications.
  • Collaborate with the healthcare team to monitor the patient’s response to treatment, assess for complications, and ensure continuity of care.

Pathophysiology of Cellulitis

Cellulitis is a common bacterial infection of the skin and subcutaneous tissues, typically caused by Streptococcus or Staphylococcus bacteria. Here’s a simplified breakdown of the pathophysiological processes involved:

 

  • Bacterial Entry:
    • Break in Skin Barrier: Cellulitis usually begins with a break or breach in the skin barrier, providing an entry point for bacteria.
    • Trauma or Skin Conditions: Factors such as cuts, abrasions, insect bites, surgical wounds, or pre-existing skin conditions increase the risk of bacterial entry.
  • Bacterial Proliferation:
    • Subcutaneous Tissues: Bacteria, commonly Streptococcus or Staphylococcus species, rapidly multiply in the subcutaneous tissues.
    • Inflammatory Response: The presence of bacteria triggers an inflammatory response characterized by redness, warmth, swelling, and pain.
  • Inflammatory Response:
    • Chemical Mediators: In response to bacterial invasion, chemical mediators such as cytokines and prostaglandins are released.
    • Vasodilation and Increased Permeability: Blood vessels dilate, and permeability increases, leading to the characteristic signs of inflammation.
  • Immune System Activation:
    • Neutrophil Infiltration: White blood cells, particularly neutrophils, migrate to the infected area to phagocytize bacteria.
    • Formation of Abscess: In severe cases, a collection of pus (abscess) may form as the immune system attempts to contain and eliminate the infection.
  • Lymphatic Involvement:
    • Lymphatic Drainage: Bacterial toxins and debris may enter the lymphatic vessels, causing lymphangitis and regional lymphadenopathy.
    • Spread of Infection: If untreated, cellulitis can spread along lymphatic channels, potentially leading to systemic complications.

Etiology of Cellulitis

 

Cellulitis is typically caused by bacterial infection, with the most common pathogens being Streptococcus and Staphylococcus bacteria. Several factors contribute to the development of cellulitis:

 

  • Break in the Skin Barrier:
    • Cuts and Abrasions: Cellulitis often starts with a break or breach in the skin, such as cuts, abrasions, or wounds.
    • Insect Bites: Bites from insects, spiders, or other arthropods can introduce bacteria into the skin.
  • Skin Conditions:
    • Eczema and Dermatitis: Pre-existing skin conditions, such as eczema or dermatitis, can compromise the skin barrier and increase susceptibility.
    • Athlete’s Foot: Fungal infections like athlete’s foot can create openings for bacteria to enter.
  • Wound Care Practices:
    • Poor Wound Hygiene: Inadequate wound cleaning and poor hygiene practices can contribute to bacterial colonization and infection.
    • Delay in Treatment: Delayed treatment of wounds or injuries increases the risk of bacterial invasion.
  • Immunocompromised States:
    • Diabetes: Individuals with diabetes are at higher risk due to impaired immune function and compromised circulation.
    • Immunosuppression: Conditions or treatments that weaken the immune system, such as HIV/AIDS or immunosuppressive medications, increase susceptibility.
  • Invasive Medical Procedures:
    • Surgery: Surgical procedures, especially if there is a breach in sterile technique, can introduce bacteria.
    • Catheter Insertion: The placement of catheters or medical devices can create entry points for bacteria.
  • Lymphatic Obstruction:
    • Lymphedema: Impaired lymphatic drainage, as seen in conditions like lymphedema, can predispose individuals to cellulitis.
    • Filariasis: In regions where filariasis is endemic, parasitic infections can lead to lymphatic obstruction.
  • Peripheral Vascular Disease:
    • Decreased Circulation: Conditions like peripheral vascular disease can compromise blood flow to the extremities, increasing the risk of infection.
    • Venous Stasis: Chronic venous insufficiency can lead to stasis of blood in the lower extremities, creating an environment conducive to bacterial growth.

Desired Outcome for Nursing Care Plan for Cellulitis

 

  • Resolution of Infection:
    • Short-Term Goal: Achieve prompt resolution of bacterial infection.
  • Pain Management:
    • Short-Term Goal: Alleviate pain associated with cellulitis.
  • Preservation of Skin Integrity:
    • Short-Term and Long-Term Goals: Prevent the spread of infection, preserve skin integrity, and minimize tissue damage.
  • Prevention of Complications:
    • Intermediate-Term Goal: Prevent the development of complications such as abscess formation or systemic infection.
  • Improvement in Lymphatic Drainage:
    • Intermediate-Term Goal: Enhance lymphatic drainage and reduce lymphangitis.

 

Subjective Data

  • Pain
  • Tenderness
  • Weakness

Objective Data

  • Redness (tends to expand)
  • Swelling
  • Warm to the touch
  • Fever/chills
  • Red spots
  • Blisters
  • Skin dimpling

 

Nursing Assessment for Cellulitis

  • History Taking:
    • Obtain a detailed medical history, including any recent skin injuries, cuts, insect bites, or wounds that may have led to the development of cellulitis.
    • Inquire about the onset of symptoms, including the duration and progression of redness, swelling, pain, and warmth in the affected area.
  • Identification of Risk Factors:
    • Assess for risk factors contributing to cellulitis, such as diabetes, peripheral vascular disease, immunosuppression, or a history of recurrent skin infections.
    • Inquire about any underlying skin conditions, such as eczema or dermatitis, and exposure to potential environmental factors.
  • Clinical Examination:
    • Perform a thorough physical examination with a focus on the affected area. Assess for signs of cellulitis, including erythema, edema, warmth, and tenderness.
    • Document the size and borders of the affected area and assess for any associated lymphangitis or lymphadenopathy.
  • Vital Signs:
    • Monitor vital signs regularly, especially in cases where cellulitis is severe or has the potential for systemic involvement.
    • Pay attention to the presence of fever, as it may indicate systemic spread of infection.
  • Laboratory and Diagnostic Tests:
    • Collaborate with healthcare providers to obtain laboratory tests, including a complete blood count (CBC) to assess for leukocytosis and inflammatory markers.
    • Consider imaging studies, such as ultrasound or CT scans, if there is suspicion of abscess formation or deeper tissue involvement.
  • Assessment of Pain:
    • Use a pain assessment scale to evaluate the intensity and characteristics of pain associated with cellulitis.
    • Monitor the patient’s response to pain management interventions and adjust as needed.
  • Wound Assessment:
    • Document the characteristics of the wound, if present, including size, depth, and any signs of infection (e.g., purulent drainage).
    • Assess the surrounding skin for signs of cellulitis expansion.

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Antibiotic Therapy/Pain medication  Many cellulitis cases are treated with PO antibiotics, but more serious cases may need to be treated in hospital with IV antibiotics

NOTE: the patient should take the full course of antibiotics 

Pain meds- assess pt’s pain level and give pain medication as needed 
Elevation of the affected extremity  elevating the affected extremity helps decrease swelling and speeds up recovery 
Assess VS/Labs/CT/MRI imaging possible  VS- the patient can develop a fever 

Labs- CBC (WBC), Creatinine, CRP

CT/MRI- if necrotizing fasciitis is a concern 
Proper Wound Care-Corticosteroid cream,

Keeping the wound clean/dry with occlusive dressings

Proper hand hygiene 

Clipping toenails

 Corticosteroid cream helps with inflammation 

Keeping the wound clean/dry and dressed with occlusive dressing avoids further infection 

Note

Toenails harbor bacteria 
Educating the patient/family  throughout therapy, it is important to always educate the patient on cellulitis, medications, and any interventions being done. 

Evaluation of Cellulitis Care Plan

 

  • Resolution of Infection:
    • Expected Outcome: Complete resolution of cellulitis.
    • Evaluation Criteria: Monitor the affected area for signs of improvement, including reduced erythema, swelling, and pain. Assess laboratory values for normalization of inflammatory markers.
  • Pain Management:
    • Expected Outcome: Alleviation of pain associated with cellulitis.
    • Evaluation Criteria: Use pain assessment scales to measure the intensity of pain. Monitor the patient’s verbal reports of pain reduction and the need for analgesics.
  • Preservation of Skin Integrity:
    • Expected Outcome: Prevention of cellulitis spread and tissue damage.
    • Evaluation Criteria: Regularly assess the wound site for any signs of worsening cellulitis, necrotizing infections, or the development of abscesses. Document improvements in skin integrity.
  • Prevention of Complications:
    • Expected Outcome: Absence of complications such as abscess formation or systemic infection.
    • Evaluation Criteria: Monitor for signs of complications, collaborate with healthcare providers for any necessary interventions, and assess laboratory values for signs of systemic involvement.
  • Improvement in Lymphatic Drainage:
    • Expected Outcome: Enhanced lymphatic drainage and reduced lymphangitis.
    • Evaluation Criteria: Assess for improvements in limb movement, decreased swelling, and resolution of signs of lymphangitis. Collaborate with physical therapy if needed.
  • Normalization of Laboratory Values:
    • Expected Outcome: Normalization of laboratory values, including white blood cell count and inflammatory markers.
    • Evaluation Criteria: Review laboratory results for trends toward normalization. Collaborate with healthcare providers for follow-up testing.

Content Reviewed

References

View the FULL Outline

When you start a FREE trial you gain access to the full outline as well as:

  • SIMCLEX (NCLEX Simulator)
  • 6,500+ Practice NCLEX Questions
  • 2,000+ HD Videos
  • 300+ Nursing Cheatsheets
Start Free Trial

Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for cellulitis. So let’s get started. First, we’re going to go over the pathophysiology. Cellulitis is a common, deep bacterial skin infection that causes redness, swelling, and pain in the affected area of the skin. Usually it’s the arms and the legs. Some nursing considerations. You want to do a full skin assessment, vital signs, administering medications, wound care, labs, and educating the patient on treatment and prevention. Some desired outcomes: the patient’s going to reestablish healthy skin integrity and be free from infection. And here’s just a little photo to show you guys of what cellulitis looks like. You’ll notice that there’s some redness, all in the lower part of the leg here. Maybe some swelling, usually pretty warm to the touch. You can feel as you get closer, that heat that comes.

We’ll go right ahead to the care plan here. So we’re going to write down some subjective data and some objective data. So what are we going to see, or what is the patient going to tell you? One of the main things with the patients is that they’re going to be complaining of pain and also some tenderness in that area. Some of the objective that you’re going to see that is the hallmark is redness or swelling. You can also see some blisters, Some other things that you’re going to see, they’ll complain of some weakness in that extremity. There’ll be some swelling, warmness to the touch. The patient can have fever or chills, red spots, and maybe some skin dimpling. 

One of the interventions we really want to make sure that we’re doing is a full skin assessment. Assessment is usually one of the main things we do for pretty much anything. And we want to make sure we’re marking the border. And you’re probably wondering, well, Kristen, why would we mark the border? So we want to assess it. We want to see if there’s any swelling, any blisters, have the blisters broken, the color if it’s like real deep red. You want to determine the severity of the cellulitis and by marking the border, you’re going to determine if it continues to spread further and or if you’ve started antibiotic therapy, is it working. Another intervention that we’re going to be doing is we’re going to be giving antibiotics and pain medication. Many cellulitis cases are treated with PO or by mouth antibiotics, but more serious cases may need to be treated in the hospital with IV antibiotics. You want to note that patients should take a full course of antibiotics. They do not want to take or stop up taking antibiotics, even if they feel better or that it looks better. And with pain medication, you want to make sure you’re assessing the patient’s pain level and giving pain medication as needed. Another intervention we’re going to be doing for the patient. You want them to elevate that extremity. So you want to elevate the affected leg or arm just to decrease the swelling. And it speeds up the recovery process. Now intervention, obviously we’re going to make sure we’re checking the vital signs and doing any sort of labs or CT or MRI. So the vital signs; patients can develop that fever. They may also have chills. Labs. We want to make sure we’re checking for CBC for that white blood count. We’re going to be checked in for their creatinine for the kidney function and for the infection. CT or MRI will be done if the physician believes the possibility of necrotizing fasciitis. Okay, another intervention we’re going to do for this patient, we want to make sure we’re doing proper wound care, whether that is by you or by the wound care nurse that comes and sees the patient. You want to keep that wound very clean and very dry with any sort of occlusive dressing. You want to make sure you’re doing proper hand hygiene prior to doing any sort of wound care and after so you’re not spreading the bacteria. I want to make sure that you’re clipping the toenails as harbor bacteria and can cause spread of the infection. You can apply some corticosteroids, topically if ordered, and that helps with the inflammation. Another intervention. We also just want to make sure we’re educating, educating, educating. Very important. We’re letting the patient know what we’re doing, why we’re doing it, any medications that we’re giving and any wound care that we’re doing.

So we’re going to go over some key points now. So cellulitis, it’s a common deep bacterial infection usually caused by bacteria that enters in by wound by a bruise, burn, surgical cuts, a bite, or an ulcer. Typically group a strep is the most common cause. Subjective and objective: you’re going to patients going to complain of tenderness in that area. Weakness, redness (very common), swelling (very common), warm to touch fever, chills, red spots, blisters, and skin dimpling. You want to do a thorough skin assessment, give any medications, make sure you’re noting the color, swelling, any blisters that might be there. Checking vital signs, antibiotic therapy and pain management, wound care, corticosteroid cream, keeping the wound dry and intact, applying any occlusive dressings, and proper hand hygiene to prevent any sort of spreading of the bacteria. And there you have a completed care plan. 

We love you guys. Go out, be your best self today and as always happy nursing.

 

View the FULL Transcript

When you start a FREE trial you gain access to the full outline as well as:

  • SIMCLEX (NCLEX Simulator)
  • 6,500+ Practice NCLEX Questions
  • 2,000+ HD Videos
  • 300+ Nursing Cheatsheets
Start Free Trial