CELLULITIS An inflammation of the deep dermal andsubcutaneous tissue that results from aninfectious process Local soft-tissue inflammatory

y reaction related tobacterial invasion of the skin. Types o Cellulities of the extremities - most commontype of cellulities o Breast Cellulities o Facial Cellulities (Erysipelas) medical attentionis urgent o Leg Cellulities o Orbital Cellulities can lead to permanent visionproblems o Perineal Cellulities around anal orifice o Periorbital Cellulities around the eyes P athophysiology and Etiology o Caused by infection with group A bet-hemolyticstreptococci, Staphylococcus aureus,Haemophilus influenza, or other organisms. o

Usually results from break in skin that may be assimple as athletes foot because it keeps nopening to bacteria. o Infection can spread rapidly through lymphaticsystem. RiskFactors o Insect bites and stings , animal bite, or humanbite o Injury or trauma with a break in the skin (skinwounds) o History of peripheral vascular disease o Diabetes -related or ischemic ulcers o Cracks or peeling skin between the toes o Use of immunosuppressive or corticosteroidmedications Clinical Manifestations o Tender, warm, erythematous, and swollen areathat is poorly demarcated. o Tender, warm, erythematous streak that extendsproximally from the area, indicating lymph vesselinvolvement. o Possible fluctuant abscess or purulent drainage. o Possible fever, chills, headache, malaise. Diagnostic Evaluation o

Appearance of skin/ presence of signs andsymptoms o Gram stain and culture of drainage o Blood cultures if generalized infectionssuspected o CBC may show an elevated WB C and indicates abacterial infection. Management 1. Oral antibiotics (penicillinase resistantpennicillins, cephalosporins, or quinolones) maybe adequate to treat small, localized areas of cellulitis of legs or trunk.2. Parenteral antibiotics may be needed forcellulitis of the hands, face or lymphatic orwidespread involvement.3. Surgical drainage and debridement forsuppurative areas. Complications o Bone infection (osteomyelitis) o Inflammation of the lymph nodes (lymphangitis) o Sepsis, generalized infection and shock o

Tissue death (gangrene ) o Blood poisoning o Abscess o F acial cellulitis and meningitis Nursing Assessment 1. Obtain history of trauma to skin, insect bite, orwound.2. Observe for expanding borders and lymphaticstreaking; palpate for fluctuance of abscessformation.3. Watch for signs of antibiotic sensitivity shortness of breath, urticaria, angioedema,maculopapular rash, or severe skin reaction, suchas erythema multiforme or toxic epidermalnecrolysis.4. Assess for patient and caretaker ability toprovide care at home, keep affected area clean,and adhere to medication prescribed. Nursing Diagnoses Risk for Impaired Skin Integrity r/t infectiousprocess Acute Pain r/t inflammation of subcutaneoustissue. Nursing Interventions P rotecting Skin Integrity 1.

Administer, or teach patient to administer,antibiotics as prescribed; teach dosage schedulend adverse effects.2. Maintain I.V. infusion or venous access toadminister I.V. antibiotics if needed.3. Elevate affected extremity to promote drainagefrom area and to minimize swelling.4. Prepare patient for surgical drainage anddebridement, if necessary. Relieving pain 1. Encourage comfortable position andimmobilization of affected are.2. Administer analgesics as prescribed; monitor foradverse effects.3. Use bed cradle to relieve pressure from bedcovers. Patient Education and Health Mintenance 1. Be sure that patient understands dosageschedule of an antibiotics and the importance of complying with therapy to preventcomplications.2. Advise to notify health care provider immediatelyif condition worsens;3. Teach patient with impaired circulation orimpaired sensation, proper skin care and how toinspect skin for trauma. Outlook ( Prognosis) It is possible to be cured with 7-10 days treatment.

Arellano UniversityCollege of Nursing 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 areabegins to enlarge, the person may develop a fever, sometimes with chills and sweats, and swollenlymph 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 theinfection (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 traumawounds, cellulitis can develop in the abdomen or chest areas. People with morbid obesity canalso develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designatedby 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 causescellulitis. 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 tomany antibiotics and is more difficult to treat.Strep (Streptococcus) is also a common cause of cellulitis. A form of rather superficialcellulitis caused by strep is called erysipelas; it is characterized by spreading hot, bright redcircumscribed 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, andupper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurellamultocida 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 thatdevelops 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 childrenand adults over age 50 (Cunningham). The actual incidence of cellulitis is unknown becausecases are seldom reported. Orbital cellulitis is uncommon but potentially very serious.The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) andother antibiotic-resistant bacteria has increased dramatically in recent years (Mayo Clinic Staff).Infection by these organisms is much more serious.

1 4 . Iris Round, brown symmetrical 1 5 . Ears Parallel, symmetrical, proportional to the size of the head Firm cartilage 1 6 . Nose In middle lie symmetrical and with discharge

 Internal nacres is pinkish 1 7 . 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 1 8 . 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 1 9 . Thorax and lungs Spine vertically aligned

No retractions, wall intact Clear breath sound heard 2 0. 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 2 1. 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 thecutis. The epidermis is a stratified squamous epithelium, composed of proliferating basal anddifferentiated suprabasal keratinocytes. The epidermis acts as the body's major barrier against aninhospitable environment.The hypodermis, also called the hypoderm, subcutaneous tissue, or superficial fascia isthe lowermost layer of the integumentary system in vertebrates. Types of cells that are found inthe 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. Inarthropods, the hypodermis is an epidermal layer of cells that secretes the chitinous cuticle.

Cellulitis Diagnosis
Most likely the doctor will make the diagnosisfrom a medical history and physical examination. The doctor may also draw blood for testing if he or she feels the infection is severe enough to be in the bloodstream or to check for an elevated white blood cell count.

The doctor also may order an X-ray of the area if there is concern that a foreign object is in the skin or that bone underneath is infected.

The doctor may try to draw fluid from the affected area with a needle and send the fluid to the laboratory for a culture.

Cellulitis Treatment Self-Care at Home

Rest the area of the body involved.

Elevate the area of the body involved. This will help decrease swelling and relieve discomfort.

Use over-the-counter pain relievers such as acetaminophen (Tylenol) oribuprofen (Advil, Motrin). This will decrease the pain as well as help keep the fever down.

Cellulitis pathophysiology
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Cellulitis Microchapters

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Overview

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Risk Factors

Causes of Cellulitis

Differentiating Cellulitis from other Diseases

Natural History, Complications & Prognosis

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Physical Examination

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Treatment

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Overview
Cellulitis results in activation of the body's inflammatory response mechanisms. When the immune system cannot respond adequately, it can spread systemically through the blood stream.

Pathophysiology
Microorganisms gain initial access into the layers of the skin through the discontinuities or cuts in the skin. The body responds to these microbes as a foreign bodies, and this causes an inflammatory response. This leads to redness, swelling, pain and itching of the area involved. A local infection leads to inflammation of the area. With a competent immune system, the spread of the infection is limited. If the immune system fails to curb the infection it may become systemic by spreading into the adjacent areas and may finally enter the blood stream causing (Bacteremia).

References

Leg Cellulitis
Leg cellulitis is a skin infection caused by a few different types of bacteria. Risk factors for the condition include obesity, skin ulcers, and swelling of the leg. Symptoms can be either localized or systemic, but redness, heat, and swelling are typically seen. Leg cellulitis is most commonly treated with antibiotics. Keeping the affected leg elevated and applying cold compresses can help relieve pain.

An Introduction to Leg Cellulitis

Leg cellulitis is a skin infection on the leg that is characterized by swelling, redness, warmth, and pain. It affects people of all ages and can occur anywhere on the body. However, cellulitis mostly affects the legs, feet, arms, and hands. These types of cellulitis are commonly referred to as "cellulitis of the extremities."

Causes of Leg Cellulitis

Leg cellulitis is an infection caused by bacteria. The most common cause of this condition in adults with no medical conditions is group A streptococcus, which is a bacterium commonly found in the throat and on the skin.

Another common cause of leg cellulitis in adults is Staphylococcus aureus (S. aureus), which is a bacterium that is commonly found on human skin and mucosa (lining of mouth and nose).

The most common cause of leg cellulitis in children under the age of three is Haemophilus influenzae type B, which is a bacterium that causes serious infections.

Leg Cellulitis (Cont.)

Risk Factors for Leg Cellulitis
Cellulitis research has shown that people with certain risk factors are more likely to develop leg cellulitis than others. Common risk factors for the condition include:

Problems with the lymphatic system Vein problems Swelling of the leg Breaks in the skin Obesity.

Specific risk factors include:

Surgical wounds Skin ulcer (such as a diabetic ulcer)

Eczema, psoriasis, or other skin conditions that may cause a break in the skin A previous episode of cellulitis Surgery to remove lymph nodes Radiation therapy Coronary artery bypass surgery IV drug use Chemotherapy Pregnancy

Certain conditions, including diabetes, HIV or AIDS,leukemia, lymphoma, psoriasis, dyshidrosis, lupus, andheart failure.

While these risk factors are not actual causes of leg cellulitis, they do increase a person's chances of developing it. People who believe that they may be at risk for leg cellulitis should discuss this concern with their healthcare provider.

Symptoms of Leg Cellulitis

Symptoms of leg cellulitis can occur at the location of the infected skin (local symptoms) or they can occur on other parts of the body (systemic symptoms).

(Click Cellulitis Symptoms for more information.)

Leg Cellulitis Article Continues on Next Page >

Leg Cellulitis (Cont.)

Diagnosing Leg Cellulitis
Your healthcare provider typically makes a leg cellulitis diagnosisby asking questions about your medical history, performing a physical exam, and ordering blood tests. The most reliable way of diagnosing leg cellulitis is by looking at the affected area. An area affected by cellulitis will be:

Red Warm to the touch Swollen Painful.

Your healthcare provider will also look for breaks in your skin (such as cuts, bruises, scrapes, skin conditions, or ulcers) where bacteria could have entered. He or she will likely also order a blood test to see if there is any indication of an infection.

Treating Leg Cellulitis

Treatment for leg cellulitis is aimed at healing the affected area and any underlying conditions that may increase the likelihood of a recurrence. Specific treatment options include medications and recurrence prevention.

Antibiotics are usually the first line of treatment, so tell your doctor if you are allergic to penicillin. During treatment for leg cellulitis, you should keep the affected leg elevated and use cold compresses to help reduce pain. However, 50 percent of people who receive treatment experience a recurrence of leg cellulitis. If this happens, your healthcare provider may prescribe antibiotics for a longer period of time.