Cellulitis Nursing Diagnosis and Nursing Care Plans

Last updated on April 29th, 2023 at 11:35 pm

Cellulitis Nursing Care Plans Diagnosis and Interventions

Cellulitis NCLEX Review and Nursing Care Plans

The skin is considered the biggest organ of the body in terms of surface area. It has three functions: (1) initial protection of the body; (2) regulation of body temperatures; and (3) responsible for tactile sensation.

In cellulitis, opportunistic bacteria seep inside a break on the skin, causing inflammation to its deep layers.

Cellulitis mostly occurs on the lower legs, but can occur in the arms, face, and other regions of the body.

It may lead to serious complications if left untreated.

Signs and Symptoms of Cellulitis

Cellulitis usually presents with the four cardinal signs of infection:

• Erythema – redness of the skin
• Swelling – usually significant size changes can be seen in cellulitis
• Pain – tenderness and pain on the site and surrounding area
• Warmth – affected area can be warm to touch

Observing these clinical findings may suggest severe infection:

• Malaise, chills, and fever
• Lymphangitic spread – occurrence of streaked, red lines away from the area of infection
• Circumferential cellulitis – e.g. cellulitis observed surrounding the whole foot
• Presence of disproportionate pain versus examination results

Indications for surgical treatment are as follows:

• Violaceous bullae – non-pruritic and non-erythematous blisters
• Cutaneous hemorrhage
• Skin sloughing
• Skin numbness
• Gas in the tissue
• Rapid progression of swelling
• Hypotension 

Causes and Risk Factors of Cellulitis

In cellulitis, the offending bacterial organism is either the Streptococcus or Staphylococcus species.

Cellulitis begins when any skin breakdown happens, thus leaving for opportunistic bacteria to enter the wound.

Animal bites, insect stings, recent surgery, puncture wounds, or even microscopic skin tears can contribute for cellulitis to happen.

A severe form of infection may arise from cellulitis and is called Methicillin resistant Staphylococcus Aureus infection or MRSA.

The risk factors that increase the likelihood of cellulitis include the following:

• Injury – presence of skin breakdown like abrasions and lacerations
• Weakened immune system – pre-existing conditions like diabetes, cancer, HIV/AIDS, and patients on immunosuppressant medications
• Skin conditions – other skin conditions like eczema and athlete’s foot may predispose a patient to develop secondary infection of cellulitis
• Lymphedema – chronic localized swelling of the upper or lower extremities
• History of cellulitis
• Obesity

Complications of Cellulitis

1. Blood infection. Severe cellulitis may cause toxins to spill into the bloodstream, thereby causing sepsis.
2. Osteomyelitis. Osteomyelitis or bone infection can occur if cellulitis is advanced enough that it penetrates the bone structures underneath.
3. Lymphangitis. This is an inflammation of the lymph nodes and vessels and is correlated with sepsis.
4. Endocarditis. This is an inflammation of the heart and its tissues.
5. Meningitis. It is the inflammation of the meninges, the outer covering of the brain. Opportunistic infection coming from cellulitis can affect the brain as its toxins circulate around the body through the infected blood.
6. Septic shock. Untreated cellulitis precipitates an inadequately controlled infection that will cause undue stress to the organs, thereby causing systemic effects, such as multi-organ failure.
7. Gangrene. Tissue death and necrosis will occur if the cellulitis is left untreated or if treatment is not effective.

Diagnosis of Cellulitis

For most cases, no further evaluation is required for uncomplicated cellulitis that meet the following criteria:

• limited area of involvement
• minimal pain in the area
• absence of systemic signs (e.g. fever, altered mental status, hypotension)
• absence of risk factors for other serious conditions (e.g. extremes of age, immunocompromised status)

For moderate or severe forms of cellulitis, further work up is necessary and they include:

1. Laboratory studies
2. Blood cultures – to detect for the specific organism causing the cellulitis
3. CBC – basic laboratory test to determine blood count levels for proper management
4. Creatinine – to assess baseline kidney function and guide for antibiotic dosing
5. bicarbonate, creatine phosphokinase – to assess for latent muscle injuries caused by infection
6.  C-reactive protein (CRP) – laboratory marker for inflammation
7. Imaging studies
8. Ultrasound – to detect hidden sources of infection (occult abscess) and can lead to proper management. (e.g. Ultrasound-guided pus aspiration for deep infections)
9. CT imaging or MRI – if necrotizing fascitis is a concern, doing this imaging procedure will aid in visualizing the extent of damage the infection has caused

Treatment for Cellulitis

Treatment approach of cellulitis involves either or both medical management and surgical intervention:

1. Medical management. Treatment of cellulitis involves using a variety or combination of antibiotics.
   • For mild cases, cellulitis can be treated on an outpatient basis with prescriptions for oral 1^st class penicillin. Macrolides may be used as alternatives for patients with Penicillin allergies. Fluoroquinolones may be used but are only warranted for gram-negative organisms to avoid resistance.
   • For severe forms of cellulitis, intravenous administrations of higher class of antibiotics are given. 3^rd class penicillin is the drug of choice for severe sepsis. However, IV lincosomides and IV Glycopeptides may be given for patients allergic to penicillin’s.
   • The main goal of antibiotic use for severe forms is to cover for all possible causative pathogens (gram positive, gram negative, anaerobic organisms) to prevent inadequate treatments. Patients with risk factors (immunocompromised state, diabetes) may necessitate in-patient IV antibiotics to properly address the infection and to monitor their hemodynamic stability already impeded by their latent conditions.
2. Surgical Management
   • Incision and drainage. This is used for simple cellulitis with presence of pus or abscess to the infected tissue. This treatment is followed with a course of antibiotics to treat remaining infection otherwise not drained from the procedure.
   • Surgical resection. In severe forms of cellulitis, deep tissues like the muscle and bone may be infected and would require surgical removal of the necrotized and dead tissues.

Nursing Diagnosis for Cellulitis

Nursing Care Plan for Cellulitis 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to cellulitis, as evidenced by erythema, warmth and swelling of the affected leg

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for cellulitis.

Nursing Care Plan for Cellulitis 2

Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will prevent spread of infection to the rest of the body, by following treatment regimen for cellulitis.

Nursing Care Plan for Cellulitis 3

Risk for Disturbed Body Image

Nursing Diagnosis: Risk for Disturbed Body Image related to visible skin lesions secondary to cellulitis

Desired Outcomes:

• The patient will speak freely about their outlook and how they feel with skin lesions, and will carry on with the activities of daily living and socializing with others.
• The patient will extract positive feelings about their physical image and will talk about having feelings of increased self-esteem.
• The client will have a more real-life picture of one’s body than an impractical one.
• The patient will take responsibility and control over their own treatment management.

Nursing Care Plan for Cellulitis 4

Acute Pain

Nursing Diagnosis: Acute Pain related to impaired skin integrity secondary to cellulitis as evidenced by inflammation, dry, flaky skin, erosion, excoriations, fissures, pruritus, pain, and blisters.

Desired Outcomes:

• The client will participate in the treatment program and prevention management.
• The patient will exhibit wound healing promptly, and maintain excellence in skin integrity within the limitation of the disease, as manifested by intact skin.
• The patient’s pain was reduced at the affected site and can move conveniently with lesser discomfort. 
• The patient will restore healthy skin by following the treatment management prescribed.  The patient will follow preventive measures to avoid having further skin damage.

Nursing Care Plan for Cellulitis 5

Ineffective Tissue Perfusion

Nursing diagnosis: Impaired Tissue Perfusion related to interrupted blood flow to organs and tissues secondary to cellulitis as evidenced by pain, reduced sensation in extremities, prolonged wound healing, skin is cold to touch, and weak peripheral pulses.

Desired Outcome: The client will sustain adequate peripheral perfusion, as evidenced by strong pulses, skin is warm to touch, with a normal capillary refill, and wounds are healed.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.