Cellulitis Nursing Diagnosis and Nursing Care Plans

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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 1st 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. 3rd 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 Interventions for CellulitisRationale
Assess the patient’s skin on his/her whole body.To determine the severity of cellulitis and any affected areas that require special attention or wound care.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Cellulitis is generally treated through the use of antibiotic therapy.
•  For mild cases, cellulitis can be treated on an outpatient basis with prescriptions for oral 1st 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. 3rd 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. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
 Apply corticosteroids over the affected skin as prescribed by the physician. Application is usually twice a day and is done thinly over the inflamed skin. It is applied for a maximum if 14 days.Topical corticosteroids promote the reduction of skin inflammation in the affected area. Mild cellulitis may benefit from over-the-counter topical corticosteroid preparations, but severe cellulitis requires prescription ones.
Prevent the use of occlusive dressing over the affected site.Occlusive dressing potentiates the systemic absorption of the corticosteroid cream or ointment.  
Prepare the patient for surgery as indicated.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.
Educate the patient and caregiver about proper skin hygiene through washing the skin with soap and water.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water.  

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 Interventions for CellulitisRationale
Assess the patient’s skin on his/her whole body.To determine the severity of cellulitis and any affected areas that require special attention or wound care.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
Educate the patient and caregiver about proper skin hygiene through washing it with soap and water.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas.Long fingernails tend to harbor more bacteria.  
Using a skin marker, mark the edges of the cellulitic area and observe for its shrinkage or spread.This method can help determine whether the antibiotics are effective, or if there is a need to change the antibiotic used.

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 Interventions for CellulitisRationale
Evaluate the client’s understanding of the changes in physical appearance.As health care providers, we need to acknowledge the client’s reaction to the changes in their skin, especially those that are visible due to inflammation reaction. .
Assess the client’s way of behaving associated with their appearance. Patients due to negative self-image may attempt to conceal their skin lesions. Their relationship and interaction with others may be affected because of distress and disquietude about other people’s reactions and rejection about their appearance.
Guide the patient in expressing their responses fluently and coherently to questions from others concerning lesions and transmission of the disease.ThePatient may need assistance in knowing how to respond to questions asked or opinions of others, concerning their skin appearance. Also, Dermatitis is not an infectious disease. Let the patient express feelings related to their skin condition. Acknowledge any expression of frustration, disappointment, and sadness. Through speaking, the patient can be guided to differentiate physical image from feelings of self-worth. Acknowledgment of these negative impressions as an expected reaction to what has occurred facilitates resolution. Refutation may be extended and be an adaptive mechanism because the patient is not prepared to deal with individual trouble.
Guide the patients in determining the ways to improve their appearance. Educate the client about adaptive practices. Fashion, make-up, and accessories may take away the attention from the skin lesion. These adaptive mechanisms help the client neutralize the existent changes in the body structure and function. The client may need assistance in choosing options that will not worsen their skin condition
Put limitations on maladaptive behavior. Sustain a neutral behavior while providing care and guide the patient to identify a positive attitude to promote recovery. In some cases, the patient and nurses keep on dealing with this crisis, in the same way in which they have given out with the same trouble before. It may be difficult and inconvenient to deal with disrupting behavior and not helping in recuperation, but it should be analyzed that the attitude is usually directed to the situation and not to the care provider.
Prepare detailed materials and accomplish aftercare direction for the patient.Strengthening teaching can support the patient to attain self-care.
Express positivity and care in daily activities.A Positive attitude by the nurses and other healthcare workers expands positive feedback to the changes of the client’s body.
Stay sensible and constructive in times of treatment, in health awareness, and putting up goals in restriction. This will establish a close and harmonious relationship between the patient and the nurse.
Extend hopes within limitations of the patient’s condition. Do not give fallacious reassurance.This develops positive behavior and promotes the opportunity to settle goals and plans according to reality.
Be of service to the client in integrating physical changes to Activities of daily living, mutual relationships, socialization, and job-related activities. The increased number of visible changes in physical aspect or purpose may increase the patient’s distress on how they will acknowledge the change. The chance for compliments and accomplishment may speed up the adjustment.
Provide positive feedback on the client’s improvement and motivate the goal in direct attainment of the rehabilitation objectives.Motivational and encouraging words can promote the development of coping attitudes.
Promote interconnection between the patient, family members, and members of the rehabilitation group.A healthy discussion brings assistance between the patient and their family.

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 Interventions for CellulitisRationale
Evaluate the overall condition of the client’s skin. Assess skin color, moisture, texture, temperature. Take note of any erythema, edema, and tenderness. Healthy skin should have a good turgor that indicates moisture, feels warm and dry to touch, free from any impairments such as abrasions, outbreaks, and rashes. Have a quick capillary refill (Should have less than 6 seconds). In cases of cellulitis, they may have a specific characteristic pattern of skin changes and lesions.
Assess the skin detailedly. Examine the areas of irritants and in contact with allergens. Body folds areas such as necks, elbows, and back of the knee areas are affected by cellulitis.
Check for skin lesions. Take notice of any excoriations, erosions, fissures, and thickening. There is an increased risk for infection with open skin lesions. Also, constant scratching of the lesions will lead to thickening of the surface.
Examine the affected site at least once a dayRegular monitoring of the affected site will allow the care management team to monitor the wound and know immediately if the condition worsens and if treatment needs to be adjusted.
Determine if there are any aggravating factors. Takedown if there are recent changes in the use of body products such as soaps, laundry detergents, cosmetics, wool or synthetic fibers, cleaning solution, and others. In some cases, cellulitis may aggravate in response to changes in the environment. Also, Extreme temperature (Hot and Cold), stress, and tiredness are contributory factors. 
Look for signs of itching and scratching. Scratching relieves intense skin itching, but it may cause open skin lesions, which increased the risk for infection. Check for any red papules, erythema, and scaling.
Clean the wound according to the Doctors advice. Instruct the patient and family members about the correct wound care techniques.Aseptic techniques are usually required in wound cleaning. For it reduces the risk of infection.
Give antibiotics as doctor’s order.Antibacterial medications are used to treat an existing infection or to lower the risk of infection and prevent further complications.
Promote skin routines to reduce skin irritations. Use lukewarm water, mild soap, or non-soap cleaners to avoid irritations.  Allow skin to air dry after bathing, or lightly pat dry the skin.   Educate the patient about the aggravating factors that should be avoided. Hot water in long bathing and showering may cause dry skin and can trigger itching.   Brisk drying may result in irritation to the skin and may aggravate the itch-scratch cycle.   Changes in lifestyle are recommended to lower the risk of triggers.
Teach the patient about the signs and symptoms of infection and when to inform their healthcare provider. These include redness, swelling, warmth to touch, discoloration, increased wound drainage, and Fever.Awareness of these signs promotes prompt treatment. 
Educate the client about adequate nutrition and hydration.Adequate hydration and nutrition assistance help sustain skin turgor, moisture, and suppleness, which give elasticity to prevent skin damage due to pressure. Patients with a restricted amount of fluid intake secondary to a cardiac reserve are limited.
Proper documentationWound and skin breakout require detailed and accurate documentation to monitor the healing process and the effectiveness of the treatment rendered. Wounds must be recorded accurately including length, width, and depth with detailed information of drainage, peri-wound area, odor, and any tunneling or undermining. A photograph should be taken for baseline comparison.

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 Interventions for CellulitisRationale
Check distal pulses regularly. Pulses are an indicative property of sufficient perfusion to the specific body part. Absence or weakness of pulses may be a sign of impaired perfusion.
Assess the skin color, temperature, and sensation of all extremities. Pale color or bluish discoloration, or spotty skin may be an indication of the presence of blockage in the skin.
Evaluate for predisposing factors that could result in circulatory problems related to arterial and venous origin. Predisposing factors for peripheral vascular disease (PVD) can differ depending on the origin. Arterial predisposing factors may be atherosclerosis or age-related. However, for venous insufficiency, predisposing factors could be a medical history of deep vein thrombosis (DVT) or valvular dysfunction.
Assess for signs of decreased tissue perfusion. For peripheral arterial disease (PAD), shiny skin, hair loss, thick nails, pallor, cool to touch the skin, decrease or absence of pulses, sharp-rest pain with intermittent claudication, necrosis in ulcers.            
For Venous insufficiency, brown discoloration of the skin from the ankles up to the calves, there is the presence of edema, skin is warm to touch, normal pulses, dull and continuous pain, superficial ulcers with uneven edges.
    Hair loss and brittle nails are because of reduced blood flow to the hair follicles and nails. Extremities are cool due to reduced perfusion in the arteries, secondary to plaque build-up (Ischemia). Weak or absent pulses are a result of decreased blood supply. At rest, there is less oxygen demand by the muscles, resulting in decreased blood supply to these areas. This will lead to sharp, intermittent pain while resting. Arterial wound ulcers are pale and sometimes are necrotic because of the small amount of blood supply to the wound.   With the increase of venous blood pressure, there is a pooling of blood that causes valvular damage in the veins. This causes fluid to back up and leak out into surrounding tissues resulting in edema. Dull and continuous pain is because of venous hypertension, ulceration.
Take note of the capillary refill time Normal capillary refill time should not exceed 3 seconds for nail beds. Pale nail beds are an indication of poor perfusion.
Monitor vital signs closely Stable blood pressure and mean arterial pressure of at least 65 is advisable to ensure an adequate perfusion of organs and tissues. Oxygen saturation should be at a satisfactory level to guarantee an adequate oxygen supply.
Determine possible precipitating factors that may attribute to a compromise in tissue perfusion. These include medications, positioning, pathology, and medical equipment. Medication including norepinephrine can lead to distal ischemia and kidney failure. Thrombus formation, medical equipment such as an endotracheal tube or a cast may cause reduced perfusion and may lead to tissue damage if not properly monitored.
Check hemoglobin level regularly.Low oxygen saturation and affinity for hemoglobin, the oxygen utilization will be reduced, resulting in less amount of oxygen circulating in the body.
Evaluate the patient’s mental status.Any changes in level of consciousness, Glasgow coma scale (GCS) scoring, or any neurological monitoring system may indicate a decrease in cerebral perfusion.
Keep track of the patient’s fluid balance. Monitor the patient’s amount of intake and output, color of the urine, and its clarity. Checking of renal function tests is advisable.Reduced urine output may be a sign of Decreased perfusion of the kidneys. If this happens, other vital organs like the brain will be affected as well. In this situation,  Impaired cerebral perfusion might take place. Lab values such as BUN and creatinine are helpful to identify if there are any changes in renal function.
Monitor the patient’s cardiac rhythm.           ECG changes such as ST depression, ST elevation, T wave inversion, new onset of left bundle branch block all indicate Ischemia or may be cardiac events that block myocardial tissue perfusion.

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

Nursing Stat Facts
Nursing Stat Facts

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

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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.

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