Nursing Care Plans for Cellulitis – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Cellulitis plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Cellulitis is a common bacterial skin condition that can be dangerous. The affected skin appears inflamed and red and is usually painful and warm to the touch.

Cellulitis mainly affects the lower legs, although it can also affect the face, arms, and other body parts. It happens when bacteria enter your body through a crack or break in your skin.

If left untreated, the infection can quickly spread to your lymph nodes and circulation, posing a serious health risk. It isn’t frequently passed on from one person to the next.

What is cellulitis?

Cellulitis is a painful skin ailment that affects many people. It may show as a discoloured, swollen area that is hot and painful to the touch at first. The swelling and discolouration can spread swiftly.

Cellulitis usually appears red or pink on light skin. It might seem dark brown, grey, or purple on dark skin. The infection most commonly affects the feet and lower legs, but it can affect any part of a person’s body or face.

Cellulitis normally affects the skin’s surface, but it can also harm its tissues. The infection has the potential to spread to lymph nodes and circulation. Cellulitis can become life-threatening if it is not treated.

Pathophysiology

Cellulitis is caused by skin breaks that are not properly covered or cleaned.

Weak defence – Cellulitis is most commonly associated with skin breaks such as puncture wounds, fissures, or lacerations.

Entry – Cellulitis is caused by organisms in the skin gaining access to the dermis and multiplying.

Inflammation – Swollen, red, and painful skin indicates infection, and a fever may accompany these symptoms.

Invasion – If left untreated, cellulitis can penetrate the skin’s inner layers, infiltrate the lymph nodes and bloodstream, and spread throughout the body.

Epidemiology & Statistics

The exact prevalence of cellulitis is unknown because it is not a reportable condition; however, it is a relatively common infection that affects all races and ethnicities.

1. Individuals above the age of 45 are more likely to get cellulitis.
2. The cellulitis has a prevalence rate of 24.6 occurrences per 1000 people.
3. Cellulitis was found in 37.3 % of patients in a comprehensive epidemiologic investigation of skin, soft tissue, joint, and bone infections.
4. Skin and soft tissue infections occur in 32.1 to 48.1 visits per 1000 people.
5. The number of abscess and cellulitis visits per 1000 people increased from 17.3 to 32.5.
6. In a general hospital in the United Kingdom, cellulitis accounted for about 3% of emergency medical consultations.

Causes

• Weak immune system. Bacteria can quickly infect a person with a weakened immune system.
• Breaks in the skin. Breaks in the skin caused by eczema and athlete’s foot, for example, allow germs to enter and produce cellulitis.
• Intravenous drug use. The insertion site is also a breach in the skin where pathogens could enter via.
• Diabetes. Patients with diabetes have a slower wound healing rate, and wounds exposed to microorganisms may get infected for an extended period of time.
• Skin ulcers
• Chronic skin conditions
• Nail infections

Risk factors

A combination of factors causes cellulitis:

Injury – Bacteria can enter through any wound, fracture, burn, or scrape.

Weakened immune system – Diabetes, leukaemia, and HIV/AIDS impair your immune system, making you more susceptible to infections. Some drugs can also weaken your immune system.

Skin conditions – Eczema, athlete’s foot, and shingles can all produce skin cracks, which allow bacteria to enter the body.

Chronic swelling of your arms or legs – This disease can occur due to surgery.

History of cellulitis – If you’ve had cellulitis previously, you’re more likely to get it again.

Obesity – Cellulitis is more likely to develop if you are overweight or obese.

Signs and Symptoms of Cellulitis

Cellulitis signs and symptoms are usually visible and noticeable on the skin tissues.

Tenderness at the injury site -The site of developing cellulitis causes pain.

Skin inflammation is a condition in which the skin becomes inflamed. Inflammation occurs as the infection progresses into the inner layer of the skin.

A rash or a sore on the skin that spreads swiftly – The skin produces rashes over the affected area due to pathogen invasion.

The skin has a tight, shiny aspect – Because of the swelling, the skin expands and appears taut and glossy.

Abscess filled with pus – Pus and an abscess form as the infection progresses.

Fever – As the body battles the illness, a fever develops.

erythema/ red streaks

Warm/hot to touch

Oedema (fluid)

Pain/tenderness

Blisters (bullae)

More serious cellulitis symptoms include:

• Shaking
• Chills
• Feeling ill
• Fatigue
• Dizziness
• Lightheadedness
• Muscle aches
• Warm skin
• Sweating

Cellulitis can spread into other parts of your body if left untreated. If it does spread, you may develop some of the following symptoms:

• Drowsiness
• Lethargy
• Blisters
• Red or dark brown streaks on the skin

Complications of Cellulitis

1. Blood infection – Severe cellulitis may cause toxins to spill into the bloodstream, 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 brain’s outer covering. Opportunistic infection from cellulitis can affect the brain as toxins circulate 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 ineffective.

Prevention

If your cellulitis recurs, your doctor may recommend preventive antibiotics. To help prevent cellulitis and other infections, take these precautions when you have a skin wound:

1. Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
2. Apply a protective cream or ointment. An over-the-counter ointment (Vaseline, Polysporin, others) provides adequate protection for most surface wounds.
3. Cover your wound with a bandage. Change bandages at least daily.
4. Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.

People with diabetes and those with poor circulation need to take extra precautions to prevent skin injury. Good skincare measures include the following:

• Inspect your feet daily. Regularly check your feet for signs of injury so you can catch infections early.
• Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling. Do not apply moisturizer to open sores.
• Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
• Protect your hands and feet. Wear appropriate footwear and gloves.
• Promptly treat infections on the skin’s surface (superficial), such as athlete’s foot. Superficial skin infections can easily spread from person to person. Don’t wait to start treatment.

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 workup is necessary, and they include:

1. Laboratory studies

2. Blood cultures — to detect 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 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

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

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 lincosamides and IV Glycopeptides may be given for patients allergic to penicillin.

• 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 address the infection properly and to monitor their hemodynamic stability already impeded by their latent conditions.

Surgical Management

• Incision and drainage. This is used for simple cellulitis with the presence of pus or abscess to the infected tissue. This treatment is followed by a course of antibiotics to treat the 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.

Cellulitis and other conditions

Many conditions can present symptoms similar to cellulitis.

Cellulitis versus Venous Stasis

Venous stasis, or venous stasis dermatitis, is a condition commonly misdiagnosed as cellulitis.

This condition causes swelling, discolouration and can develop into skin ulcers. It results from poor circulation in the lower limbs and typically affects the lower legs and ankles.

Unlike cellulitis, this condition can affect both sides of the body and is not the result of bacterial infection. However, should you develop sores or ulcers due to venous stasis, your risk of a skin infection will increase.

Cellulitis versus Erysipelas

Erysipelas is another skin infection. Like cellulitis, it can start from open wounds, burns, or surgical cuts.

Most of the time, the infection is on the legs. Less often, it can appear on the face, arms, or trunk.

However, cellulitis affects deeper tissue, while erysipelas is often the result of strep bacteria and its effects are more superficial.

Other symptoms of erysipelas include:

• Fever
• headache
• nausea
• chills
• weakness
• ill feeling

Doctors treat erysipelas with antibiotics, most often penicillin or a similar drug.

Cellulitis versus Abscess

An abscess is a swollen pocket of pus underneath the skin. It forms when bacteria — often Staphylococcus — get into your body through a cut or other open wound.

Your immune system sends in white blood cells to fight off the bacteria when this happens. The attack can form a hole under your skin, filling with pus. The pus contains dead tissue, bacteria, and white blood cells.

Unlike cellulitis, an abscess looks like a lump under the skin. You may also have symptoms like a fever and chills.

Some abscesses shrink on their own without treatment. In other instances, you may require antibiotics, or a doctor may need to drain the abscess.

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Cellulitis versus Dermatitis

Dermatitis is a general term for a swollen skin rash that covers many conditions. These include atopic dermatitis, or eczema, and contact dermatitis, an allergic reaction to an irritating substance.

Unlike cellulitis, most forms of dermatitis are the result of allergic reactions, not bacterial infections.

General dermatitis symptoms include:

• Discoloured skin
• Blisters that ooze or crust
• Itching
• Swelling
• Scaling

Doctors treat dermatitis with cortisone creams and antihistamines to relieve the swelling and itching.

Cellulitis versus DVT

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins, usually in the legs. You can get a DVT after you sit or lie in bed for a long period of time, such as on a long plane trip or after surgery.

Symptoms of DVT include:

• Pain in the leg
• Redness
• Warmth

It’s important to get medical help if you have DVT. If the clot breaks free and travels to the lungs, it can cause a life-threatening condition called pulmonary embolism (PE).

Doctors treat DVT with blood thinners. These prevent the clot from getting bigger and stop you from getting new clots.

Nursing Care Plans for Cellulitis Based on Diagnosis

Nursing Care Plan Based on Impaired Skin Integrity Diagnosis

Nursing Diagnosis: Impaired Skin Integrity related to skin infection 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 a treatment regimen for cellulitis.

Intervention	Rationale
Assess the patient’s skin on their 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 antibiotics 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 lincosamides and IV Glycopeptides may be given for patients allergic to penicillin. 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 done twice a day and is done thinly over the inflamed skin. It is applied for a maximum of 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 the presence of pus or abscess to the infected tissue. This treatment is followed by a course of antibiotics to treat the 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.

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Nursing Care Based on Risk for Infection

Nursing Diagnosis: Risk for Infection.

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

Intervention	Rationale
Assess the patient’s skin on their 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 antibiotics 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 by 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 harbour 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.

Summary

Cellulitis is a common skin infection that causes inflammation, skin discolouration, and pain. Complications are but can be severe. It can affect the surface or deep tissue, and if left untreated, it can lead to catastrophic complications, including amputation of a limb. Cellulitis is more common in people with diabetes, cancer, or immunocompromised. Nursing care plans will focus on effective pain management, antibiotics, and skin integrity evaluation.

Most people fully recover from cellulitis after 7 to 10 days on antibiotics. If left untreated, cellulitis can lead to gangrene and septic shock and may require surgery to treat severe cases.

Related FAQs

1. What is the main cause of cellulitis?

Cellulitis is usually caused when bacteria enter a wound or area where there is no skin. The most common bacteria that cause cellulitis include: Group A ß – hemolytic streptococcus (Strep) Streptococcus pneumoniae (Strep)

2. What does cellulitis look like in the beginning?

In general, cellulitis appears as a red, swollen, and painful area of skin that is warm and tender to the touch. The skin may look pitted, like the peel of an orange, or blisters may appear on the affected skin. Some people may also develop fever and chills.

3. What is the fastest way to get rid of cellulitis?

Treatment for cellulitis, which is an infection of the skin and tissues, includes antibiotics and addressing any underlying condition that led to the infection. Home remedies can also help cellulitis go away faster, such as keeping the area dry, using antibiotic ointments, rest, and elevating the affected leg or arm.

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4. Is cellulitis caused by poor hygiene?

Most commonly, it occurs in areas that may have been damaged or are inflamed for other reasons, such as inflamed injuries, contaminated cuts, or areas with poor skin hygiene. Bad circulation from poor vein function or peripheral arterial disease is a common cause of cellulitis.

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