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Cellulitis Nursing Guide

Content Creator: Rakesh Tripathi MBA, MPH, BSN, RN-CEN

Overview: Cellulitis

This content is intended as a Quick Reference for Cellulitis and will cover an overview and nursing considerations utilizing the nursing process.

Cellulitis Etiology and Epidemiology

Cellulitis is an inflammation of the cells. It refers to an acute spreading infection in the dermis and subcutaneous tissues. The inflammation results in pain, erythema, edema, and warmth. Most cellulitis originates from a previous skin injury, such as a wound or insect bite. It accounts for approximately 3.7 billion dollars in ambulatory care costs and 650,000 hospitalizations annually (Raff & Kroshinsky, 2016).

Causes of cellulitis include:

  • Bacterial infections
    • Most common are group A Streptococci and Staphylococcus aureus (Han et al., 2020)
  • Extension of a skin wound
  • Fungal infections
  • Furuncles or carbuncles

Complications from cellulitis include:

  • Deep vein thrombosis (DVT)
  • Facial cellulitis in children
  • Gas-forming cellulitis or gangrene
    • May require amputation and may result in mortality
  • Local abscess
  • Lymphangitis
  • Sepsis
  • Thrombophlebitis

The risk factors for cellulitis include (Kaye et al., 2019):

  • Chronic steroid use
  • Diabetes
  • Immunodeficiency
  • Impaired peripheral circulation, venous stasis, or arterial insufficiency
  • Lymphadenectomy
  • Other systemic illness
  • Prolonged edema
  • Skin trauma
  • Varicella
  • Venectomy

Cellulitis Diagnosis

The Infectious Disease Society of America recommends the following lab tests:

  • Blood cultures
  • Complete blood count (CBC) with differential
  • Creatinine, creatine phosphokinase, bicarbonate
  • C-reactive protein levels
  • X-rays for severe cases to rule out gangrene of affected area
  • Ultrasonography to detect occult abscess
  • Aspiration and culture

Cellulitis Management

  • May be treated with oral antibiotics after an initial dose of IV or IM antibiotics
    • Severe or complicated cases require hospitalization and IV antibiotics
  • Reevaluate within 24 to 48 hours
    • If no improvement, hospitalization required
  • Analgesics for pain relief
  • Amputation if gangrene develops
  • Possible abscess aspiration
  • Possible tracheostomy with severe head or neck cellulitis

Cellulitis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with cellulitis are listed below.

Assessment

  • History
    • Possible fever, malaise, and chills
    • Redness and warmth at site
    • Swelling at site
    • Tenderness at site
  • Physical Examination
    • Four cardinal signs of infection at site:
      • Edema
      • Pain
      • Swelling
      • Warmth
  • Erythema with indistinct margins
    • Possible lymphadenopathy
    • Red streaks visible in the skin proximal to the area of cellulitis

Cellulitis Nursing Diagnosis/Risk For

  • Fear
  • Pain
  • Ineffective tissue perfusion
  • Infection
  • Activity intolerance
  • Injury

Cellulitis Interventions

  • Administer antibiotics, as ordered.
  • Administer pain medications and nonpharmacological pain relief measures.
  • Apply moist heat, as ordered.
  • Encourage adequate hydration.
  • Encourage individual to express feelings and communicate.
  • Give individual and family emotional support.
  • Immobilize and elevate the affected extremity.
  • Maintain infection precautions.
  • Insert and maintain an IV line, as ordered, per hospital policy.
  • Maintain a calm environment.
  • Maintain normal vital signs and good tissue perfusion.
  • Mark, measure, and record the circumference of the affected extremity.
  • Perform lab tests and monitor results, as ordered.
  • Implement safety precautions.
  • Monitor for:
    • Adverse reactions or complications, including infection and edema
    • Level of pain
    • Treatment response
    • Vital signs

Expected Outcomes

  • Ability to perform activities of daily living
  • Decreased feelings of fear
  • Maintain all of the following:
    • Adequate tissue perfusion
    • Normal peripheral pulses and skin color
    • Normal vital signs
    • Skin integrity
  • Remain free of infection and injury
  • Verbalize a decrease in level of pain

Individual/Caregiver Education

  • Understand medications and potential adverse effects.
    • Antibiotics are effective in over 90% of individuals, if taken correctly.
  • Call healthcare provider if experiencing worsening symptoms such as:
    • Increasing pain
    • Redness
    • Swelling
    • Red streaks proximal to the affected area
    • Fever
    • Chills
  • Follow up with primary healthcare provider or surgeon.
  • Use warm compresses and elevate affected area.
  • Learn and look for the signs and symptoms of DVT and infection.
  • Prevent injury or trauma to the skin.
  • Utilize a collaborative interprofessional team approach in educating individuals to ensure successful treatment, as well as education of individuals, to prevent recurrent infections (Gibbons et al., 2017; Singh et al., 2019).

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2029

Course Contributor

The content for this course was created by Relias external nursing content writer and editor Rakesh Tripathi MBA, MPH, BSN, RN-CEN. He is a Certified Emergency Nurse (CEN) with extensive experience, primarily in acute care settings. Mr. Tripathi has considerable experience in travel nursing, as well as more than a decade of general nursing experience. He has conducted nursing research for the European governments and worked as a nursing lecturer for Glasgow Caledonian University (GCU) Scotland, affiliated colleges, and has practiced nursing in Asia, the UK, and the U.S.

Resources

References

  • Gibbons, J. A., Smith, H. L., Kumar, S. C., Duggins, K. J., Bushman, A. M., Danielson, J. M., ... & Wadle, J. J. (2017). Antimicrobial stewardship in the treatment of skin and soft tissue infections. American journal of infection control45(11), 1203-1207. https://doi.org/10.1016/j.ajic.2017.05.013
  • Han, J., Faletsky, A., & Mostaghimi, A. (2020). Cellulitis. JAMA dermatology156(12), 1384-1384. https://doi.org/10.1001/jamadermatol.2020.2083
  • Kaye, K. S., Petty, L. A., Shorr, A. F., & Zilberberg, M. D. (2019). Current epidemiology, etiology, and burden of acute skin infections in the United States. Clinical Infectious Diseases68(Supplement_3), S193-S199. https://doi.org/10.1093/cid/ciz002
  • Raff, A. B., & Kroshinsky, D. (2016). Clinical Review & Education. JAMA316(3), 325-337. https://doi.org/10.1001/jama.2016.8825
  • Singh, M., Negi, A., Zadeng, Z., Verma, R., & Gupta, P. (2019). Long-Term Ophthalmic Outcomes in Pediatric Orbital Cellulitis: A Prospective, Multidisciplinary Study From a Tertiary-Care Referral Institute. Journal of Pediatric Ophthalmology & Strabismus56(5), 333-339. https://doi.org/10.3928/01913913-20190807-01

 

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