Cellulitis

What went wrong?

Cellulitis is an infection of the skin, caused by bacteria that enter the skin through
an opening. The legs are the most common site of cellulitis, although it may occur
anywhere bacteria enters. The most common bacteria are streptococcus and
staphylococcus. Bacteria may enter through fissures in the feet from fungal infections,
through cracks in dry skin, from insect bites, or cuts from shaving. The elderly,
immunocompromised patients, and patients with lymphedema, diabetes, or poor
circulation are at greatest risk.

Prognosis
If treatment is started early, the prognosis is good. If the symptoms dont begin to
resolve or the infection is on the face or widespread, hospitalization and IV antibiotics
are needed. A severe cellulitis of deep tissue, necrotizing fasciitis, is caused by a
streptococcal bacteria and is considered a medical emergency.
Hallmark Signs and Symptoms
Hot, red skin over the area of infection
Swollen and painful skin and tissue due to infection

Interpreting Test Results

CBC to check on the white blood cell count.
Culture of the wound to identify the organism causing the cellulitis.
Ultrasound of the leg to rule out a DVT-deep vein thrombosis.

Treatment
Treatment for a beginning infection is oral antibiotics. If fever and body aches
accompany the infection or if the face is involved or the area is extensive,
hospitalization may be necessary. Empiric treatment is started immediately and is
effective against the most common bacteria.
Cephalexin
Dicloxacillin
Levofloxacin
Tetanus booster if needed
Drainage of abscess by a surgeon if necessary
Pain medications

Nursing Diagnoses
Pain discomfort
Risk of infection
 Impaired Skin Integrity

Nursing Intervention
Explain to the patient the importance of good hygiene.
Wash the affected area daily.
Use a topical antibiotic ointment and a dry dressing twice daily.
Elevate the area if possible
Monitor for temperature, enlarging area of redness, increase in drainage
Explain to the patient how to prevent openings in the skin by using proper
skin care interventions.
Monitor feet and legs daily for cracks, fissures.
Use care in trimming nails, or visit podiatrist.
Use moisturizing lotions regularly.

Osteomyelitis
What went wrong?
Osteomyelitis is an infection of the bone. In an adult, it is most commonly due to
direct contamination of the site during trauma, such as an open fracture. Bacteria that
cause infections elsewhere in the body may also enter the bloodstream and become
deposited into the bone, starting a secondary infection site there. This is more common
in children and adolescents. Some of the patients have been treated with antibiotics
previously for the initial infection.
The causative organism is not always identified. More than three-quarters of the
identified organisms are Staphylococcus aureus. Acute infection is associated with
inflammatory changes in the bone and may lead to necrosis. Some patients will develop
chronic osteomyelitis.
Prognosis
The sooner the infected area can be made infection-free, the better the prognosis for
the patient. There is a risk for developing chronic osteomyelitis. This risk is greater in
patients with a compromised immune system or poor blood supply to the area (such as
diabetics).
Hallmark Signs and Symptoms
Pain
Fever, chills
Malaise

Interpreting Test Results

Elevated white blood count (wbc)
 X-ray osteolytic lesions (localized loss of bone density)
Bone scan shows area of increased cellular activity-detects site of
infection
Culture and sensitivity tests to determine the infecting organism and
antibiotic-may be difficult to determine infecting organism.
Bone biopsy to identify organism.

Treatment
Removal of