Cellulitis is a bacterial subcutaneous skin infection. It appears as a reddened, swollen area of the skin and is usually easily diagnosable through inspection. Cellulitis can occur from a simple break in the skin allowing bacteria to enter.
Common causes include:
- Injury to the skin (cuts, burns, puncture wounds)
- Insect/animal bites
- Skin conditions (eczema, chickenpox, shingles)
- IV drug use
- Infected surgical incisions
- Poor hygiene practices when getting a tattoo or piercing
Patients are also more at risk for cellulitis when they are overweight, have chronic swelling (lymphedema), and conditions affecting circulation such as peripheral vascular disease.
Antibiotics are needed to treat cellulitis. Complications are uncommon though can be severe resulting in osteomyelitis, sepsis, endocarditis, gangrene, and necrotizing fasciitis.
The Nursing Process
Cellulitis is a common diagnosis nurses will become familiar with in the inpatient setting. Patients often require education about this condition if they lack an understanding of potential causes, how their comorbidities influence skin infections, and why treatment is so important. Cellulitis can quickly become life-threatening so the nurse must monitor vital signs, lab work, and the skin for complications.
Impaired Skin Integrity Care Plan
Cellulitis causes redness and swelling to the skin that can worsen into blisters and abscesses if untreated.
Nursing Diagnosis: Impaired Skin Integrity
Related to:
- Injury to the skin
- Inflammation
- Edema
- Poor circulation
As evidenced by:
- Erythema
- Warmth
- Swelling
- Tight, shiny skin
- Abscess formation
- Reports of pain, burning, or itching
Expected Outcomes:
- Patient will not experience worsening cellulitis as evidenced by erythema localized to one area
- Patient will display skin healing without the formation of blisters or abscesses
Impaired Skin Integrity Assessment
1. Assess the skin.
Cellulitis presents as redness and swelling initially. Assess for any open areas, drainage, and the condition of surrounding skin.
2. Mark the area of erythema.
Using a skin marker, outline the area of redness. This is the best way to assess if redness is continuing to spread.
3. Monitor wounds.
If an open area has already occurred, measure the size, color of the wound, any drainage, and if an odor is present. Document accurately to allow for ongoing assessment.
Impaired Skin Integrity Interventions
1. Keep the skin clean and dry.
Proper skin care includes washing the skin with warm water and mild soap. The area may or may not be covered with a dressing to prevent further damage. Sometimes the skin will weep and should be wrapped to protect bedding and clothing.
2. Premedicate before wound care.
Cellulitis can be painful. Certain wound care techniques such as packing, debridement, and incision and drainage are also painful. General discomfort from swelling and burning can be eased with a cool, damp cloth.
3. Prevent shearing or further irritation.
If the patient is immobile or is unable to guard against further skin breakdown take care when turning and repositioning. Ensure the patient is not putting pressure on the area.
4. Elevate the extremity.
Swelling can be alleviated by elevating the extremity. Cellulitis often occurs in the lower leg but can affect the arms, face, and other areas. Prop extremities on pillows.
Risk For Infection Care Plan
Untreated cellulitis can advance to systemic infections and can be life-threatening.
Nursing Diagnosis: Risk For Infection
Related to:
- Decreased immune function
- Improper antibiotic usage
- Broken skin barrier
- Improper hygiene practices
- Chronic diseases
- Malnutrition
- Delayed treatment
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are aimed at prevention.
Expected Outcomes:
- Patient will not experience signs of systemic infection (fever, tachycardia, confusion)
- Patient will take antibiotics as prescribed until completion
Risk For Infection Assessment
1. Assess for worsening infection.
Life-threatening infections can result from cellulitis such as osteomyelitis, sepsis, and gangrene. The nurse should monitor closely for systemic signs of infection.
2. Monitor lab work.
It will be expected for the WBC and CRP to be elevated. Monitor for these values trending up as infection worsens. Blood cultures or needle aspiration may be ordered to pinpoint a specific pathogen.
3. Assess for contributing conditions.
Chronic conditions such as diabetes or a suppressed immune system can complicate an infectious process as well as predispose the patient to worsening infection.
Risk For Infection Interventions
1. Instruct on oral antibiotic use.
Oral antibiotics are the usual course for uncomplicated cellulitis. Instruct the patient to take all of their medication, even if the cellulitis has significantly improved or resolved. If the condition does not improve after a few days, have the patient contact their provider for a change in treatment.
2. Administer IV antibiotics.
Some patients will require hospitalization and IV antibiotics. The usual pathogen is either streptococci or staphylococcus and the antibiotic prescribed should address this.
3. Prepare for I&D.
Once abscess formation occurs, it must be drained as antibiotic therapy alone will not treat it. The nurse can assist the provider with bedside incision & drainage by preparing a sterile field with all medication and equipment. The nurse should premedicate the patient as this can be a painful procedure.
4. Teach the patient about signs of infection.
If the patient is treating cellulitis at home or has recently undergone surgical intervention, the nurse should educate on worsening signs of infection. Encourage the patient to monitor the skin for worsening redness or swelling along with any discoloration or drainage. If they experience fever or changes in breathing or LOC, they should seek immediate treatment.
Deficient Knowledge Care Plan
Cellulitis is preventable and can be easily managed if identified early with prompt treatment.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Unfamiliarity with condition
- Lack of access to care
- Lack of understanding of treatment
As evidenced by:
- Worsening of condition
- Recurrent cellulitis
- Inability to perform skin care
- Nonadherence with treatment or follow-up
- Poor management of other risk factors
Expected Outcomes:
- Patient will demonstrate proper skin care to prevent cellulitis
- Patient will identify risk factors contributing to cellulitis
- Patient will verbalize signs and symptoms of cellulitis
Deficient Knowledge Assessment
1. Assess how the cellulitis started.
Patients are often unaware of how easily cellulitis can occur. An animal bite, insect sting, or small cut can become cellulitis. The patient may attempt to self-treat at home not realizing the need for antibiotics.
2. Assess health history.
Patients with diabetes and neuropathy may not feel when their skin has been cut. The swelling and redness may not be evident until it has become severe. Patients who cannot care for themselves (paraplegia, dementia, brain injury) may not be aware of skin breakdown or cannot assess their skin themselves.
3. Assess access to care and support.
Assess if the patient isn’t able to seek treatment due to a lack of accessible providers, transportation issues, or financial barriers. If cellulitis is a recurrent issue identify a caregiver or family member that can accept the teaching and manage the care and follow-up of the patient.
Deficient Knowledge Interventions
1. Prevent scratching or rubbing.
Instruct the patient not to scratch or rub the skin as this causes damage. Have the patient keep their nails cut short to prevent opening the skin. This is especially important for a patient who has numbness to their extremities or who cannot visualize their skin as they may be unaware of the damage they are causing. If the patient cannot cognitively comprehend not scratching, apply gloves or mittens to protect the skin.
2. Educate on the prevention of infection.
Handwashing is paramount before touching open areas of the skin. Have the patient demonstrate proper wound care to prevent the introduction of bacteria.
3. Educate on causes and risk factors.
Patients with weakened immune systems from HIV/AIDS, diabetes, or cancers will be more susceptible to skin infections. These chronic conditions must be properly managed to prevent secondary infections.
4. Advise on skin care.
The skin is the first barrier against the invasion of pathogens. Instruct on basic skin hygiene with bathing and keeping the skin dry from sweat or incontinence. Keep skin moisturized with a lotion or cream as dry, flaky skin is more likely to crack. Patients with diabetes must inspect their feet and lower legs daily for open areas.
References and Sources
- Cellulitis. (2020, May 29). CDC. Retrieved April 27, 2022, from https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html
- Cellulitis – Symptoms and causes. (2020, February 6). Mayo Clinic. Retrieved April 27, 2022, from https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762
- Herchline, T. E., & Stuart, M. (2019, June 14). Cellulitis: Practice Essentials, Background, Pathophysiology. Medscape Reference. Retrieved April 27, 2022, from https://emedicine.medscape.com/article/214222-overview
- Pastorino A, Tavarez MM. Incision and Drainage. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556072/
