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Cellulites

A Nursing Case Study


Presented to the
University of Saint La Salle
College of Nursing
School Year 2007-2008

In Partial Fulfillment of the


Course Requirements in
Related Learning Experience

Submitted to:

Mr. Norman Verdeflor

Submitted by:

Jessil Mei L. Ocdinaria

BSN3E

February 26, 2008


Table of Contents

Page No.

■ Title Page i

■ Table of Contents ii

■ Introduction 1-4

■ Objectives 5

■ Anatomy and Physiology 6-9

 Definition of Terms 9-10

■ Baseline Data 11

■ Nursing History 12-14

■ Health History 15-16

■ Assessment 17-18

■ Laboratory 19-21

■ Pathophysiology 22

■ Nursing Care Plan 23-28

■ Drug Study 29-34

■ Health Teaching 35

■ References 36
I. Introduction

What is cellulites and what are the symptoms of cellulitis?

Cellulitis is a spreading bacterial infection of the skin and tissues beneath the

skin. Cellulitis usually begins as a small area of tenderness, swelling, and redness. As

this red area begins to enlarge, the person may develop a fever—sometimes with chills

and sweats—and swollen lymph nodes ("swollen glands") near the area of infected skin.

Unlike impetigo, which is a very superficial skin infection, cellulitis refers to an

infection also involving the skin's deeper layers: the dermis and subcutaneous tissue.

The main bacteria involved in cellulitis are Staphylococcus ("staph"), the same bacteria

that cause many cases of impetigo. Occasionally, other bacteria may cause cellulitis as

well.

Where does cellulitis occur?

Cellulitis may occur anywhere on the body, but the leg is the most common site

of the infection (particularly in the area of the tibia or shin bone and in the foot), followed

by the arm, and then the head and neck areas. In special circumstances, such as

following surgery or trauma wounds, cellulitis can develop in the abdomen or chest

areas. In cases of morbid obesity, it can also develop in the abdominal area.

What does cellulitis look like?

The signs of cellulitis include redness, warmth, swelling, and pain in the involved

tissues. Any skin wound or ulcer that exhibits these signs may be developing cellulitis.

Other forms of noninfected inflammation may mimic cellulitis. People with poor

leg circulation, for instance, often develop scaly redness on the shins and ankles; this is

called "stasis dermatitis" and is often mistaken for the bacterial infection of cellulites
What are risk factors for cellulitis?

Some cases of cellulitis appear in areas where the skin has broken open, such

as the skin near ulcers or surgical wounds. Many times, however, cellulitis occurs where

there has been no break in the skin at all, such as with chronic leg swelling (edema).

People who have diabetes or conditions that compromise the function of the

immune system (for example, HIV/AIDS or those receiving chemotherapy or drugs that

depress the immune system) are particularly prone to developing cellulitis.

Conditions that reduce the circulation of blood in the veins or that reduce

circulation of the lymphatic fluid (such as venous insufficiency, obesity, pregnancy, or

surgeries) also increase the risk of developing cellulitis.

What causes cellulitis?

The majority of cases of cellulitis are caused by either staph (Staphylococcus) or

strep (Streptococcus) bacteria.

Staph (Staphylococcus aureus) is the most common bacteria that causes

cellulitis. There is a growing incidence of community-acquired infections due to

methicillin-resistant S. aureus (MRSA), a particularly dangerous form of this bacteria

that is resistant to many antibiotics and is more difficult to treat.

Strep (usually group A or B Streptococcus) is also a common cause of cellulitis. A

form of rather superficial cellulitis caused by strep is called erysipelas; it is characterized

by spreading hot, bright red circumscribed area on the skin with a sharp raised border.

The so-called "flesh-eating bacteria" are, in fact, also a strain of strep that can

sometimes rapidly destroy tissues.


Cellulitis can be caused by many other types of bacteria. In children under 6

years of age, H. flu (Hemophilus influenzae) bacteria can cause cellulitis, especially on

the face, arms, and upper torso. Cellulitis from a dog or cat bite or scratch may be

caused by the Pasteurella multocida bacteria, which has a very short incubation period

of only four to 24 hours. Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are

causes of cellulitis that develops after exposure to freshwater or seawater.

Pseudomonas aeruginosa is another type of bacteria that can cause cellulitis, typically

after a puncture wound.

Is cellulitis contagious?

Cellulitis is not contagious because it is an infection of the skin's deeper layers

(the dermis and subcutaneous tissue), and the skin's top layer (the epidermis) provides

a cover over the infection. In this regard, cellulitis is different from impetigo, in which

there is a very superficial skin infection that can be contagious.

How is cellulitis treated?

First, it is crucial for the doctor to distinguish whether or not the inflammation is

due to an infection. The history and physical exam can provide clues in this regard, as

can sometimes an elevated white blood cell count. A culture for bacteria may also be of

value, but in many cases of cellulitis, the concentration of bacteria may be low and

cultures fail to demonstrate the causative organism.

When it is difficult or impossible to distinguish whether or not the inflammation is

due to an infection, doctors sometimes treat with antibiotics just to be sure. If the

condition does not respond, it may need to be addressed by different methods dealing

with types of inflammation that are not infected. For example, if the inflammation is

thought to be due to an autoimmune disorder, treatment may be with a corticosteroid.

Antibiotics, such as derivatives of penicillin or other types of antibiotics that are

effective against the responsible bacteria, are used to treat cellulitis. If the bacteria turn
out to be resistant to the chosen antibiotics or in patients who are allergic to penicillin,

other appropriate antibiotics can be substituted. In many cases, treatment requires the

administration of intravenous antibiotics in a hospital setting, since oral antibiotics may

not always provide sufficient penetration of the injury to be effective. In certain cases,

intravenous antibiotics can be administered at home.

In all cases, physicians choose a treatment based upon many factors, including

the location and extent of the infection, the type of bacteria causing the infection, and

the overall health status of the patient.


II. Objectives

A. General Objectives:

After the nursing case study the student nurse will be able to:

a.1) discriminate the essential information’s that would

be vital in dealing with related situations which calls for

valuable judgment

a.2) practice the knowledge learned in rendering effective

independent nursing care to future exposures to clients with

similar conditions

a.3) accept willingly the importance of comprehending the

information being presented in order to have the

fundamentals in dealing with related potential cases

B. Specific Objectives:

After the nursing case study the student nurse will be able to:

b.1) identify what is cellulites and its different types in

relation to its causative agents

b.2) conform to the appropriate ways of dealing clients with

cellulites

b.3) perform competent independent nursing care interventions in

order to alleviate any conditions experienced by the client with

cellulites

b.4) demonstrate appreciation for the significance of understanding

the anatomy and physiology of the affected area/system

relative to the disease and the disease process

b.5) appraise the importance compliance to the treatment

regimen for the said condition


III. Anatomy and Physiology
Epidermis

The epidermis is the thin outer layer of skin that contains melanin which gives skin its

color and allows for the skin to tan. Carotene, and oxygen-rich hemoglobin also

contributes to the color of skin. The epidermis also encompasses the protein keratin

which stiffens epidermal tissue to form finger nails. The outermost layer consists of 25-

30 layers of dead cells. Further levels include:

1. Scaly Cells form the surface of the skin

2. Melanocytes give the skin color

3. Langerhans cells are formed in the bone marrow and work to fight infection

It is divided into the following sub-layers:

Sub layers

Epidermis is divided into the following 5 sublayers or strata:

1. Stratum corneum- is the outermost layer of the epidermis (the outermost layer of

the skin).

2. Stratum lucidum- is a thin, clear layer of dead skin cells in the epidermis, and is

named for its translucent appearance under a microscope.

3. Stratum granulosum- layer of the epidermis lies between the stratum spinosum,

below, and the stratum lucidum, above, in stratified squamous keratinized thick

skin of palms and soles. Thin skin, which covers the rest of the body, lacks a

definite stratum lucidum and stratum granulosum.

4. Stratum spinosum- is a multi-layered arrangement of cuboidal cells that sits

beneath the stratum granulosum. Adjacent cells are joined by desmosomes,


giving them a spiny appearance when the cells shrink during the staining process

while the desmosomes hold firm.

5. Stratum germinativum (also called "stratum basale")- is the layer of keratinocytes

that lies at the base of the epidermis immediately above the dermis. It consists of

a single layer of tall, simple columnar epithelial cells lying on a basement

membrane. These cells undergo rapid cell division, mitosis, to replenish the

regular loss of skin by shedding from the surface. About 25% of the cells are

melanocytes, which produce melanin, which provides pigmentation for skin and

hair.

Dermis

The dermis is the bottom-most, thick inner layer of skin, which comprises blood vessels,

connective tissue, nerves, lymph vessels, sweat glands and hair shafts. It has two main

layers:

1. Upper Papillary: Contains touch receptors which communicate with the central

nervous system and is responsible for the folds of the fingerprints

2. Lower Reticular: Made of dense elastic fibers that house the hair follicles, nerves,

and gland

Subcutaneous tissue

The subcutaneous tissue or subcutis is the layer of tissue directly underlying the cutis. It

is mainly composed of adipose tissue. Its physiological function includes insulation and

storage of nutrients.

Functions of the integumenatry system

The integumentary system has multiple roles in homeostasis. All body systems work in

an interconnected manner to maintain the internal conditions essential to the function of

the body. The skin has an important job of protecting the body and acts somewhat as
the body’s first line of defense against infection, temperature change or other

challenges to homeostasis. Functions include:

• Protects the body’s internal living tissues and organs

• Protects against invasion by infectious organisms

• Protects the body from dehydration

• Protects the body against abrupt changes in temperature

• Helps excrete waste materials through perspiration

• Acts as a receptor for touch, pressure, pain, heat, and cold (see Somatosensory

system)

• Protects the body against sunburns

• Generates vitamin D through exposure to ultraviolet light

• Stores water, fat, and vitamin D

IV. Definition of Terms

• Skin (integumentary)- is an organ of the integumentary system made up of a

layer of tissues that guard underlying muscles and organs. As the interface with

the surroundings, it plays the most important role in protecting against

pathogens.

• Integumentary system- consists of the skin, hair, nails, the subcutaneous tissue

below the skin, and assorted glands. The most obvious function of the

integumentary system is the protection that the skin gives to underlying tissues.

The skin not only keeps most harmful substances out, but also prevents the loss

of fluids.

• Cellulites- is an infection of the skin and underlying tissues that can affect any

area of the body. It often begins in an area of broken skin, like a cut or scratch,

when bacteria invade and spread, causing inflammation, pain, swelling, warmth,

and redness.
• Staphylococcus aureus- The staph bacteria is the most common if not is one of

the highest reported causative agent in the incidence or cases of cellulitis

• Streptococcus pyogens- bacteria causing strep throat infections; another

probable cause of cellulitis.

• Seizure- sudden attack or spasm, as in epilepsy or a similar disorder. Seizures

differ with the type of condition and may consist of loss of consciousness,

convulsive jerking of parts of the body, emotional explosions, or periods of mental

confusion.

• Benign Febrile Seizure- seizure occurring during high temperature rates or

increased episodes of fever

• Methicillin-Resistant Staphylococcus Aureus (MRSA)- community-acquired

staphylococcus aureus and a particularly dangerous form of this bacteria that is

resistant to many antibiotics and is more difficult to treat.

• Lesions- wound; area of the skin that is broken, open or infected; may be a

trauma or impairment in any area of the skin after an illness, injury or surgery

• Benign Febrile Seizures- A convulsion that occurs in association with a rapid

increase in body temperature. Febrile seizures are common in infants and young

children and, fortunately, are usually of no lasting importance.


V. Baseline Data

Name: C. J.

Address: Lopez Jaena St., Bacolod City, Brgy. 27

Age: 1 year and 7 months

No. of dependents: N. A.

Birth date: 12/09/06

Birthplace: Bacolod City

Gender: Female

Marital Status: N. A.

Religion: Roman Catholic

Educational Level: N.A.

Nationality: Filipino

Occupation: N.A.

Mother’s Name (guardian): L. D.

Date of Admission: February 13, 2008 Time of Admission: 6:30 am

Admitting physician: Dr. Abaja


Attending Physician: Dr. Vasquez, Dr. Guiritan

Chief Complaints: upward rolling of eyeballs

Diagnosis: Cellulites at the Left leg secondary to Benign Febrile Seizure (BFS)

VI. Nursing History (Gordon’s Functional Health Pattern)

• Health Maintenance-Perception Pattern

The client has no noted allergies to foods, drugs/medication or other substances.

The mother of the client also stated that she takes her child to the baranggay health

center only in cases of fever, colds or if she feels like her child is really not feeling well

but does not visit it regularly for check-ups. The client’s mother claimed that she had no

idea in terms of the disease prevention and the factors which cause or contribute to the

disease and the appropriate treatment regimen for health maintenance and promotion.

The mother also claimed that last year her child (client) was also hospitalized because

of severe pneumonia and this is her second episode of benign febrile seizure (noted at

patient’s health history). The mother of the client also claimed that she does not follow a

treatment regimen prior to the clients hospitalization but she claimed that she does her

best to comply with the medications needed at present.

• Nutrition-Metabolic Pattern

The client prior to admission had a good appetite, eating 5-6 times a day

including solid and liquid foods. The mother claimed that the client drinks milk in the

morning, during lunch time, during snack time at around 3 o’clock in the afternoon, at

dinner and before going to sleep. The client also eats rice about half a cup in every

meal with any viands including vegetables, fish, meat and poultry products. The client

loves to eat fruits including oranges, grapes, apples and banana which is her favorite.

She drinks about 4-6 glasses of water each day at different settings.

During her hospital stay the client was placed on a soft diet (feb.13-19) and was

changed to diet as tolerated. She had a good appetite and was still eating 5-6 times a
day. She was eating rice with vegetables, fish, poultry products, meat and she also ate

fruits including oranges, grapes and bananas. Her fluid intake was same as before. She

had no difficulty eating or swallowing as well. The client weighed 12 kgs and no weight

loss was noted.

• Elimination Pattern

The client moves usually her bowel once a day in the afternoon or in the evening

with amounts within normal limits and with normal consistency. During her hospital she

was not able to defecate upon assessment.

In terms of the clients voiding pattern, she voids freely to an amber colored urine

of approximately 900-1000 cc/day. Upon assessment the client was able to void freely

to an amber colored urine at approx. 240 cc per diaper, fully soaked. No difficulties in

terms of her voiding and no abnormalities as to the qualities of urine were noted as well.

• Activity and Exercise Pattern

Before admission, the client because of her age performed activities of daily

living such as eating/drinking, bathing, dressing/grooming, toileting, bed mobility,

transferring, ambulating with dependence to her mother or any family member present.

She had a high energy level and undertook daily activities without any difficulties and

she was physically fit as well.

Upon assessment, the client had a high energy level, responsive to any

environmental stimuli and performed activities of daily living with aid of her mother. She

is capable of rolling to the sides, lying down from a sitting position and sitting up from a

lying position.

• Sleep and Rest Pattern

Prior to admission, the client gets an average of 11-12 hours of sleep a day. She

sleeps at around 8-9 o’clock in the evening and wakes up at around 7 or 8 0’clock the

next morning. Every afternoon, the client also takes a nap/rest, she sleeps at around 1

o’clock and wakes up 30 mins or an hour after. After sleeping or taking a nap, the
client’s mother claimed that her child(client) looks well rested and feels full of energy as

manifested by her enthusiasm.

During his hospitalization, the client did not have any sleep pattern disturbances

as claimed by her mother. She sleeps at around 8 or 9 o’clock in the evening and wakes

up at around 6 or 7 o’clock the next morning. And she also took naps in the afternoon

after taking her lunch.

• Cognitive-Perception Pattern

The client is only one year old and seven months so she is still not capable of

reading or answering questions rationally but she had no problems with her eyesight

and hearing. She was capable of responding to both verbal and non verbal stimuli

appropriate for her age.

• Self Perception-Self Concept Pattern

The client’s feelings about herself, her body image, self-esteem and emotional

state could not be properly assessed in relation to her age.

• Role-relationship Pattern

The client has six older brothers and sisters five are actually boys and two are

girls including her. Her mother is a plain housewife and her father is a jeepney

(shopping la salle libertad) driver. They all live together in a shanty bungalow house in

a squatter’s area and they only depend on his father’s income for their daily living. The

mother of the client claimed that the income which her husband provides for them is

really not enough or is not sufficient to meet all their needs or unexpected outcomes or

circumstances like the occurrence of health problem/s and illnesses.

• Sexuality and Reproductive Pattern

She has no problems with her reproductive system before admission and upon

assessment.

• Coping-Stress Pattern
Based on observation and as claimed by the client’s mother that her child

manages stress through playing around, focusing her attention and deviating it from her

situation. Upon assessment, the client was very energetic and enthusiastic.

• Values and Belief Pattern

The client is baptized Roman-Catholic. The client’s mother stated that they go to

Sunday masses once in a while if they have the time or if her husband takes a break

from his job.

VII. Health History

A. History of Present Illness

Patient has been having a non-remittent, erythamous, ulcerating, purulent

skin lesions over left leg for months. No meds given, no consultation sought.

2 days prior to admission, mother noted redness of left leg with onset of

low grade fever. Paracetamol 5 mL q4h, PRN given with temporary relief.

A day PTA, redness on left leg allegedly spread, now warm and tender to

touch, still with persistence of fever. Amoxicillin 5 mL TID was given along with

PRN doses of Paracetamol without relief of symptoms.

A few minutes later PTA, mother woke up to patient having upward rolling of

eyeballs, unresponsive to stimulation with stiffening of arms and legs and

excessive salivation.

B. Past Health History (Prenatal/Natal/Postnatal History)

Patient as born FT to 36 year old G7P7 mother with no PNCU, via NSVD-

NID (home delivery) assisted by a TBA. Patient had good cry and was able to

void and pass meconium within 24 hrs.

B.1 Childhood Illness/es

The child had fever, common colds, and streptococcal infections.

B.2.Past Hospitalization
Positive hospitalization (2007) severe pneumonia secondary

to benign febrile seizure

Second episode of febrile seizure

No FDA’s

B.3. Serious illnesses/Chronic Illnesses

The occurrence febrile seizure and severe pneumonia.

B.4. Previous Surgery

The client has/had not undergone any previous surgery/ies.

C. Immunization

BCG

DPT 123

OPV 123

MEASLES

HEP B 123

D. Growth and Development

At pace with age

E. Feeding History

Not breastfed since birth

Started on milk formula (Bonna) since birth

Started on solid foods at 6 months

F. Social/ Personal/ Environmental History

Water supply: mineral water (delivered)

Flush type toilet

Stagnant Canal
Squatter’s area/crowded place

VIII. Assessment

February 19, 2008 Tuesday

(6am-2pm) shift

A. General Appearance

Awake, lying on bed, wearing a loose white blouse with shorts; with fair

complexion, with untrimmed nails, combed hair.

responsive to verbal and nonverbal stimuli.

B. Vital Signs

Temperature: 35.5 C

Respiratory rate: 32 cpm

Pulse rate: 128 bpm

Cardiac Rate: 138 bpm

C. Integumentary

Warm to touch

With good skin turgor

Afebrile with temperature of 35.5 C

Skin peeling at left lower leg


D. Cardiovascular

With IVF #3 d5.03 NaCl at KVO rate infusing well at the right dorsal venous

arch

With strong palpable pulse

With PR=128 bpm; Cardiac rate=138 bpm

With good capillary refill at 1 sec

E. Respiratory

Breathes spontaneously to room air at 32 cpm

With clear breath sounds auscultated at both lung fields

F. Gastrointestinal Tract

On soft diet

With good appetite; drank approx. 100 cc of milk

With normoactive bowel sounds at 6 cpm

G. Genito Urinary Tarct

Able to void to an amber-colored urine at approx. 70 cc per diaper

H. HEENT

Pupils Equally Round Reactive to Light

Pale conjunctive

I. Musculoskeletal

Able to move without difficulty

Roll over to the sides

Move upper and lower extremities


IX. Laboratory

Corazon Locsin Montelibano Memorial Regional Hospital


Laboratory Department
Bacolod City
Patient: Jhong age: 1 year Hospiatl no.01038606

Phsycian: Dr. Vasquez Ward: pedia_misc Date of request: 2/13/08

Urinalysis

Physical Results Normal Interpretation Implication

Properties values/results

Color Straw Pale to dark Normal Normal renal


yellow / amber functioning.
Transparency Slightly hazy Clear Normal Presence of
infection.
pH 7.0 4.5-8.5 Within normal Normal renal
functioning.
range
Specific Gravity 1.005 g/mL 1.002-1.035 Within normal Normal renal
functioning.
g/mL range
Chemical Test
Glucose Negative Negative normal Normal renal
functioning.
Protein Negative Negative Normal Normal renal
functioning.

Cells
Pus 2-4 /hpf absent Normal Due
to/Presence of
infection.
Transitional
- squamous Few/hpf absent Normal Dueto/
Presence of
infection.
- Renal Dec1/L/hpf absent Normal Presence of
infection.
Crystals
Amorphousorates None Absent Normal Normal renal
functioning.
Amorphosphate None Absent Normal Normal renal
functioning.
Uric acid None Absent Normal Normal renal
functioning.
Calcium oxalate None Absent Normal Normal renal
functioning.
Triple PO4 None Absent Normal Normal renal
functioning.

Hematology

Complete Blood Count

Laboratory/Diagnostic Result Normal Interpretation Implication

Test Values
Hemoglobin 125 g/L Female: within normal The patient has
enough oxygen
110-150 range carrying protein in
her blood. No
g/L bleeding has
occurred.
Hematocrit 0.37 L/L Female: within normal The percentage of
red cells in her
0.37-0.47 range blood is normal
relative to a normal
L/L oxygen carrying
protein(hemoglobin)
.
WBC count 4.05 Female: within normal The patient’s
defense mechanism
4.0-5.5 x range against infection,
invasion of bacteria,
10(12)/L parasites, and
tumor cells is
maintained.
Indicating the
body’s response
against infection
and other foreign
bodies.
Differential Count
Neutrophils 40% 50-70% within normal The patient’s
defense against
range infection is
maintained.
Indicating the
body’s response
against bacterial
infection.
Lymphocytes 51% 25-35% increased The defense
mechanism against
infection is
increased due to
presence/invasion
of foreign bodies/
microorganisms.
Monocytes 5% 4-8% Within normal The patient’s body
is responding to the
range bacterial infection.
Indicative that the
patient has an acute
bacterial infection, if
increased may
indicate chronic
infection.
Eosinophils 4% 1-5% Within normal The patient’s
defense mechanism
range against infection is
maintained.
Platelet count 276 x 10 150-400 x Within normal Client inhibits the
normal clotting
9
/L 10 9/L range ability.
Clotting ability is not
impaired and is not
at risk for bleeding.

Blood Chemistry II

Microworld

Examinations Results Normal values Interpretation Implication


Potassium 4.82 meq/L 3.5-5.5 meq/L Within the The client has
normal
normal range potassium
levels needed
for normal cell
functioning.
Sodium 141.60 meq/L 135-14 meq/L Within the The client has
normal sodium
normal range levels needed
for normal cell
functioning and
rejuvenation of
damage cells.
Other Diagnostic Examinations:
Your doctor can diagnose cellulitis by asking a few questions and examining the area

of affected skin. Sometimes, especially in younger kids, a blood culture may be done

to check for bacteria growth. A positive blood culture means that bacteria from the skin

infection have spread into the bloodstream, a condition known as bacteremia. This can

potentially lead to septicemia, an infection affecting many systems of the body.

x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce

images of internal tissues, bones, and organs onto film.

X. Pathophysiology

Precipitating Factors: Predisposing Factors:


• Environmental factors/contributors: Age: 1 year old and 7 months; low
• poor environmental sanitation immunity and resistance against infectious
(presence of flies, mosquito’s, ants and diseases
rodents)
• improper disposal of waste products
• lack of resources to maintain healthy
living and hazard free environment
• over-crowded settings (they are 9 all in
all in the family living in the squatters
area)
• Economic reasons:
• lack of financial resources
• Low family income (mother is a plain
housewife; father is a jeepney driver
with an income of P150-300/day)

• Family related:
• Lack of knowledge with regards to
disease prevention and control, health
maintenance and treatment regimen
• Lack of proper attitude towards gaining
health control and promoting over-all
well being
• Health status: previous hospitalization
for severe pneumonia, previous
episode of benign febrile seizure
Break in the skin caused by scratched insect bites (probable cause; flies, mosquito’s or
ants) in the left lower leg

Bacteria enters the broken skin particularly, staphylococcus aureaus (most common
causative agent present in the community/environment)

Bacterial invasion occurs and bacteria secrets an enzyme which results to at first as
red, blemished skin

Results to the following


Signs and Symptoms low immunity
Left lower leg: -Swelling
-Warm to touch
-Inflammation
-High persistent fever--- resulting to seizure
-Skin Lesions, Skin peeling
References:

Nursing Care Plan 7th Edition

Nursing Diagnosis Handbook

Medical-Surgical Book

Encarta Encyclopedia 2007

http://www.healthsystem.

http://www.mayoclinic.com/health/cellulitis/
XI Nursing Care Plan
Assessment Nursing Rationale Desired Outcome Nursing Intervention Justification Evaluation
diagnosis
XII. Drug Study

Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing


Frequency, Route Action responsibilities
Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing
Frequency, Route Action responsibilities
Assessment Nursing Rationale Desired Outcome Nursing Intervention Justification Evaluation
diagnosis
Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing
Frequency, Action responsibilities
Route
Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing
Frequency, Action responsibilities
Route