HASBULLAH ROSLI

SD01-201704-002560
 DEFINITION
• Cellulitis (sel-u-LIE-tis) is a common, potentially serious
bacterial skin infection. Cellulitis appears as a swollen, red
area of skin that feels hot and tender. It can spread rapidly to
other parts of the body. Cellulitis isn't usually spread from
person to person.
 PATHOPHYSIOLOGY
• Cellulitis occurs when bacteria, most commonly streptococcus
and staphylococcus
• Enter through a crack or break in your skin
• Although cellulitis can occur anywhere on your body, the most
common location is the lower leg. Bacteria is most likely to
enter disrupted areas of skin, such as where you've had recent
surgery, cuts, puncture wounds, an ulcer, athlete's foot or
dermatitis.

• Certain types of insect or spider bites also can transmit the

bacteria that start the infection. Bacteria can also enter through
areas of dry, flaky skin or swollen skin
 SIGN AND SYMPTOMS
• Red area of skin that tends to expand

• Swelling

• Tenderness

• Pain

• Warmth

• Fever

• Red spots

• Blisters

• Skin dimpling
 CAUSES
• Staphylococcus
• Streptococcus Group A β
• H. Influenzae (periorbital
cellulitis)
• pasteurella multocida
• Facial cellulitis in children <
3 years old
• Hemophilus influenzae or
Streptococcus pneumoniae
 DIAGNOSTIC
• Blood Test
• Ufeme
• Skin Test
• Physical Examination
 COMPLICATION
• Blood infection (septicaemia)
• Bone infection (osteomyelitis)
• Inflammation of the lymph vessels (lymphangitis)
• Inflammation of the heart (endocarditis)
• Meningitis
• Shock
• Tissue death (gangrene)
 CASE SCENARIO
• Sazali Abdullah came to ed with mild pain at the lefft
leg when walking 1/52.
• Loss of appetite
• No nausea and vomiting
• Patient alert and concious.
• 1.MEDICAL RECORD:
SA00024563
• 2.NAME: Sazali Bin Abdullah
BI OBSERVATION RESULTS
• 3.GENDER: Male L
• 4.AGE:40 YEARS OLD
01 Pain score 5/10
• 5.ETHNIC:MALAY
02 Temperature 36.8 ˚C
• 6.OCCUPATION: Businessman
03 Respiration 20/minutes
• 7.WEIGHT: 78kg
rate
• 8.DIAGNOSIS: Cellulitis
04 Blood pressure 120/74mmH
g
05 Pulse rate 95 bpm
06 Pulse rhythm Normal
07 Pulse volume Good
08 Body weight 78kg
09 GCS 15/15
Chief Complaint
Pain at left leg x 1/52.

History of presented illness

-Become pain at left leg when walking x 1/52
-Came with mild pain at the left leg at casualty Hospital Alor Star
yesterday.
- Loss of appetite x 2/7
- No lost of weight
- No fever
-No accident history
- Become swelling at left leg x 3/7

Patient History
PMH:
- Known case as Hypertension.
- No history of Diabetes mellitus
- His father have hypertension and passed away 5 year ago.
PSH: Patient no past surgical history
Family history:
-First son from 3 siblings
-Smoking
-No alcoholic
Physical examination

Neck examination:
-Inspection : No Scar, no wound and no torticollis
-Palpation : No trachea deviated, no nodules, or no tenderness of
Thyroiditis.
Cardiovascular system
-Inspection : No cyanosis, normal breath rate.
-Percusion : Nil ( Normal ).
-Palpation : Mid Sharf Clavicle 5th Intercostal Space. ( Apex Beat ).
-Auscaltation : Dual Rythm No Murmur ( DRNM ) Apex Beat : 80 /
min.
Respiratory system
-Inspection : Bilateral ( 17 / min ).
-Percusion : Resonance.
-Auscaltation : Air Entry equal bilateral, no Crep and no
Rhonci.
Abdomen examination: Auscultation
Inspection - Bowel sound positive.
- Normal. Central nerves system :
Inspection
- No striae.
- patient allert ( GCS 15 / 15 ).
Palpation
Sensory nerves
- Soft. - non abnomality ditected.
- No mass. Motor nerves
- No tenderness. - able to move.
- No Organomegali. Per rectum :
Percussion -Good anal tone.
- Resonance. -No mass at anal region.
-Prostate enlarged ( moderate to servere)
Leg Examination: Palpation:
-Tender posterior parts tibia
RIGHT LEG -No loss of pulses
Inspection:
-No trauma or injuries found Per rectum :
-No abnormalities found -Good anal tone.
-No mass at anal region.
Palpation: -Prostate enlarged ( moderate to servere ).
-No tender
-No Swelling
-No infection.

LEFT LEG
Inspection:
-Swelling at left leg
-No discharge
-Seen redness.
- Can move all toes
Management

-Rest in bed
-infusion intravenous stat antibiotic unasyn 1.5 gram
-infusion intravenous normal saline 0.9% maintanence
-Infusion intravenous Tramal 50 mg prn.
-Vital Sign: B/P,Pulse,Temp,R/R 4 Hourly
-Monitor Intake & Output Chart.
-Encourage for Therapeutic Diet.

Drug : -
-Tab.Lovastatin 20mg ON- CVS> For reduce cholestrol
-Tab.Metoprolol 100mg BD- Anti Hipertension.
Health Education

1.Instruct the patient to:

2.follow doctor's instructions for taking medication and for skin care.
3.Take all of medication as prescribed.
4.Proper skin care skin. Any measure that prevents injury to skin will help to prevent
cellulitis.
5.Elevate affected leg or arm to reduce swelling.
6.Apply warm compresses to the affected area.
7.Use pain relievers as needed.
8.Use support stockings to prevent fluid buildup.
9.Take steps to treat or prevent fungal infections, such as athlete's foot. If athlete's foot
is hard to treat or recurs, ask primary health care provider about oral antifungal
medications
10.Take care of feet, especially in patients having diabetes or other conditions that may
increase the risk of infection.
11.Avoid touching possible sources of infection, such as ill family members and their
belongings; raw fish, meat, or poultry; or soil, particularly when you have an area of
broken skin.
12.Follow up visits.
 SUMMARY
Cellulitis may be more severe in people with chronic
diseases and those who are more prone to infection
because their immune system is not working properly
(immunosuppressed).

People with fungal infections of the feet may have

cellulitis that keeps coming back. The cracks in the skin
offer an opening for bacteria to get inside.