I. INTRODUCTION a.

) definition of the disease Cellulitis: An acute spreading bacterial infection below the surface of the skin characterized by redness (erythema), warmth, swelling, and pain. Cellulitis can also cause fever, chills, and "swollen glands" (enlarged lymph nodes). Cellulitis is a clinical diagnosis based on the spreading involvement of skin and subcutaneous tissues with erythema, swelling, and local tenderness, accompanied by fever and malaise. Cellulitis commonly appears in areas where there is a break in the skin from an abrasion, a cut, or a skin ulcer. It can also be due to local trauma, such as an animal bite. Only rarely is cellulitis due to the bacteremic spread of infection -- bacteria arriving from a distant source via the bloodstream

b.)Risk factors for cellulitis include diabetes and impairment of the immune system (from, for example, HIV/AIDS or immunosuppressant drugs). Cellulitis is not contagious because it is an infection of the skin's deeper layers, thedermis and subcutaneous tissue, and the skin's top layer (the epidermis) provides a cover over the infection. The main bacterium that causes cellulitis is Staph (Staphylococcus aureus) and Strep (Group A Streptococcus) is next most common. Cellulitis can be caused by many other types of bacteria. In children under six, H. flu(Hemophilus influenzae) 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 Pasturella multocida bacteria. Cellulitis after an injury from a saltwater fish or shellfish can be due to the Erysipelothrix rhusiopathiae. These same bacteria can also cause cellulitis after a skin injury on the farm, especially while working with pigs or poultry. Antibiotics such as derivatives of penicillin that are effective against the staph germ are used to treat cellulitis. If other bacteria, as determined by culture tests, turn out to be the cause, or if patients are allergic to penicillin, other appropriate antibiotics are substituted. Symptoms in adults In adults, cellulitis typically develops near a surgical site or at the site of an injury, such as a burn, a cut, or an animal bite. It usually affects the legs but can occur on other areas of the body, such as the face and ears. Pain and tenderness may be the first signs of cellulitis before visible signs of infection appear. Cellulitis often comes back (recurs), especially if you have a weakened immune system or a condition that affects the health of your skin, such as a fungal infection or diabetes.

Recurrence is also more common if you have problems with the lymphatic system that drains fluids from your tissues, or with your blood circulation. Recurring infection in the legs can cause a condition called elephantiasis, an enlargement of the skin and underlying tissues in the legs. Other conditions with similar symptoms (such as pain, swelling, and redness) include contact dermatitis and shingles. One study found that inflammation caused by toes rubbing together (toe-web intertrigo) may be a cause of cellulitis in the leg, and that treating this skin inflammation could prevent cellulitis.1 Significance of the study a. Nursing Education this study is significant to nursing education. b. Nursing practice, this study is significant to nursing practice because it helps stress the importance of not only identification and treatment of patients with cellulitis but also the importance of promoting a healthy lifestyle. it explore the need for a thourough case analysis of a client to deliver the best nursing care. c. Nursing Research this study is significant to Nursing Research because it explore the need for a thourough case analysis of a client to deliver the best nursing care. This study can be used as reference for further study/research. OBJECTIVES GENERAL -upon completion of this case the student nurses will be able to develop and apply specific knowledge, skills, and attitude on the disease process of cellulitis; will be able to anticipate and provide effective nursing care, and deliver specific nursing intervention needed to manage the disease. SPECIFIC 1. Nurse centered objectives Upon compilation of this case study, the student nurses will be able to; a. Make thourough assessment about the patients personal history, family background, lifestyle, and developmental data. b. Discuss on appropriate nursing theory that is relevant to the patients condition. c. Explain the etiology and pathophysiology of cellulitis in reference to the patients condition.

d. Cite factors that contribute to the patients condition. e. Discuss the significance of diagnostic procedures and laboratory result of the patients. f. Make comprehensive nursing care plans for the patients. g. Discuss the drugs that patient is currently taking, in terms of generic name, dosage, and frequency, mechanism of action of the drug, indication, side effect and nursing precaution and implication. h. Discuss discharge care plan focusing on the nursing health teaching. i. Discuss recommendations to patient and family. j. Discuss the prognosis of the disease. 2. patient-centered objective a. establish rapport and trusting relationship with the student nurse. b. give information about self, family and past health developmental experience. c. verbalize feelings and thoughts about present condition. d. verbalize understanding of the disease process and its management. e. enumerate possible causes of the disorder. f. apply the learned self-care measures to improve well-being through Compliance to treatment and disease management.

II. PROFILE OF THE PATIENT NURSING HEALTH HISTORY A. Socio Demographic Data A case of patient Nanay G, 70yrs. Old female, married, Filipino citizen,a Roman Catholic, presently living in Elbosian, Midsayap city. Patient used to be a smoker but when she was diagnosed with DM and Hypertension, she stopped smoking, patient is non-alcoholic drinker. Patient is the youngest of the three (3) siblings, born to a farmer father and full time House wife/mother. B. Chief Complaint and Reason of the visit Patient was advised for follow-up check-up after a week from initial consultation, on Sept.20, 2011 at around 11:25am patient went to the OPD of APSMAC with chief complaint of Erythematuos rashes and non-relief of treatment from consultation. Vital signs were as follows T-36.3, RR-18, PR-86,

BP-130/80. She was examined and admitted by Dr. Garcesa and was referred to Dr. Tanud-tanud for further evaluation and management due to her Medical History of DM&HPN.

B.

a. HISTORY OF PRESENT ILLNESS -condition started 3 weeks prior to admission as itching and rashes. The patient went for consultation and was given ceterizine 10mg 1tab 2x a day for 3-5days. Patient was advised to make a follow up visit one week after the initial consultation. During her second visit, she was advised admission due to impression of cellulitis and extreme hypersensitivity reaction to unknown etiology.

b. PAST HEALTH HISTORY -patient has been hospitalized due to CVA, patient revealed that she had experience dizziness; she had been treated in hypertension and DM. c. FAMILY HISTORY Positive DM mother side Positive HPN mother side Positive HPN father side d. FUNCTIONAL HEALTH PATTERNS PTA, the usual diet from breakfast lunch and dinner was composed of rice and vegetable from their backyard vegetable garden. During admission, patients dietary status is hypoallergenic diet. Since she has edema fluid is restricted. e. Functional Health patterns of Marjorie 1. HEALTH PERCEPTION/HEALTH MANAGEMENT Patient Nanay G.defines health as maayong panglawas she scaled her health 6 out of 10. She was aware of the fact that she was sick when she came into the hospital. Her past medical history was concise as presented previously. She wanted to see a

doctor each time she feels ill but not realize due to financial restraints. She exercises by walking daily and doing her chores in their house and helping in their farm, she was not well oriented with her disease. She was not well educated about her cellulitis and the dietary restrictions it imposed.

ELIMINATION Prior to admission, patient experienced 1-2 bowel movements per day and usually voids 4-5 times a day. During admission, patient experiences irregular bowel movement of once a day or sometimes none, voiding is still about 4-5times a day. 2. ACTIVITY AND EXERCISE Prior to admission, patient activity was normal. She did her household chores and cleaning of backward. She woke up early to plant in their farm. She cooked their meals for breakfast. Her chores were considered her exercise. 3. SLEEP/REST PTA, patient had an approximately 4-5 hours of sleep, clients woke up at 4am to visit their farm. During admission. She reported sleep disturbances due to her rushes. she complaints that sleep is only about 4 hours per night and feeling not well rested during the day because of itchiness. 4. COGNITIVE/PERCEPTUAL Patient could follow simple instructions such as advising her to change her position or clothes. She had no real visual difficulties but had hearing problem. Reported numbness. Tingling and pain in her extremities. Patient was able to read and write. Patient had auditory problem. Patient demonstrated good verbal communication. 5. SEXUAL/REPRODUCTIVE -Patient reported that at the age of 50 her menstrual cycle has stopped. She reported menarche at the age of 14. 6. SELF-PERCEPTION/SELF-CONCEPT She described herself as a good mother. She said that she is a typical mother/wife. 7. ROLE RELATIONSHIP PATTERN She was fully functional in all setting, she had a good relationship to her family, and she helps her husband on their farm.

I.

Discharge Care Plan

Patient with Cellulitis and Hypersensitivity Reaction, watchers or relative are instructed to take the following plan for discharge: M-Medications should be taken regularly as prescribed, on exact dosage, time and frequency. E-Exercise regularly, participating in at least 20 minutes (40 is preferred) of vigorous exercise 5 times a week. T-Treatment after discharge is expected for patient with cellulitis and hypersensitivity reaction to fully participate in continuous treatment. H-Hygiene must be maintained for patient with cellulitis and hypersensitivity reaction, promotion of personal hygiene should be encouraged such as bathing and changing of clothes. O-OPD such as regular follow up check up should be greatly encourage to client with cellulitis and hypersensitivity reaction as ordered by physician to ensure the continuing management and treatment. D-Diet should be promoted, the patient was on Diet as tolerated(DAT) proper selection of food should be observed, eat a diet low in total fat, saturated fats, cholesterol and increasing the intake of dietary fibers.

II.

Recommendations

A. Patient with Cellulitis Hypersensitivity Reaction should be given the following recommendations: 1. Explain the symptoms of Cellulitis Hypersensitivity reaction to the client and family and emphasize when to contact the care provider. 2. Explain to the client about the importance of maintaining regular physical activity to promote circulation and vascular health. Emphasize the need to increase activity level gradually with the goal exercising as recommended by the care provider.

3. Instruct the client and family about prescribed dietary restriction since the patient has DM and hypertension. 4. Discuss dietary measures to reduce the risk of atherosclerosis, including reducing total saturated fats and the diet and increasing the intake of dietary fiber. 5. Instruct the client and family about the prescribed medication, including effects, side effects and administration instruction. 6. Advise patient to stop smoking and drinking alcohol. 7. Instruct patient to regularly monitor blood glucose level.
a) Patient b) Family c) Community- Clean environment to reduce allergens. - avoid exposing chemicals.

ANATOMY and PHYSIOLOGY

The Epidermis The epidermis, as its name suggests, is the outermost layer of the skin. It is comprised of four separate layers of epithelial tissue. The outermost layer of the epidermis is thestratum corneum. It is approximately 20-30 cells thick. The cells here are completely keratinized and dead, and this is what gives the skin its waterproof quality. The next two layers, the stratum granulosum and the stratum lucidum, are similar in that they represent an intermediate stage of keratinization. The cell here are not fully keratinized yet, but as the growth of the skin pushes them outward, they will increasingly move towards that state. The deepest layer of the epidermis is the stratum germinativum. The cells here are automatically active-- that is, they are alive and reproducing. This is where the growth of skin takes place.

The Dermis

The dermis is the second layer of skin, directly beneath the epidermis. Unlike the epidermis, the dermis has its own blood supply. Because of the presence of this blood supply, more complex structures are able to exist here. Sweats glands are present to collect water and various wastes from the bloodstream, and excrete them through pores in the epidermis. The dermis is also the site of hair roots, and its here where the growth of hair takes place. By the time hair reaches the environment outside of the skin, it is completely dead. The dermis also contains dense connective tissue, made of collagen fibers, which gives the skin much of its elasticity and strength.

The Subcutaneous Layer Beneath the dermis lies the final layer of skin, the subcutaneous layer. The most notable structures here are the large groupings of adipose tissue. The main function of

the subcutaneous layer is therefore to provide a cushion for the delicate organs lying beneath the skin. It also functions to insulate the body to maintain body temperature. 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 as the bodys first line of defense against infection, temperature change, and other challenges to homeostasis.

Functions include: >Protect the bodys internal living tissues and organs >Protect against invasion by infectious organisms >Protect the body from dehydration >Protect the body against abrupt changes in temperature, maintain homeostasis >Help excrete waste materials through perspiration >Act as a receptor for touch, pressure, pain, heat, and cold (see Soma sensory system) >Protect the body against sunburns >Generate vitamin D through exposure to ultraviolet light >Store water, fat, glucose, and vitamin D

SPC-SHE College of Nursing Parang, Maguindanao __________________________________________

A Case Study on a Patient Diagnosed with Cellulitis and Hypersensitivity Reaction

________________________________________

Presented to the Faculty In Partial Fulfillment Of the Requirements in Related Learning Experience ___________________________________________

Presented by Baman, Norshaima Binasing, Bai Muhainee Demaguil, Michelle Andrea Eskak, Bailyn Midtemeg, Samsiya Usop, Bai Minnah San Luis, Justin Kirk __________________________________________ Presented to Clinical Instructor Soriano, May-Lyn O. RN,MN

__________________________________________ October 12, 2011 LABORATORY STUDY HEMATOLOGY DATE&TIME September 20, 2011 LABORATORY TEST Hemoglobin ACTUAL VALUES 139 NORMAL VALUES 120-160 INTERPRETATION Normal Increase: Severe burns, COPD. Decreased: Kidney disease, Sickle cell anemia.

Hematocrit

39.2

35.9-50

Normal Increase: Dehydration, Burns, COPD. Decrease: Anemia, Hyperthyroidism. Normal Increase: Chronic infection, viral infection. Decrease: Leukemia, sepsis.

Lymphocyte

22.7

20.0-40.0

CHEMISTRY September 20,2011 Creatinine 121 53-115umol/L Normal Increase: Acute or Chronic renal failure, urinary tract obstruction.

Uric acid

235

150-420umol/L

Normal

URINALYSIS
September 20,2011 Color: Light Yellow

Transparency: Reaction: Specific Gravity:

Clear 5.0 1.010 1.010-1.025 Normal Increase: Fluid deficit or dehydration.

RBS/HEMOGLUCOTEST MONITORING

Date/Time

Result

Normal values

September 20,2011 12nn 6.9mmol/L 70-110mg/dl

6pm

12.8mmol/L

70-110mg/dl

DEVELOPMENTAL DATA Stage Infancy age 0-18months Central task Trust vs. Mistrust Patients development patient used to be a smoker, one indication that oral stage was not fully achieved. However, patient was able to develop basic trust and perceives her loved ones during as dependable especially during her times of trouble. Patient developed autonomy as evidenced by her participation in tending their form and doing choux. She reported to having control of her life. Patient understanding and supportive of a childs efforts to show initiative, the patient developed purpose was set a goals and acts in ways to reach them. Patient was developed creativity and competence because of her family, she doing anything by own way to achieved their ambitions. Patient was achieved feminine role because patient engaged a

Early childhood

18mon-3yrs

Autonomy vs. Shame and Doubt

Late childhood

3-5yrs

Initiative vs. Guilt

School Age

6-12yrs

Industry vs. Inferiority

Adolescence

12-20yrs

Identity vs. Role confusion

 Young Adulthood

18-25yrs

Intimacy vs. Isolation

Adulthood

25-65yrs

Generativity vs. Stagnation

Maturity

65yrs-Death

Integrity vs. Despair

love with her husband. Patient was developed concepts necessary for everyday living, achieved personal independence Patient was learned to live with a partner, she had a 9 siblings, she manage at their home and she work as a farmer. Patient was related oneself to ones spouse as a person. And patient was accepted and adjusted to the physiologic changes of middle age. Then patients was assisted teenage children to become responsible and happy adults. Patient was developed and accepted situation in her life & she satisfied what they have.

PROGNOSIS

CRITERIA Poor fair good 1 2 3

Age Nutrition 2 2

REMARKS

>The patient is 70 years old >pt. was provided 3 meals a day with adequate nutritious but fails to finish it all. >pt. was with family during hospitalization and provided unconditions care and assistance. >since the pt. has history of DM >poor healing of wound >she takes her medication on time. >she is exposed to chemical because she works in the farm.

Family Support

History of Family/ bacterial infection Compliance of the treatment

Environment

Present Health Status POOR-1 FAIR-4 GOOD-2 TOTAL-15

>because all the treatment can be tolerated.

Fair: because the age of pt. is 70yrs.old the immune system was weak, the nutritious is provided 3 meals but fails to finish, pt. history was have a DM and the pt. health status is fair because the treatment can be tolerated.