Bsnc 6000- module 9: cellulitis Test
Questions and Correct Answers.
Cellulitis definition
What is it caused by?
Is it localized or systemic? - Answer A spreading bacterial infection of the skin and
subcutaneous tissues (deeper dermis and subcutaneous fat)/
Most commonly caused by group A beta-hemolytic Streptococci or S. aureus.
Infection is diffuse and has a source of entry point (bite, puncture, excoriation).
Infection is local but may progress to deep tissue (necrotizing fasciitis) and systemic (sepsis).
Clinical manifestations of cellulitis (7) - Answer Skin becomes red (rubor), swollen (tumor),
warm to touch (calor), tender (dolor), and has undefined margins = inflammation.
Nearly always unilateral
+/- fever
+/- petechiae or hemorrhage
+/- purulent exudate
Onset of symptoms is over a few days.
Lymphangitis (red streaking up the lymphatic tract) and enlarged regional lymph nodes.
Lab findings of cellulitis (5) - Answer Inflammatory panel: elevated ESR, elevated CRP
Leukocytosis
May have positive blood cultures
Cultures from intact skin are not helpful, cultures from purulent drainage are diagnostic
Risk factors of cellulitis (10) - Answer Skin barrier disruption due to trauma (abrasion,
penetrating wound, pressure ulcer, venous leg ulcer, insect bite, injection drug use)
Poor nutrition
Poor access to/use of hygiene
Edema due to poor lymphatic drainage
Skin inflammation (eczema, radiation therapy, psoriasis)
Edema due to impaired lymphatic drainage
Obesity
, Immunosuppression diabetes, HIV infection
Skin breaks between the toes ("toe web intertrigo"), these may be clinically inapparent
Pre-existing skin infections (tines pedis, impetigo, varicella)
Medical and nursing management of mild cellulitis (noticing, interpreting, pharmacologic, non-
pharmacologic, diagnostic, IPC) - Answer Noticing: localized area of warmth, redness, swelling,
client reports pain, possible exudate
Interpreting: infection d/t invading pathogens AEB localized inflammation
Pharmacologic: PO antibiotics (clindamycin & cephalexin), analgesics (no steroids, NSAIDs is
okay at this stage)
Non-pharmacologic: warm, moist compress to increase perfusion to site so WBCs can help clear
infection, elevate limb
Diagnostics: VS Q4-6h if in hospital, C&S if exudate is present, lab values (increased WBC,
increased CRP, increased ESR)
IPC: pharmacy, infection control, lab techs
Medical and nursing management of moderate cellulitis (noticing, interpreting, pharmacologic,
non-pharmacologic, diagnostic, IPC) - Answer Noticing: spreading redness, swelling, purulent
drainage, pain, fever (above 38C), lymphadenopathy
Interpreting: infection, inflammation
Pharmacologic: IV antibiotics (vancomycin, clindamycin (watch for toxic epidermal necrolysis)),
analgesics (NSAIDs, tylenol, opioids), consider PICC/CVC
Non-pharmacologic: warm, moist compress to increase perfusion to site so WBCs can help clear
infection, cool compress is secondary, elevate limb
Diagnostics: VS Q2h, C+S of wound and blood, lab values (increased WBC, increased CRP,
increased ESR)
IPC: wound care, dietitian, pharmacy, infectious disease, lab techs
Medical and nursing management of severe cellulitis (noticing, interpreting, pharmacologic,
non-pharmacologic, diagnostic, IPC) - Answer Noticing: redness and swelling spreading, poor
perfusion (poor CWMS distal to wound, weak/absent pulses), necrosis, drainage/purulent,
systemic effects (fever above 37.3, above 37.8 is very febrile)
Interpreting: impaired perfusion
Pharmacologic: IV antibiotics (clindamycin (GI disturbances), vancomycin (nephrotoxicity,
ototoxicity), cefazolin), analgesics (opioids), antipyretics, wound debridement, possible
amputation
Non-pharmacologic:
Diagnostics: VS Q1-2h, (S&S of sepsis (decreased BP, +/- temp, increased HR), C+S of wound and
blood
IPC: doctor/surgical consult, wound care nurse, pharmacist, lab tech, infectious disease
Questions and Correct Answers.
Cellulitis definition
What is it caused by?
Is it localized or systemic? - Answer A spreading bacterial infection of the skin and
subcutaneous tissues (deeper dermis and subcutaneous fat)/
Most commonly caused by group A beta-hemolytic Streptococci or S. aureus.
Infection is diffuse and has a source of entry point (bite, puncture, excoriation).
Infection is local but may progress to deep tissue (necrotizing fasciitis) and systemic (sepsis).
Clinical manifestations of cellulitis (7) - Answer Skin becomes red (rubor), swollen (tumor),
warm to touch (calor), tender (dolor), and has undefined margins = inflammation.
Nearly always unilateral
+/- fever
+/- petechiae or hemorrhage
+/- purulent exudate
Onset of symptoms is over a few days.
Lymphangitis (red streaking up the lymphatic tract) and enlarged regional lymph nodes.
Lab findings of cellulitis (5) - Answer Inflammatory panel: elevated ESR, elevated CRP
Leukocytosis
May have positive blood cultures
Cultures from intact skin are not helpful, cultures from purulent drainage are diagnostic
Risk factors of cellulitis (10) - Answer Skin barrier disruption due to trauma (abrasion,
penetrating wound, pressure ulcer, venous leg ulcer, insect bite, injection drug use)
Poor nutrition
Poor access to/use of hygiene
Edema due to poor lymphatic drainage
Skin inflammation (eczema, radiation therapy, psoriasis)
Edema due to impaired lymphatic drainage
Obesity
, Immunosuppression diabetes, HIV infection
Skin breaks between the toes ("toe web intertrigo"), these may be clinically inapparent
Pre-existing skin infections (tines pedis, impetigo, varicella)
Medical and nursing management of mild cellulitis (noticing, interpreting, pharmacologic, non-
pharmacologic, diagnostic, IPC) - Answer Noticing: localized area of warmth, redness, swelling,
client reports pain, possible exudate
Interpreting: infection d/t invading pathogens AEB localized inflammation
Pharmacologic: PO antibiotics (clindamycin & cephalexin), analgesics (no steroids, NSAIDs is
okay at this stage)
Non-pharmacologic: warm, moist compress to increase perfusion to site so WBCs can help clear
infection, elevate limb
Diagnostics: VS Q4-6h if in hospital, C&S if exudate is present, lab values (increased WBC,
increased CRP, increased ESR)
IPC: pharmacy, infection control, lab techs
Medical and nursing management of moderate cellulitis (noticing, interpreting, pharmacologic,
non-pharmacologic, diagnostic, IPC) - Answer Noticing: spreading redness, swelling, purulent
drainage, pain, fever (above 38C), lymphadenopathy
Interpreting: infection, inflammation
Pharmacologic: IV antibiotics (vancomycin, clindamycin (watch for toxic epidermal necrolysis)),
analgesics (NSAIDs, tylenol, opioids), consider PICC/CVC
Non-pharmacologic: warm, moist compress to increase perfusion to site so WBCs can help clear
infection, cool compress is secondary, elevate limb
Diagnostics: VS Q2h, C+S of wound and blood, lab values (increased WBC, increased CRP,
increased ESR)
IPC: wound care, dietitian, pharmacy, infectious disease, lab techs
Medical and nursing management of severe cellulitis (noticing, interpreting, pharmacologic,
non-pharmacologic, diagnostic, IPC) - Answer Noticing: redness and swelling spreading, poor
perfusion (poor CWMS distal to wound, weak/absent pulses), necrosis, drainage/purulent,
systemic effects (fever above 37.3, above 37.8 is very febrile)
Interpreting: impaired perfusion
Pharmacologic: IV antibiotics (clindamycin (GI disturbances), vancomycin (nephrotoxicity,
ototoxicity), cefazolin), analgesics (opioids), antipyretics, wound debridement, possible
amputation
Non-pharmacologic:
Diagnostics: VS Q1-2h, (S&S of sepsis (decreased BP, +/- temp, increased HR), C+S of wound and
blood
IPC: doctor/surgical consult, wound care nurse, pharmacist, lab tech, infectious disease
