Nursing Diagnoses for Cellulitis?

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    Hi all! Ok so I'm stuggling trying to figure out nursing diagnoses and the order if which they would go for my client with left foot and leg cellulitis. Here is his history: 45 yo male. he was admitted the night before which according to him "he had an infection on his foot," he is up and ambulating fine, doesn't complain of pain and isn't on any PRN pain meds but says he is a little sore, his left lower leg and foot are inflamed- they are reddened, extremely warm to touch compared to his other leg and rest of the body, he has alot of swelling, and a part on the left lateral side of his foot is ulcerated. He says he doesn't have much feeling in that foot, and he wanted his foot elevated with 3 pillows on the bed. He didn't having a dressing on it, but the doctor called right before I left and was concerned that it wasn't covered so we covered it. He is on antibiotics. He has type 2 diabetes and cardiac disease, and had a stent placed a few months ago - this is his only medical history. His lungs sounds are clear, his breathing is regular and unlabored, his heart sounds are normal, and bowel sounds are normoactive. The rest of his body is normal temperature and the color is wnl. Radial pulses and pedal pulses are all present and palpable, even in the left foot. His vital signs are all within normal range except his BP was elevated some to 148/80 around noon. Lab values were all within normal range except chloride was a little low.

    I've read many entries on here about cellulitis, and some seem very contradicting. Some say it's acute pain and impaired skin integrity, others say it's not impaired skin integrity. Some say its impaired tissue integrity (along with my book), while other entries say it's not impaired tissue integrity.

    Can someone PLEASSSEE help me with this? I know impaired skin integrity is one of the diagnoses for him because the left lateral side of his foot is ulcerated, but would impaired tissue integrity be one also? or ineffective tissue perfusion - peripheral? Ineffective tissue perfusion peripheral is pale skin, cold extremeties though - and that's opposite of my client. I've seen all these being used - and they are very similar so I'm unsure as to which is right, along with the order they would go in. yikes

    pleasssee help ASAP thanks! daytonite- you know this, help please if you see this!!!!
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  3. 7 Comments so far...

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    if you have read any of my posts then you know that i am going to tell you to look at the assessment data which also includes the patient's medical diagnoses. assessment consists of:
    • a health history (review of systems) - admitted with left foot and leg cellulitis and has type 2 diabetes and cardiac disease with a stent placed a few months ago.
    • performing a physical exam - your exam focused on the foot and leg: it was "a little sore" which still fits the definition of pain, inflamed and has redness, warmth and swelling (3 of the 4 cardinal signs of inflammation), has an ulcer on the left lateral side of his foot which you do not describe so the issue of whether it is impaired skin integrity or impaired tissue integrity cannot be determined from a statement of "has an ulcer on the left lateral side of his foot", and he says he doesn't have much feeling in that foot.
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - no information provided
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition -
    • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - no information provided other than he is on antibiotics
    so your first step in constructing your care plan is to list the abnormal data:
    • a little sore (where?)
    • left lower leg and foot red, warm to touch and swollen
    • part on the left lateral side of his foot is ulcerated (what gave this ulcer its start?)
    • says he doesn't have much feeling in that foot
    the second step is to determine what nursing problems this abnormal data represents and give them names (nursing diagnoses). let me solve the issue of the ulceration and its nursing diagnosis. if you read about cellulitis you will find that it affects the subcutaneous tissues. that means the correct nursing diagnosis to use for it is impaired tissue integrity because its definition is damage to mucous membrane, corneal, integumentary, or subcutaneous tissues. (page 323, nanda international nursing diagnoses: definitions and classifications 2009-2011). ineffective peripheral tissue perfusion can be used if the doctor's h&p says there is a circulation problems there secondary to the diabetes or heart condition. does it? it's probably a good bet that it is, but is it in the chart? however, the inflammatory response is also creating a tissue perfusion problem as a result of the swelling (edema).

    based on the data, the nursing diagnoses would be:
    1. ineffective peripheral tissue perfusion r/t inflammatory response secondary to cellulitis
    2. impaired tissue integrity r/t (what caused this ulcer to form)
    3. disturbed sensory perception, tactile r/t altered sensory reception
    4. acute pain
    Circulator, RN likes this.
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    Thank you so much for your help! We didn't exactly learn how to do care plans, we were kind of just thrown into them, so your help is really appreciated! I think I've learned more from you from reading all your posts than anywhere else. I think I am beginning to understand the whole concept better now.

    I have a few questions. The ulcer was probably like a stage 2 pressure ulcer, so it wasn't through to the subcutaneous tissue at all yet. Would that just be considered impaired skin integrity then? And then could I still use impaired tissue integrity.....r/t inflammatory response?
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    The Stage 2 Ulcer is Impaired Skin Integrity R/T (whatever caused it--trauma?) The cellulitis is Impaired Tissue Integrity r/t inflammatory response because cellulitis is an infection that extends into the subcutaneous layer of the skin. Didn't you read the information I gave you in the Merck Manual on cellulitis?
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    Ok thanks so much! That's what I was thinking. I did read a lot about cellulitis before starting my care plan and I understand that its a bacterial infection of the skin and subcutaneous tissue but I wasn't sure if I could prove that it was impaired tissue integrity by just knowing that the patient had cellulitis. So would the inflammation signs be enough supporting evidence for Impaired Tissue Integrity? For your post before, I thought you meant when you wrote "Impaired Tissue Integrity r/t (what caused the ulcer to form)," that this relating to the ulcer was the only way I could use that diagnosis.

    Thanks again for your help
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    you were pretty clear in your original post that you were using impaired skin integrity for the ulcer. i was just giving you help on constructing the diagnostic statement. the problem i was seeing was that i didn't think you were addressing the cellulitis adequately. you need to use impaired tissue integrity to cover the cellulitis. i would also include the ulcer under that diagnosis as well to save space on the care plan. now, whether or not your instructor will go for that, i don't know. to be on the safe side, you might want to put the goals and interventions for the ulcer under their own diagnosis of impaired skin integrity and the goals and interventions for the cellulitis under their own diagnosis of impaired tissue integrity. when you care plan you need to remember to consider all your abnormal data especially when you are turning these things in for grading.
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    Hello Daytonite, you are AWESOME by the way, I just LOVE all your posts!

    I have a similar case study and I would like to know, how does the inflammatory response hinder tissue perfusion? I have been trying to search for the answer online to no avail. Based on the assessment data presented, what would be my priority nursing diagnoses? Are there any collaborative problems?

    Cellulitis
    Patient Profile
    W.B., a 72-year-old, cut his lower arm on a kitchen knife. At the time of the injury, he did not seek medical attention. On the fourth day following the injury, he began to be concerned about the condition of the wound and the way he was feeling.
    Subjective Data:
    States he has a fever and has had a general feeling of malaise
    Has pain in the area of the cut and the entire lower arm
    Objective Data:
    4-cm area around his cut is hot, erythematous, and edematous with redness extending both up and down his arm
    Temperature: 100.8 F (38.2 C)
  10. 0
    I regret to inform you that our lovely Daytonite passed away on April 8th, 2010, yet her legacy lives on.

    http://allnurses.com/general-nursing...ed-476765.html


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