Cellulitis Care Plan Help

[preshee92]

Hi, I need some help with this assessment i have been given in regards to a patient who has been diagnosed with having Cellulitus. This is the scenario:

Mrs. Rogers is 81-years old and lives in residential care. She has type 2diabetes and has avenous leg ulcer on her lower left leg that is managed by the District Nurses with a weeklydressing change. At today's dressing change, she complains of an ache and swelling in herright foot with a blister and suggested she may have been bitten by an insect. The rightankle on observation shows signs of inflammation and redness spreading up the right legaffecting her mobility slightly due to the pain. Mrs. Rogers is also complaining of feelingunwell, tired and experiencing fever symptoms. On examination it is evident that she hascellulitis

I am unsure if it is a skin integrity or a tissue integrity i need to focus on.

I have to do the Problem in the format PES - Problem, Etiology and Symptom). Would the Problem be: " Impaired Skin/Tissue Integrity related to inflammatory response secondary to cellulitis manifested by inflammation, redness, swelling, pain and Fever''

I do not know what to do, I am so confused, please help me.

[Rose_Queen, BSN, MSN, RN]

The goal of care plans/nursing diagnoses is to get you to focus on the patient, who is much more than just their medical diagnosis. You aren't making a "cellulitis" care plan; you are making a "Mrs. Rogers" care plan. It's about the patient assessment and what they need; it has nothing to do with the medical diagnosis, although the medical diagnosis may have influence.

So let's look at that patient assessment:

Mrs. Rogers is 81-years old and lives in residential care. She has type 2 diabetes and has a venous leg ulcer on her lower left leg that is managed by the District Nurses with a weekly dressing change. At today's dressing change, she complains of an ache and swelling in her right foot with a blister and suggested she may have been bitten by an insect. The right ankle on observation shows signs of inflammation and redness spreading up the right leg affecting her mobility slightly due to the pain. Mrs. Rogers is also complaining of feeling unwell, tired and experiencing fever symptoms. On examination it is evident that she has cellulitis.

So, that's just a few key things that are highlighted above. You can make several nursing diagnoses based on this assessment. What one(s) do you think would be priority?

[preshee92]

Would her mobility and pain be a priority?

[MSBREELEE]

The Mobility and pain are two aspects that should be focused on as primary concerns and should be treated with pain medication to make her comfortable. The next thing that should be adressed is the cellulitis; it should be treated with agressive antibiotics. this is just my opinion.

[Atl-Murse]

Would her mobility and pain be a priority?

When I think priority , I consider ABC and then pain. ABC is not indicated in the PT so I would consider pain first priority.

[Zyprexa_Ho]

When I think priority , I consider ABC and then pain. ABC is not indicated in the PT so I would consider pain first priority.

I would have to disagree. Any physiological need comes before a psychological one, so the tissue/skin integrity should come before addressing pain in terms of priorities.

[Rose_Queen, BSN, MSN, RN]

I would have to disagree. Any physiological need comes before a psychological one, so the tissue/skin integrity should come before addressing pain in terms of priorities.

Pain is not a psychological issue; it is indeed physiological and can have many deleterious effects on the body. Also, it is what is important for the patient. Whether that is physiological or psychological is irrelevant.

[Zyprexa_Ho]

Rose_Queen, what you are saying goes directly against Maslow's hierarchy of needs. Yes, pain can have physiological consequences like increasing cortisol levels and other hormonal reactions, but that kind of long term effect on the body is nowhere near the same level of urgency as skin integrity is. Yes, long term stress on the body can cause ulcers, decreased immune function, etc. but impaired skin integrity can cause infection a whole heck of a lot faster.

[Rose_Queen, BSN, MSN, RN]

Rose_Queen, what you are saying goes directly against Maslow's hierarchy of needs. Yes, pain can have physiological consequences like increasing cortisol levels and other hormonal reactions, but that kind of long term effect on the body is nowhere near the same level of urgency as skin integrity is. Yes, long term stress on the body can cause ulcers, decreased immune function, etc. but impaired skin integrity can cause infection a whole heck of a lot faster.

A. Pain is physiological. Therefore, it is part of the basic level of Maslow's hierarchy. Also, Maslow is only one of many theorists.

B. Patients are different. What is important for a specific patient will depend on them. There are those where pain is severe enough that it must be addressed before impaired skin integrity. Would you be more concerned about debriding a burn patient's wounds or would you provide prophylactic pain medications prior to that debridement?

C. It is possible to multitask with patients. Yes, I will give pain medication as ordered. At the same time, I can have another nurse or a unit secretary paging a physician about the impaired tissue integrity if it warrants a call.

[Zyprexa_Ho]

Pain is a physiological process, but almost all the bad things (negative consequences) that result from pain are psychological consequences, not physiological consequences. Compared to the ABCs and skin integrity, pain results in much less physiological negative consequences. Yes, you would administer pain medicine before debreiding a burn victim, but that is only more urgent, not more important, and it also helps to accomplish the higher priority task: debridement. More negative consequences come from not debriding than come from not giving the pain medicine.

Also, just because something is a priority for the patient does not mean it is a medical priority. That is completely irrelevant.

[Zyprexa_Ho]

And of course there are exceptions to every rule where it is possible for pain to be a higher priority for some patients, but as a general rule, pain is psychological and physiological needs come first.

[Rose_Queen, BSN, MSN, RN]

And of course there are exceptions to every rule where it is possible for pain to be a higher priority for some patients, but as a general rule, pain is psychological and physiological needs come first.

I think you need to educate yourself about the bolded part. Pain has psychological components and psychological pain exists. However, physical pain is indeed physiological.