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.

[Zyprexa_Ho]

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.

You clearly are not understanding what I am saying. There is a difference between something being composed of physiological processes and something negatively impacting important physiological processes. Yes, pain affects the physiology in the part of the brain where pain is interpreted, but it cannot cause infection, pain cannot cause blood volume changes, etc. The physiology of pain is just not directly related to keeping your body running and keeping you from dying like maintaining boundaries, maintaining temperature, and other things necessary for life to go on.

[Zyprexa_Ho]

Not giving pain meds results in the consequence of someone being in temporary psychological discomfort. Not debriding can cause death or loss of limb because of infection. Both of these are composed of physiological processes, while only one results in negative physiological *consequences*

[Farawyn]

"Psychological" discomfort that can impede mobility which in turn can further skin integrity and cause infection.

Pain is one of the first things you address, always. It' doesn't matter if it's "medically' the first priority. These are nursing diagnoses. It's a priority for the patient. It's your priority as a nurse.

[MilieuRN]

I am a student at this point, but based on what I have learned thus far, pain does indeed have many physiologic implications. The stimulus of pain causes fluctuations of neurotransmitters, which in turn affects blood glucose, respiration (thus ABGs), blood pressure, heart rate, etc. The sympathetic nervous system is activated during a pain response, which causes the body to enter a state of survival, which in turn delays healing. Depending on the patient's current health problem and health hx, pain control could be the difference between exacerbating a failing body system or supporting it with pain control (among all other supportive interventions), and impacting long-term patient outcomes.

[preshee92]

I'm very confused.

So would it be

"Impaired Mobility related to pain characterised by swelling, inflammation and redness"

Or

"Impaired skin integrity related to insect bite characterised by pain, swelling, inflammation to right foot"

Or

"Impaired skin integrity related to pain characterised by swelling, redness and inflammation to right foot"

[Purple_roses]

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.

This is the exact opposite of what nursing schools teach. Are you in nursing school right now?

[direw0lf, BSN]

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.

This concept confuses me too that pain isn't physiological for priority determination. My teacher this last semester taught us pain is psychological rather than physiological and therefore not on Maslow's bottom 2 tiers. She taught us: physiological, safety, then pain.

[Rose_Queen, BSN, MSN, RN]

So are they no longer teaching that pain is the 5th vital sign? Boy, things sure have changed, and not necessarily for good.

[direw0lf, BSN]

So are they no longer teaching that pain is the 5th vital sign? Boy, things sure have changed, and not necessarily for good.

We were taught it's now O2 saturation but that pain and O2 switch over the years...

[Purple_roses]

So are they no longer teaching that pain is the 5th vital sign? Boy, things sure have changed, and not necessarily for good.

My lecture and clinical instructor both place pain as a top priority. I even had to redo part of one of my care plans. I was taught that pain should always always be dealt with before dealing with non-emergent procedures and that I should accept what the patient states about his/her pain because it is the patients personal experience. The patient feels the pain, whether it's a trauma or phantom limb pain--it's real and can affect their outcomes. You can't properly care for an infection when a patient is flinching and guarding d/t pain. You can't educate a patient if they are distracted by pain. Take care of the ABCs, and then tackle that pain before beginning procedures that are non-emergent. This was drilled into my head last semester.

[Purple_roses]

We were taught it's now O2 saturation but that pain and O2 switch over the years...

I'm being taught to take 6, including both pain and O2.

[direw0lf, BSN]

I'm being taught to take 6, including both pain and O2.

I definately understand the rationales for this and agree, I guess though for passing school I need to follow their ways. I wonder how the nclex exam does it though? (Placing pain I mean)