Cellulitis ppt

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Cellulitis:

Cellulitis Dermatology Module Family Nurse Practitioner Program University of Southern Mississippi K. Michelle Pendergrass PhD(c), PNP, FNP-BC

Definitions:

Definitions An acute, diffuse inflammation of the skin and subcutaneous structures characterized by hyperemia, edema, and leukocytic infiltration An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. An acute, spreading infection of the deep tissues of the skin and muscle that causes the skin to become warm and tender and may also cause fever, chills, swollen lymph nodes, and blisters.

Risk Factors:

Risk Factors Trauma, Injury Underlying skin lesion-furuncle, skin ulcer Neoplasms Extremity Stasis or Edema Diabetes Mellitus Immunocompromised

Causes:

Causes Most common Staphylococal Group A Stretococcus

Symptoms:

Symptoms Inflamed skin wound develops rapidly days after injury Local tenderness Pain Very red, hot, swollen and painful Associated symptoms Malaise, fever, chills

Signs:

Signs Erythema , warmth, edema, erythematous plaque usually tender-to-painful to touch without sharply demarcated border May cover small to large area of skin Fever, lympadenopathy frequent

Indices of Emergent Condition:

Indices of Emergent Condition Extensive Fever or other s/s septicemia Diminished arterial pulse in cool swollen infected extremity Presence of cutaneous necrosis Closed space infections of hand Periorbital cellulitis (proximity to brain) Immunosuppressed or diabetic Infants and children <2 y/o

Erysipelas:

Erysipelas Superficial Margins more clearly demarcated Lower legs, face, ears most frequently Lymphatic involvement (“streaking”) prominent in erysipelas

Differential Diagnosis:

Differential Diagnosis Vascular conditions Superficial thrombophlebitis DVT Dermatologic Contact derm Bites Drug reaction Rheumatologic Gouty arthritis

Diagnostic Tests:

Diagnostic Tests C&S if drainage CBC and blood cultures if extensive or systemic symptoms-refer for emergent care

Plan General Care:

Plan General Care Tetanus prophylaxis Immobilization & elevation of involved limb Splint in a position of function Decreases swelling Clean wound site Copious irrigation Debride devitalized tissue Incision and Drainage if deep fluctuant pocket Compresses Cool sterile saline dressings decrease pain Later, moist heat helps localize infection

Management:

Management MRSA more common and more resistant: Consider Septra or Doxycycline if MRSA suspected Avoid Fluoroquinolones due to high resistance ( Floxacins -spar, moxi , trova , levo , cipro ; zagam , avelox , trovan , levaquin , cipro )

Mild to Moderate:

Mild to Moderate 10 days standard course antibiotics 5 day as effective as 10 day if uncomplicated Adults: Dicloxacillin 500 mg PO every 6 hours or Augmentin 875 mg PO BID

Penicillin Allergy:

Penicillin Allergy Erythromycin or Azithromycin or Clarithromycin or

Prevention of Recurrent:

Prevention of Recurrent Reduce peripheral edema (support stockings) Good skin hygiene Prophylactic antibiotics: Efficacy Not useful if underlying predisposing condition No Penicillin Allergy Penicillin G 1.2 MU IM q4 weeks Penicillin V 250 mg PO bid Penicillin Allergic Erythromycin 500 mg PO qd Azithromycin 250 mg PO qd Clarithromycin 500 mg PO qd

Complications:

Complications Thrombophlebitis in older patients Necrotizing Fasciitis

Pictures:

Pictures

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