Cellulitis
Cellulitis
is the most common infectious cause of limb swelling. Cellulitis can occur as a
single isolated event or a series of recur-rent events. It is often
misdiagnosed, usually as recurrent throm-bophlebitis or chronic venous
insufficiency. Cellulitis occurs when an entry point through normal skin
barriers allows bacteria to enter and release their toxins in the subcutaneous
tissues. The acute onset of swelling, localized redness, and pain is frequently
associated with systemic signs of fever, chills, and sweating. The redness may
not be uniform and often skips areas. Regional lymph nodes may also be tender
and enlarged.
Mild
cases of cellulitis can be treated on an outpatient basis with oral antibiotic
therapy. If the cellulitis is severe, the patient is hos-pitalized and treated
with intravenous antibiotics for at least 7 to 14 days. The key to preventing
recurrent episodes of cellulitis lies in adequate antibiotic therapy for the
initial event and in identify-ing the site of the bacterial entry. The most
commonly overlooked areas are the cracks and fissures that occur in the skin
between the toes. Other possible locations are drug use injection sites,
contu-sions, abrasions, ulcerations, ingrown toenails, and hangnails.
The
patient is instructed to elevate the affected area above heart level and apply
warm, moist packs to the site every 2 to 4 hours. Individuals with sensory and
circulatory deficits, such as diabetes and paralysis, should use caution when
applying warm packs because burns may occur; it is advisable to use a
thermometer or have a caregiver ensure that the temperature is not more than
lukewarm. Education should focus on preventing a recurrent episode. The patient
with peripheral vascular disease or diabetes mellitus should receive education
or re-education about skin and foot care.
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