CHAPTER ONE

INTRODUCTION
Health can be define as the state of physical,mental,and social well being and as a resource for full
life. (www.medianewstoday.com).
Personal hygiene involves keeping all parts of the external body clean and healthy.
(www.medicalnews.today). Maintaining good health and hygiene is crucial for our overall wellbeing.
Simple habits like regular hand washing, proper wound care and skin cleaniness can prevent various
infections. However, neglecting these basic health practices can lead to the occurrence of infections.
One such condition being Cellulitis. A common skin infection that arise from poor skin hygiene. This
condition (Cellulitis), was recorded worldwide accounting for just 1.1% of death yearly and
accounting for over 14 million cases occuring in the united state of America
annually.
Cellulitis is a bacterial infection which affects the superficial and subcutaneous layer of the skin.It
usually affects the lower legs,but it can occur on the arms,face and other areas of the body.
Cellulitis occurs when there is a break in the skin which allows invasion of bacteria, other causes
include low immune system.
If left untreated, the infection can spread to the lymph nodes and blood streams and rapidly become
life threatening.it is a non-contagious and cannot be transmitted from one person to another.
(Sandhya pruthi 2022).
It is an acute bacteria infection causing inflammation to the deep dermis and surrounding the
subcutaneous tissues of the skin characterised by redness, swollen,tenderness, pain, purulent
discharge,and edema.
It is a common bacteria infection which accounts for over 14million cases occurring in the united
state of America annually.
In Nigeria,it accounts for over 100,000 cases per year and approximately 200 cases per 100,000
individuals worldwide.(S.S Jones 2005).Cellulitis can be caused by different types of bacterias,but it
is commonly caused by beta hemolytic streptococci and resent research showing methicillin-
sensitive staphylococcus.
1.Methicillin-resistant stahylococcus (MRSA) is one of the most successful modern pyogens
responsible for causing infection.it is a type of bacteria that has become resistant to many antibiotics
used to treat staphylococcus infections.it is of two different types:
● Health associated methicillin staphylococcus Aureus infection (HA-MRSA):it occurs in people
who have been hospitalized for a long period of time such as patient in nursing homes and
dialysis center,it can also spread by direct contact with an infected wound or contaminated
hands or surfaces.
● Community associated methicillin resistant staphylococcus (CA-MRSA):it was discovered
recently,it is a clone of hospital associated methicillin resistant staphylococcus aureus with
different strains.they affect healthy people, cause different clinical syndromes.it is common
amongst people who live in crowded communities and it can be transmitted through skin to
skin contacts.
Infections from methicillin resistant staphylococcus Aureus can be prevented by
observing the following measures:
● Washing of the hands regularly
● Keep wounds covered
● Sanitize linen
 ● Shower regularly especially after athletic games or coming in contact with
somebody's sweat.

2.Beta hemolytic streptococci is a gram positive bacteria responsible for causing soft tissue
Infections,myocarditis, endocarditis,and other bacteria infections.it is associated with
diarrhoea,bright yellow feaces and high mortality rates.these bacteria shows high resistance to
broad spectrum antibiotics and increased adverse reactions.
It can be prevented with regular handwash with soap and water for atleast 20 seconds.(Douglas
and Bennett 2015).
Cellulitis if diagnosed early, correctly, promptly and well managed typically resolves with
appropriate antibiotics with wound dressing in aseptic environment within few weeks depending on
the individual level of immune system.(BD brown 2022).
OBJECTIVES OF THE CASE STUDY

1. To determine the cause and prevention of cellulitis.

2. To provide an indepth knowledge about the current management and control of cellulitis.
3. To health educate the patient and relatives on the importance of personal hygiene and
different hygienic practices that helps to promote one's personal hygiene
4. To provide additional information and foundation to other nurses and
Foundation to other nurses and health personnel's for further studies.

CHAPTER TWO
LITERATURE REVIEW

ANATOMY AND PHYSIOLOGY OF THE SKIN

The skin is the largest organ of the body system,it covers about 1.5-2 square meters in adults.
In many parts of the body,it contains accessory structures,glands,hairs and nails,it varies in
thickness, been the thickest in the palms of the hands and soles of the feet l
The skin also harbors normal floral on its surface which has its benefits but when they move out
from their normal habitat, they can pose threat to the individual.
The skin is divided in to two layers namely:
● Epidermis or superficial layer
● Dermis layer
HiBetween the dermis and underlying structures is a subcutaneous layer composed of areolar tissue
and adipose or fat tissue.
● Epidermis layer
The epidermis of the skin is composed of stratified keratinized squamous epithelium.there is no
blood v2essels or nerve endings in the epidermis,it deeper layer is bathed in interstitial fluid from the
dermis which provides oxygen and nutrients and also drains away as lymph.
The epidermis is composed of several layers or strata of cells which extends from the deepest layer
to the superficial layer stated below:
● Stratum corneum
● Stratum lucidium
● Stratum granulosum
● Stratum spinosum
 ● Stratum basale
● stratum corneum:it consist of about 90 layers of of dead keratinized cells.those cells on the
surface flakes off, exfoliate or desquamation as tiny scale called dandruff.it gives the skin its
toughness and poses sebaceous glands and hair follicles.
● Stratum lucidium:it is a translucent zone superficial to stratum granulosum seen only in thick
skin.the keratinocytes are densely packed with elastic.its cells has no nuclei and organelles it
appearance is pale because of abscence of organelles and blood supply.
● Stratum granulosum: it is more in thick skin than in thin skin.It is composed of three to four
layers of keratinocytes.The keratinocytes contains coarse dark straining keratohyaline
granules.These granules consist of substances that combine with intermediate filament of
the cytoskeleton and convert them to keratine.
● Stratum spinosum:It contains several layer of keratinocytes.The deepest cell undergoes
mitosis and contributes to the replacement of epidermal cells that exfoliate from the surface.It
contains dendrite cells.these are macrophages that arises in the bone marrow but migrate to
the stratum spinosum.the dendrite cells helps to protect the body against pathogens by
capturing foreign matter presenting it to the immune system for response.
● Stratum basale:The cells of the epidermis originates in the basale layer.It is made up of
cuboidal, nucleated,highly active epithelial cells that are constantly dividing.the cells are
resting on the basement membrane of the epithelium.there are three types of cells in this
layer:
a)keratinocytes: These are the majority of the cells, they're known for synthesizing the keratine of the
skin,keratinocytes undergoes mitosis and produces new cells to replace dead cells.
b) Melanocytes: ,It synthesizes the pigment melanin,they have long branching process that spread
among the basale keratinocytes and continuously shed melanin.the difference in skin color results
from difference in melanin synthesis,in light skin the melanin is less abundant and is relatively
dumped near the nucleus imparting less color to the nucleus.
C) Tactile cells:They're relatively few in numbers.It contains the receptor for the sense of touch and
tactile cells which are contained in a disc.

DIAGRAM SHOWING THE SKIN AND ITS MAIN STRUCTURES

2)Dermis layer
The dermis is tough and elastic,it is formed from connective tissue and the matrix contains collagen
fibers interlaced with elastic fibers.
Fibroblast, macrophages and mast cells are the main cells found in the dermis.The subcutaneous
layer containing areolar tissue and varying amount of adipose tissue lies under the dermis.structures
found under the dermis are:
a) Small blood and lymph vessels
b) sensory nerve endings
c) sweat glands and their ducts
d)hair follicles
e) Arrector pilli muscles
f) sebaceous glands
g) Nails.
 ● Blood and lymph vessels: Arterioles forma fine network with capillary branches supplying
sweat glands, sebaceous glands, hair follicles and the dermis lymph vessels also forms a
network throughout the dermis.
● Sensory nerve endings: sensory nerve endings are specialised nerve endings sensitive to
touch,temperature, pressure and pain are widely distributed in the dermis.Incoming stimuli
activate different sensory receptors,the skin is important sensory organ through which nerve
impulse generated in the sensory receptors in the dermis are transmitted to the spinal cord
by sensory nerve.
● Sweat glands: sweat glands are contained in the skin and are more numerous in the
palms,soles of the the feet axillae and groin.They are formed from epithelial cells,they lie on
the subcutaneous tissues.They are of two types:
a)Ecrine sweat glands: are the most common type and are found on the skin surface through tiny
pores.The sweat produced here is clear, watery fluid important in regulating body temperature.
b)Apocrine sweat glands:they are open into hair follicles and become active at puberty.They are
found in the axilla and genital area.
● Hair follicles:The hair grows outwards from hair follicles.hair us formed from the multiplication
of cells of the bulbs android as the hair are pushed upwards away from their source of
nutrition, the cells die and become keratinised.hair color is genetically determined and it
depends on the amount and type of melanin present, hair turns white when melanin
production by the follicles stops.
● Arrector pilli muscles:Are little bundles of smooth muscle fibers attached to the hair
follicles.contraction of the muscle fibers makes the hair stands and raises the skin around the
hair causing goose flesh.this is stimulated by sympathetic nerve fibers in response to fear
and Cold.
● Sebaceous glands:it consist of secretory epithelial cells derived from the same tissue as the
hair follicles.They secrete an oily antimicrobial substance called sebum into the hair follicles
and are present in the skin of all parts of the body except palms of the hands and soles of
the feet.They are most numerous in the scalps,face,axillae and groin.
Sebum keeps the hair soft pliable and gives it shining appearance.It acts as water proof in
the skin and acts as a microbial and fungicidal agent preventing infection.
● Nails:Human nails are equivalent to claws,horns and hooves of animals.They are derived
from the same cells as epidermis and hairs.these are hard, horny keratin plates that protect
the tips of the fingers and toes.The root of the nail is embedded in the skin and covered by
the cuticle which forms the hemispherical pale area called the lunula.The nails plate is the
exposed part that has worned out from the nail bed and basal layer of the epidermis.The
fingernails grows faster than the toe nail and the growth is faster when the environmental
temperature is high.

FUNCTIONS OF THE SKIN

1. Its acts like a mechanic barrier to prevent injury to the underlying tissue
2. It aids in the formation of vitamin D
3. It aids in the secretion of sebum, sweat and waste products
4. It beautifies the body
5. It gives the skin colour of an individual
6. It regulates body temperature
7. It is an organ that contains receptors which are responsible to pain,touch and feel
 8. The pigment melanin protects against ultraviolet rays.

REGULATION OF BODY
TEMPERATURE
The body temperature is controlled by the heat regulating centre in the hypothalamus and vasomotor
centre in medulla oblongata.core body temperature remains fairly constant at around 36.8oc across
a wide range of environmental temperature ensuring that the optimal range of enzyme activity
required for metabolism is maintained.To maintain this constant temperature,a negative feedback
system regulates the balance between heat produced in the body and heat lost to the environment.
(Ross and Wilson 2018).

HEAT PRODUCTION
When metabolic rate increases, body temperature rises, when it decreases,body temperature
falls.some of the energy released during metabolic activity is in form of heat.The most active organ
produces most heat.The principal organ involved are:
● Skeletal muscle contraction produces large amount of heat during exercise
● The liver generates considerable heat as a by-product
● The digestive organs generates heat during peristalsis and the chemical reactions involved
in digestion
● Heat is produced after eating hot food

HEAT LOSS
Most heat loss from the body occurs through the skin.Small amount are Lost in expired air,urine and
faeces.Only heat loss through the skin can be regulated,heat loss by other routes cannot be
controlled.
Heat loss through the skin is affected by difference between body and environmental
temperature,the amount of the body surface exposed and the types of clothes worn.
Air insulates against heat loss when trapped in layers of clothing and between the skin and
clothing.For this reason, several layers of light weight clothes provides nore effective insulation
against low environmental temperature than one heavy garment.

MECHANISMS OF HEAT LOSS

There are four mechanism of heat loss:

1. Radiation: It is the main mechanism of heat loss, when exposed parts of the body radiates
heat away from the body.
2. Evaporation: when the body is cooled as body heat converts the water in sweat to water
vapor.
3. Conduction:when clothes other objects in direct contact with the skin takes up heat .
4. Convection: when air passing over exposed parts of the body is heated and rises and
cool.Air replaces it, setting up convection currents.convection also cools the body when
clothes are worn, except when they are wind proof.

CONTROL OF BODY TEMPERATURE

The temperature regulating centre in the hypothalamus is sensitive to the temperature of circulating
blood .This centre responds to decreasing temperature by sending nerve impulse to:
 1. Arterioles in the dermis constrict decreasing blood flow to the skin.
2. Skeletal muscles stimulate shrivering.
As heat is conserved, body temperature rises, when it returns to the normal range,the negative
feedback mechanism is switched off.
Conversely, when the body temperature rises,heat loss is increased by dilatation of Arterioles in the
dermis increasing blood flow to the skin and stimulation of sweat glands causing sweating.This
continues until the body temperature falls into normal range again, when the negative feedback is
switched off.(Ross and Wilson 2018).

INCIDENCE
The incidence rate of cellulitis was carried out by a population base insurance company who used
population database to examine the incidence, anatomical sites of infection, complications and
diagnosis.
The incidence rate of cellulitis was 24.6/1000 per year with a higher incidence among males
between the ages of 45-54 years 39.9% of cellulitis occurs mostly in the lower extremity with 82.0%
had only one episode of cellulitis.
In Nigeria, incidence rate of cellulitis accounts for more than 100,000 cases per year.
In America, cellulitis accounts for over 14 million cases occurring in the USA.
Low mortality rate of cellulitis was recorded worldwide accounting for just 1.1% of deaths yearly.
(s.s jones 2005).

CAUSES OF CELLULITIS
It is as a result of bacteria From streptococci and staphylococi groups when they enter through a cut
or breakage in the skin.
Others are risk factors which can increase a person risk of having cellulitis.
The risk factors includes the following:
1. Age
2. Obesity
3. Lymphedema
4. History of cellulitis
5. Other skin infection such as chicken pox, eczema, athlete's foot
6. Diabetes mellitus
7. Weaken immune system
8. Injury
9. Individual who undergone surgery
10. Patient on intravenous drugs or infusion

REHABILITATIVE MEASURE
Rehabilitative measures that can used in the care of cellulitis is as follows:
1. Rest and elevation of the affected limb is important and can help alleviate pain
2. Application of cool,wet, sterile bandages is recommended for pain relief
3. The use of compression stockings
4. Promotion of exercises
5. Health educate patient on the need of maintaining good personal hygiene
6. Adequate cleaning or wound dressing of the affected limb to maintain and restore skin
integrity.
 CLASSIFICATION OF CELLULITIS
Cellulitis is classified based on the location and part of the body affected
1. Periorbital cellulitis
2. Orbital cellulitis
3. Facial cellulitis
4. Breast cellulitis
5. Perianal cellulitis
1. periorbital cellulitis:it is a bacteria infection that usually kids younger than five years of
age.It affects the eyelid or skin Around the eyes.it is also referred to as preseptal cellulitis, it
affects children more than adults.It is very rare for preorbital cellulitis to cause severe long-
term symptoms,most people recovers in about a week after starting antibiotics treatment
2. Orbital cellulitis:it is also caused by a bacteria infection,it affects fat muscles and deeper
layers of the eye.it is different from periorbital cellulitis because it is More dangerous and can
cause permanent vision loss.
3. Facial cellulitis:it is a form of cellulitis which affects the face, typically affecting one side of
the face.The condition can become serious if not properly managed and can lead to
gangrene when it begins to affects deeper layer of the skin.
4. Breast cellulitis: Breast cellulitis is a serious type of bacteria infection that affects the skin of
the breast, this condition may occur from broken skin,but it is most often as a result of
complications of surgery or cancer treatment.
5. Perianal cellulitis:It is also known as perianitis,it is an infection affecting lower layers of the
skin around anus.It present as a bright red skin, difficulty in defaecating,pain, itching and
bleeding.It occurs mainly in male children between the ages of six months to ten years of
age.

PATHOPHYSIOLOGY OF CELLULITIS
Cellulitis is a bacteria infection which affects the superficial and deep layer of the skin.
When there is a breakage or discontinuity in the skin barrier,microorganism have a portal of entry
into the layers of the skin.The body response to these microbes as foreign bodies and their detection
initiates inflammatory response or process.This response leads to swelling,pain and itching of the
area involved.
A local infection leads to the inflammation of the area involved, with a competent immune
system,the spread of infection is limited,but if the immune system fails to curb the initial infection,the
infection may become systemic by spreading into adjacent organs.If the infection spreads to the
blood streams,it is called bacteremia.
In rare cases,if not properly managed can spread to the deeper layers of the skin,fascial linning
leading to complications like necrotizing fasciitis, which is characterized by tissue death, gangrene
and separation of the underlying tissues.(Daniel 2021).

CLINICAL MANIFESTATIONS
1. Pain
2. Tenderness
3. Erythema or redness
4. Oedema
5. Fever
 6. Chills
7. Discharge of pus
8. Muscles ache
9. Shivering
10. Dizziness

DIAGNOSTIC PROCEDURES
1. History taking: To check if the patient has had the infection before
2. Physical examination:To detect any abnormality using the sense organs
3. Complete blood count:To detect the presence of systemic infection
4. Wound culture: To detect the causative microorganism or agent
5. Ultrasonography: To detect the presence of abscess formation.

COMPLICATIONS OF CELLULITIS
Without prompt diagnosis and treatment cellulitis could lead to several complications which includes
the following:
● Endocarditis
● Osteomyelitis
● Bacteremia
● Sepsis
● Deep vein thrombosis
● Necrotizing fasciitis
● Gangrene
● Amputation

PROGNOSIS
Overall, cellulitis have a good prognosis if not promptly diagnosed and treated with correct
antibiotics.
Reoccurrence is preventable with prompt treatment of cut, abrasion,proper hand hygiene and
effective treating of any underlying cause.

EPIDERMIOLOGY
Cellulitis is relatively common occuring often in middle aged and older adults.men and women have
a similar incidence of cellulitis.There are approximately 50 cases per 1000 patient yearly.(BD brown
2022)

SPECIFIC MANAGEMENT
Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and maybe treated
with cefalozin,cefuroxime,ceftriazone,nafcillin or oxacillin.
Antimicrobial options in patient who are allergic penicillin including Clindamycin.

GENERAL NURSING OBJECTIVES

ADMISSION
Patient should be admitted in to a comfortable ward,free from noise and anything that can disturb
patient healing process.
 OBSERVATION
Patient should be observed for restlessness,loss of skin turgor, vital sign should be taken and
charted respectively.site of injury should also be observed for discharge,pain and any abnormal
changes.

REST
Encourage bed rest to conserve energy and to reduce body metabolic demand.

DIET
patient should be encouraged to take foods rich in protein to enhance wound healing and
replacement of worn out tissue.patient should also be encouraged to take fruits to boost immunity
and prevent infection

PHYSICAL CARE
patient should be supported to the bathroom and assisted to carry out activities patient is not able to
carry out on his own.oral care should also be done for patient to prevent tooth decay.

PSYCHOLOGICAL CARE
Patient and patient relative should be constantly reassured pertaining patients condition,all patient
question should be correctly answered respectively.The patient should also be educated on patient
condition,causes, complications and possible outcome.

ELIMINATION
Patient waste should be properly disposed and pan used for it should be disinfected.

DRUGS
Patient should be encouraged to complete course of medication to promote condition, prevent
further complications and spread of the infection to other parts of the body system.

MEDICAL MANAGEMENT
The following medications can be used to treat cellulitis:
● Cefuroxime 500mg
● Ceftriazone 1g
● Paracetamol 600mg
● Iv flagyl 1500mg 8hrly
● Nafcillin
● Clindamycin
Administer antibiotics as prescribed after appropriate investigation is carried out or obtained.
Administer prescribed analgesics to relieve pain
Wound dressing should be done daily in aseptic technique to promote healing and return skin
integrity.

PREVENTION AND CONTROL

● Keep skin clean and well moistured
● Prevent cuts and scrapes by wearing appropriate clothes and foot wear
● Trim finger nails and toe nails with care
 ● Hands should be washed properly and regularly under running water
● Promptly treat any cuts or infection on the skin surface.(Lawrence E.2023)

CHAPTER THREE
SUBJECTIVE CLIENT ASSESSMENT
PERSONAL DATA
NAME:Mrs Y.S.A
AGE:106 years
SEX: Female
MARITAL STATUS: Married
TRIBE:Ebira
RELIGION: Muslim
NATIONALITY: Nigerian
STATE OF ORIGIN:Kogi State
L.G.A:okene
HOME ADDRESS:Inike
OCCUPATION: retired civil servant
OFFICE ADDRESS:Nil
DATE OF ADMISSION:20-09-2024
MEDICAL DIAGNOSIS: Cellulitis
CONSULTANT:Dr Jennifer
Ward: female medical ward

NEXT OF KIN
NAME:Mr Y.h
RELATIONSHIP:Son
ADDRESS: Inike
PHONE NUMBER:08107922921
RELIGION: Muslim
OCCUPATION:farming

PAST MEDICAL HISTORY

Patient is a known congestive cardical failure (c.c.f) patient

PAST SURGICAL HISTORY

Patient have never undergone any surgery since she was born.

PRESENT MEDICAL HISTORY

patient was accompanied to the ward from the accident and emergency unit through a wheelchair at
about 10:00am followed by her relatives. Patient came with complain of pain, swollen right leg, and
weakness of the body. Laboratory investigation was carried out and the doctor diagnosed her of
cellulitis and she was placed on the following medication

● Iv tandak 1.5g 12hrly×72hrs

● Iv torsemide 60mg stat then 40mg 12hrly
● Iv metronidazole 500mg 8hrly
 ● I.v.f 5%dextrose saline 8hrly
● Iv paracetamol 600mg 8hrly ×3/7
● Tab spironolactone 25mg dly 10/7
● Iv Clindamycin 600mg 12hrly

OCCUPATION
Patient is a retired civil servant.

SOCIAL/FAMILY HISTORY
Patient relates well and communicates with family members and friends.

NUTRITION
Patient eats well,her three square meal are been taken serious.patient consumes less salt because
of her medical history.

ELIMINATION PATTERN
Patient passes stool and urinates well everyday without observing any difficulty atleast two times
daily.

ACTIVITY EXERCISE
Patient does not exercise due to her condition.

SLEEPING PATTERN
Patient sleeps for roughly 8hours daily Patient sleeps around 9:00pm and wakes up at 7:00am in the
morning

COMMUNICATION AND SPECIAL

SENSES
Patient communicates well and all special organs are intact with no physical deformity.

SELF IMAGE
Patient accepted her interpersonal relationship with the nurses and other patient.

COPING WITH STRESS

Patient has the ability to cope with stress.

VALUES AND BELIEF

Patient believes in Allah and prophet Muhammad(sallahu alayhi wassallam) as the messenger.

CHAPTER FOUR
OBJECTIVE ASSESSMENT OF THE. PATIENT
PHYSICIAN VIEW POINT
Patient was assessed by the doctor in charge of her care,she made her complaints,the doctor
assessed the site of swelling on the patient right leg.
 The doctor diagnosed her of cellulitis and asked her to go for test first so that a proper diagnosis
could be done

SYSTEMIC REVIEW
Respiratory system:Respiration is normal,it was within the normal range.No abnormality detected.
Gastrointestinal system: patient experienced no abnormality with gastrointestinal tract.patient had
good bowel movement.
Cardiovascular system: There is rapid and febrile pulse.
Urinary system: patient passes urine without difficulty and it is normal.
Integumentary system:The skin was warm to touch,there is swelling on the right leg of the patient
Nervous system: patient was conscious and oriented to time and place.

PHYSICAL EXAMINATION
palpation: The abdomen was palpated to detect any abnormality.No abnormality detected.
Inspection: patient was inspected from head to toe,nil abnormality was detected on the upper
extremity but there is swelling seen on the right leg of the patient

TEXT ORDERED
Patient was told to do full blood count, random blood sugar and urinalysis which she did the same
day of admission and the result states:
Random blood sugar:4.9mmol/l
Full blood count:
● WBC:8.5×10⁸/l
● PVC:35%
● Hb:11.2g/dl
Differential count:
● Neutrophil:65%
● Lymphocytes:32%
● R.B.C:4.19 10^12/l
Urinalysis
 Blood: (++)
 Urinobillinogen: nil
 Birillrubin: nil
 Protein: nil
 Nitrate: nil
 Ketone: nil
 Leucocyte: (++)
 Glucose: nil
 P.h: 6.0
 Specific gravity: 0.015

NURSES VIEW POINT

Based on the following
OBSERVATION/INTERVIEW
Patient was brought to the ward while on a wheelchair from the accident and emergency unit at
about 10:00am and she was followed by her relatives. Patient came with complain of pain, swollen
right leg and weakness of the body
Vital sign on admission:
● Temperature:36°c
● Pulse:89b/m
● Respiration:22c/m
● Blood pressure:100/80mmHg

HAIR:No scalp itching,no presence of lice on hair roots,no loss of hair and no excessive body hair.

HEAD: patient has normal shape of head with normal texture of hair.

EYES:on inspection, patient can see very well,no pain,no itching and no discharge from the eyes

MOUTH & THROAT: Patient has dried lips,no sore gum,no stomatitis, and no dentures.

MENTAL STATE: Patient is well oriented about the three states of life i.e place, time and people.

DAILY CARE
DAY 1,20/9/2024
Patient was admitted into female medical ward around 10:00am and was nursed on bed M2,and she
complained of pain and swelling on the right leg.On physical examination, patient looked weak.
Vital signs was checked and charted
● Temperature:36°c
● Pulse:89b/m
● Respiration:22c/m
● Blood pressure:100/80mmHg.
The prescribed medication were made available and treatment commenced immediately at 1:00pm.
● Iv tandak 1.5g 12hrly×72hrs
● Iv.f 5% dextrose saline 8hrly
● Iv Clindamycin 600mg 12hrly
● Iv paracetamol 600mg 8hrly×3/7
● Iv metronidazole 500mg 8hrly
● Tab spironolactone 25mg dly×10/7

DAY 2,21/9/2024
patient still looked weak but she was improving,she complained of pain at the site of the swelling and
she was reassured paracetamol 600mg was given I.v. patient ate apapa with pap. Due medication
was served. Doctor on call came to review her and he was impressed about her improvement
Vital signs taken and charted:
● Temperature:36.5°c
● Pulse:73b/m
● Respiration:18c/m
● Blood pressure:110/70mmHg
● SPO2:97%
DAY 3,22/9/2024
Patient’s condition has improved,most of the symptoms have subsided and she no longer complain
of pain and weakness.As at 6:00am,his vital signs was checked and charted.
● Temperature:36.5°c
● Pulse:62b/m
● Respiration:18c/m
● Blood pressure:110/60mmHg
No fresh complain,she ate very well and looked bright.

DAY 4,23/9/2024
Patient condition has improved, patient was encouraged to take her bath and she also had oral care
done.patient ate well,no complaints
Due medication was served, nursing care rendered..vital signs checked and charted:
● Temperature:36.6°c
● Pulse:62b/m
● Respiration:18c/m
● Blood pressure:110/60mmHg
● Spo2 97%

DAY 5,24/9/2024
Patient looked stronger and healthy.There was no complaints from the patient.patient took her bath
and had oral care done, she had her breakfast and her morning medication was served.patient vital
signs was checked and charted,
● Temperature:36.4°c
● Pulse:70b/m
● Respiration:18c/m
● Blood pressure:140/80mmHg

NURSING DIAGNOSIS:
● Risk for infection related to broken skin barrier.
● Excessive Anxiety related to unknown outcome of condition evidenced by facial expression.
● Knowledge deficiet related to patient condition evidenced by patient asking too many
questions.

NURSING CARE PLAN

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2. Excessive Patient level ● Asses ● To Patient level

Anxiety related of anxiety s level serve of anxiety was
to unknown will be of as a reduced after
outcome of reduced patient baseli 40mins of
condition within 30- anxiet ne nursing
evidenced by 40mins of y data intervention
patient facial nursing ● Give ● To
expression intervention psych ease
ologic patient
al anxiet
therap y
y and ● To
assura increa
nce se
● Introd patient
uce level
patient of
to confid
 other ence
patient ● To
who enable
has the
encou nurse
nter to
similar know
conditi the
on patient
● Create level
good of
interp anxiet
erson y
al
relatio
nship

3. Knowledge Patient Will ● Asses ● To Patient was

deficiet related be able to s serve able to gain
to patient gain patient as a adequate
condition adequate history baseli knowledge
evidenced by knowledge and ne during course
patient asking during how data of
too many course of Cellulit ● To hospitalization
questions hospitalizatio is enlight
n starte en
d patient
● Explai about
n the his
diseas conditi
e on
proces ● To
s, enable
durati the
on,cau nurse
ses to
and know
compli level
cation of
s to patient
patient knowl
● Create edge
good and
interp make
erson patient
al comfo
relatio rtable
nship with
with the
patient nurse
● Answe ● To
r clear
 patient patient
questi misco
ons ncepti
objecti on
vely toward
s
Cellulit
is

HOME VISIT
On the 31st October,2024 I visited Mrs Y.S.A at her residence in Inike at okene. On visitation, I met
her sitting down inside the house with her family.with my observation of the client, her environment
was clean and neat, she speaks well and looked healthier than when she was admitted in the
hospital.
I asked her about her medication and follow up with the doctor, and also how she has been coping,
she told me that she has been taking her medication well and alway attends her follow up with the
doctor.
I used the privilege to check his vital signs which reads:
Blood pressure:120/70mmHg
Temperature:36.5⁰c
Pulse:64b/m
Respiration:16c/m
And I also advised her to continue taking her medication, eat healthy and balanced meals avoid cuts
and ensure to go to the hospital for check up if she is feeling unwell.

CHAPTER FIVE
SUMMARY
Cellulitis is a bacteria infection which affects the superficial and subcutaneous layer of the skin.It can
also affect the deep layer of the skin.It is an infection which affects children and adults and can occur
in any part of the body.In children,it affects the neck and in Adults it mostly affects the legs.
It accounts for 14 million cases in the united state of America and 100,000 cases per year in
Nigeria and approximately 200 cases per 100,000 individual worldwide.
The rate of occurrence of this disease was discovered through research to be due to cuts,low
immune system, diabetes mellitus and other disease condition which can trigger it.
This care study was written on Mrs.Y.S.A with diagnosis of cellulitis, chosen from female medical
ward, reference hospital,okene.During his admission into the ward on 20th September,2024.
With adequate nursing and medical management, patient recovered successfully and was
discharged home on 23th October,2024.

CONCLUSION
Cellulitis is a life threatening condition caused by bacteria.The disease requires prompt management
to prevent development of complications.
The prognosis of Cellulitis is good if early diagnosis is made and adequate treatment given.
Based on the damages caused by this disease,I here by urge the health professionals to hold the
bull by the horn before more damages are done to people's health,this can be achieved through
prevention, control, health education and curative means.If individuals and families in the society can
adhere to good personal and environmental hygiene, good nursing and medical intervention is
required during the course of illness in order to prevent the complications that may arise if not
properly treated.

RECOMMENDATION
The following are recommendations that needs to be in place to reduce the occurrence of Cellulitis:
● Government health staff should organise a mass campaign on Cellulitis and enlighten the
masses on the causes, prevention and control of the disease.
● The government should regulate the disposal of waste in various communities and
industries.
● Good source of drinking water should be made available to the populace.
● The populace should be enlighten on the importance of good personal and environmental
hygiene.
● Immunization should be made available for children.

REFERENCE
● BD brown 2023, National library of medicine and
Center for biotechnology. information on
Epidermology of cellulitis.
● Cellulitis -sign & symptoms and causes (February 6th,2020) mayoclinic.
www.mayoclinic.org/disease
 Cellulitis (may 29th 2020), C.D.C
www.c.d.c.govt/group past rep/disease.
● Daniel 2021, Wikipedia,pathophysiology of Cellulitis.
www.wikipedia.org
 Herchine T.E and Stuart m(June 14th 2019)
Cellulitis practice essential background and
Incidence.
 Ross and Wilson (2018) 14th edition anatomy and
Physiology of the skin.
 Sandhy MD pruthi 2022, mayo clinic
Definition of cellulitis.
 Waugh A& grant A(2018).

PHARMACOLOGY OF DRUGS FOR MRS. Y.S.A

S/N NAME DOSAG ROUTE MODE INDICA CONTR SIDE NURSIN

OF E OFADMI OF TION AINDIC EFFECT G
DRUG NISTRA ACTION ATION S IMPLIC
TION ATION
1. Tandak 1-2g IV/IM It inhibit -serious - - -Monitor
daily the infection Hyperse Diarrhor patient
synthesi due to nsitivity ea for
s of sensitive to drug - hyperse
bacteria bacteria - Nausae nsitive
cell wall, including porphyri & reaction
mitosis septice a vomiting s
and mia, - - -Monitor
growth pneumo Hypoalb Abdomin patient
of nia and uminae al vital
bacteria meningit mia discomf signs
is - ort -Instruct
- Neonate - patient
Gonoco with Headac to take
ccal jaundice he full
infection -Body course
s rashes of
- -sleep medicati
infectiou disturba on to
s fever nce maintain
-urinary therapeu
tract tic effect
infection -Instruct
- patient
osteomy not to
litis take
alcohol
containi
ng
beverag
es to
avert
abdomin
al
pain,nau
sea and
vomiting

2. Flagyl 500mg IV slowly It acts by - -First -Nausae -Instruct

penetrati Urogenit trimester - patient
ng the al of vomittin that
cells of trichomo pregnan g consum
the niasis cy - ption of
microorg - -Blood Abdomin alcohol
anism Giardiasi dyscriasi al cramp with
and s s - flagyl
subsequ -Acute - Constipa may
ent ulcerativ Lactatin tion result to
damage e g - headach
of DNA gingivitis mothers Darkeni e,
strands - -CNS ng of abdomin
or Amoebic disorder urine al
 inhibition dysenter s cramps
of their y - &
synthesi -Liver Hyperse flushing
s abscess nsitivity -Teach
patient
about
good
person's
hygiene
and
handwa
shing
after
toileting
-It
should
not be
administ
ered to
pregnant
women
and
lactating
mothers
-Instruct
patient
to avoid
intake of
alcohol
during
course
of
therapy

3. Torsemi 20-30mg ORAL It inhibits -Cardiac -Anuria - -Monitor

de daily IV the oedema -Hepatic Hyponat patient
IM reabsorp -Renal coma raemia input
tion of oedema - - and
sodium -Hepatic Hypokal Dehydra output
and coma aemia tion -Weigh
chloride -Mild to - -Muscle patient
from moderat Hyperse cramps daily
loop of e nsitivity - -Assess
Henle hyperten Constipa vital
and sion tion signs
distal especiall
renal y blood
tubule pressure
affecting when
diuresis lying
and and
subsequ standing
 ent -
mobilizat Administ
ion of er drug
excess in the
fluid morning
to
prevent
sleep
disturba
nce and
nocturia

4. Paracet 300- IM It alters -Mild to -Liver -Skin -Warn

amol 600mg IV the moderat disease rash patient
(IV) ORAL respons e pain - -Vertigo to avoid
500mg(o e of heat -Fever Hyperse - use in
ral) regulatin - nsitivity Leucope high
g center Headac -Renal nia fever
in the he impairm -Blood persistin
hypothal - ent disorder g longer
amus Toothac than 3
and he days
raises -pyrexia -
pain -Acute Administ
threshol migrativ er drug
d e attack with
food,mil
k or
large
glass of
water to
minimize
gastroint
estinal
distress
-Drugs
should
not be
given to
hyperse
nsitive
patient