26 year old Native American female admitted with the diagnosis of Cellulitis. Her chief complaint of fever and vomiting that started at 1600 on 11/2/2016 with pain, swelling and redness in the right and left forearm. Patient reported shooting up Opana and using cocaine in the last 12 hours. Patient cleans her needles with Clorox and believes she may have injected Clorox into her right forearm. She also reports pain in the left forearm as well. The patient has no known drug allergy, no past medical history, but does have past drug use.
Etiology and Pathophysiology Cellulitis is a serious bacterial nfection of the skin and the tissue under the skin. It can be life threatening if not treated. Cellulitis can spread to different areas of the body quickly. This type of infection can also spread to your bloodstream and lymph nodes as well. Cellulitis can occur when bacterial enters the skin at areas like surgical incisions, cuts, puncture wound, ulcers, and athlete foot or dermatitis. The most common bacteria is streptococcus and staphylococcus. MRSA is the most serious type of bacteria.
A person can be bite by certain types of spiders and insects which can spread the bacteria. (http://www. mayoclinic. rg/diseases-conditions/ cellulitis/basics/definition/con-20023471 Mayo clinic feb 11, 2015) Risk Factors The risk factors for my patient are intravenous drug use and injury to the skin. My patient injected Opana and possible Clorox. The intravenous drugs use increase her chances of getting cellulitis. The injury to her skin comes from the needle enter the skin and leaving opening for the bacteria to enter. (http://www. mayoclinic. rg/ diseases-conditions/cellulitis/basics/preparing-for-your- appointment/con-20023471 Mayo clinic feb. 11,2105) Clinical Manifestation/ Assessment The clinical manifestation my atient had was red, swollen, warm skin on the right forearm. On the left forearm she had a red skin sore (open wound). She complained of pain. There is nothing that makes the pain better or worst. It is a burning and stabbing type of pain. The location of the pain is in the right and left forearms in the area of the cellulitis. The pain was rated a 10 out of 10 on a pain scale.
The intensity of the pain does not change with time. It is a constant pain. She also complained fatigue and nausea and vomiting. Upon assessment the patients baseline V/S are 134/82, Pulse 122, Resp 20, Temp 100. pain 10 out of 10 on pain scale taken on 11/1/16 at 2233. Recent V/S is BP 102/56, Pa02 99% on room air, Resp. 18, HR 77, and Temp is 96. 9 Pain nothing makes better or worst. It is a burning and stabbing type of pain. The location of the pain is in the right and left forearms in the area of the cellulitis. The pain was rated a 10 out of 10 on a pain scale.
The intensity of the pain does not change with time. It is a constant pain taken 11/2/16 at 1530. Patient is alert and oriented X3 to person, date of birth, and place. HEENT is clear. Pupils are PERRL. The pupil size was 4mm. Mouth is moist, pink, and teeth ave a brownish discoloration. Respiratory is A&P bilaterally clear and unlabored. Has equal rise and fall of chest. Capillary refill are less than 3 seconds. Radial pulse and dorsalis pedis are strong and equal bilaterally. Radial pulse is 76. Heart rhythm is regular and strong. S1 and S2 sound noted. Patient has full ROM and a steady gait.
Abdomen is non-tender and non-distended. Bowel sounds are normal and present in all four quadrants. Last bowel movement was 11/1/16. Last urination was 11/2/16. Wound #1 on right forearm was red, swollen, and measures 11cm length X 6cm width. Wound #2 on left forearm is a stage 2 ound that is red and open. Its measurements are 4cm length X 3cm width. Patient has upper extremity bilateral bruising that is dime sizes and bluish purple color. Lower extremity has bilateral bruising that is dime size and bluish purple color. IV site is 18 g left AC of NS @125mL/hr infusing on pump.
No redness, swelling, or tenderness noted. Development Consideration** My patient is in the Erikson’s development stage of intimacy versus isolation. This is young adult ages 18-40 years old. In this stage searching for others to have friendship and intimated relationship with. According to Potter and Perry, “Erikson ortrayed intimacy as finding the self and then losing the self in another. ” Fear of rejection is one reason why people in this stage who does have this relationships. This is when people start isolating their self from people and they can become depressed.
If a person masters the intimacy part of this stage the will have long term relationship that is full of love, commitment and safety. (http://www. simplypsychology. org/ Erik-Erikson. html#industry) My patient is 26 years old. Considering her age and development stage I will have to find ways to communicate with her about treatment, medications, nd her drug use. My patient was in the isolation part of this stage. She stated “It is only me. ” When asked about if she was married. When we talked about her drug use and health she also stated “It don’t matter to her.
When dealing with a patient in this stage I need to show them support and that people do care about what happens to them. I would speak with my patient on her level. I would provide clear instructions and ask her if there is any questions. I would use a verbal method by having her to repeat what we have discussed. I would also find websites she could use about her condition and drug use. Psychosocial Impact of disease on patient, family, and community My patient is unemployed and has no insurance. She is single and lives with her sister and friend. She does not have transportation.
Her educational level is 9th grade. The impact of this disease for the patient can be she has no positive support system. Patient stated “sister and friend also does drugs with her. ” She lives in an environment that promotes drug use. She may benefit from an inpatient drug treatment center if she is willing to go. She does not have transportation to go to cocaine anonymous (CA), marijuana anonymous, and narcotics nonymous (NA). She does not have good coping skills. She copes with stress my using drugs and crying. Her drug use is what caused her cellulitis.
She has not insurance and no ways of paying her hospital bills because she is unemployed. She may be less likely to get help for her drug use and health care needs. Nutritional Needs Patient is on a regular diet and tolerated it well. There is no restrictions on the patients diet. Due to her drug use she may not have a good appetite. The patient needs be educated on the importance of eating a well balance meal. She should eat 3 times a day or 5-6 small meals a day. Education/Teaching My patient educational level is 9th grade. She dropped out of school in the 9th grade.
For my patient we will use written and verbal teaching. She will need teaching on cellulitis and what puts her at risk. We would teach her that her intravenous drug use puts her at a higher risk of cellulitis. She needs to be taught the signs and symptoms of infection which are pain, redness, warmth, and swelling. Teach her to rest and elevate arm. Take any antibiotics and medication as prescribed. Take the full course of medication even of you feel better. Drug teaching can be done. Teach her that her drug use can be a cause of the cellulitis.
We can provided her with names and numbers of different drug rehabilitation centers in and around the around she lives. She can be given numbers of outpatient services for drug treatment center. Education on nutrition and diet because of the patients decrease appetite when using drugs. Smoking cessation will be discussed. Patient is on a nicotine patch. Patient teaching on the dangers of smoking while on a nicotine patient. She can become very ill and have a heart attack. Patient needs education on positive ways to cope and dealing ith stress other than drug use and crying.
We can teach her to mediate. Other ways to cope can be art, music, exercise like yoga, finding support groups and positive people to talk to when you feel stress or like you need to use drugs. Discharge teaching on medications that she will be sent home on and the importance of taking as prescribed. Keep all follow appointments with the surgery and primary health care provider if any are provided. Patient activity level was up at lib. Patient can lie in bed, sit in Activity chair and walk around as desired. Patient should rest and elevate arm as much as possible.
Collaboration includes RN, CNA, hospitalist/surgeon, Lab tech, and pharmacy. The Rn will need to collaborate with the Hospitalist about the patient care and any orders given and lab results. The surgeon and the RN must speak about the date and time of surgery, pre-operative care, and post-operative care. The RN and CNA must communicate on basic care like V/S, personal hygiene, and have a clear understanding on what is expected from both of them. The lab tech must communicate with the RN about lab results and especially critical ones. The Rn needs to collaborate with the pharmacy about patient medication and dosage.