Cellulitis Case Study

Cellulitis Case Study

By Wayne Hintz

Wilbur is a 27-year-old man presents to the emergency room complaining of pain in his right hand. He was well until the previous day, when he sustained a deep scratch at the base of his right thumb while playing with his cat. He washed the wound and bandaged it tightly to stop the bleeding. Overnight, however, his palm began to swell, turned red, and became increasingly painful.

Let's meet your patient

​The patient was born and raised in the United States. He has been in good health before this illness and has no history of hospitalizations.

He recalls having had a tetanus booster shot 7 years ago.

He has no history of allergic reactions to medications.

His 7-year-old cat was also born and raised in the United States, has received all appropriate vaccinations, and is apparently healthy.

​Physical examination findings are notable for a laceration on the right fleshy part of the right thumb that is 2 cm long and 0.5 cm deep.

The wound is partially crusted over with blood, with a small amount of serosanguineous discharge.

The surrounding tissue is erythematous, hot, and exquisitely tender.

There are two red streaks ascending the lower half of his anterior forearm.

He has a tender, mobile, 1-cm lymph node in the right axilla.

There is full range of motion without discomfort in any of the digits or the wrist of his right upper extremity.

Neurologic examination of the hand reveals normal findings, and Allen's test result is normal.

​Vital Signs:

BP 120/70

HR 90

RR 14

T 103F

Fill in the Blanks

Based on the information on the previous slide, what vital sign is of most concern

WBC 15,000, with a differential count of 75% polymorphonuclear leukocytes

5% band forms

17% lymphocytes

2% monocytes

1% eosinophils.

His serum chemistry values are normal.

Gram's staining of the serosanguineous discharge from the wound reveals large numbers of small gram-negative rods and a few gram-positive cocci in chains.

Samples of the discharge and blood are sent for culture

Lab Results

Poll

Anything out of the ordinary

• Yes

• No

Multiple Choice

What infectious agents should be considered as the most possible causes of this patient's cellulitis?

• Clostridium perfringens
• MRSA, VRE

• Streptococcus pyogenes, Staphylococcus aureus

• Candida albicans

Multiple Choice

What would be the most appropriate antibiotic treatment for this patient?

• Doxycycline
• Ciprofloxacin
• Amoxicillin
• Clindamycin

Multiple Choice

In addition to antibiotics, what other measures should be taken to treat this cellulitis?

• Ignore the symptoms and wait for improvement
• Keep the area clean, elevate the limb, apply warm compresses, and monitor for worsening symptoms.
• Use topical steroids
• Apply ice packs to the area

Word Cloud

What was something that you learned from the case study that you did not know?

Word Cloud

Any other nursing or interdisciplinary things we can do to treat Wilbur?