Cellulitis Email this page to a friend Share on facebook Share on twitter Bookmark & Share Printer-friendly version Cellulitis

is a common skin infection caused by bacteria. See also: Causes Staphylococcus and streptococcus bacteria are the most common causes of cellulitis. Normal skin has many types of bacteria living on it. When there is a break in the skin, these bacteria can cause a skin infection. Skin in the infected area will become red, hot, irritated, and painful. Risk factors for cellulitis include: Cracks or peeling skin between the toes History of peripheral vascular disease Injury or trauma with a break in the skin (skin wounds) Insect bites and stings, animal bites, or human bites Ulcers from certain diseases, including diabetes and vascular disease Use of corticosteroid medications or medications that suppress the immune system Wound from a recent surgery Orbital cellulitis Periorbital cellulitis

Symptoms Symptoms of cellulitis include: Fever Pain or tenderness in the affected area Skin redness or inflammation that gets bigger as the infection spreads Skin sore or rash that starts suddenly, and grows quickly in the first 24 hours Tight, glossy, "stretched" appearance of the skin Warm skin in the the area of redness

Signs of infection: Chills or shaking Fatigue General ill feeling Muscle aches and pains Warm skin Sweating

Other symptoms that can occur with this disease: Hair loss at the site of infection

Joint stiffness caused by swelling of the tissue over the joint Nausea and vomiting

Exams and Tests The health care provider will perform a physical exam. This may reveal: Redness, warmth, and swelling of the skin Possible drainage, if there is an infection Swollen glands (lymph nodes) near the affected area

Your health care provider may mark the edges of the redness with a pen, to see if the redness goes past the marked border over the next several days. Tests that may be done: Blood culture Complete blood count (CBC) Culture of any fluid or material inside the affected area

Treatment Most of the time, treatment involves antibiotics taken by mouth and close follow-up by your doctor. You may be given painkillers. You should raise the infected area higher than your heart to reduce swelling. Rest until your symptoms improve. You may need to stay in a hospital if: You are very sick (for example, you have a very high temperature, blood pressure problems, or nausea and vomiting that does not go away) You have been on antibiotics and the infection is getting worse Your immune system is not working well (due to cancer, HIV) You have an infection around your eyes You require antibiotics through a vein (IV)

Outlook (Prognosis) Cellulitis usually goes away with 7 - 10 days of antibiotics. Longer treatment may be needed if cellulitis is more severe. This may occur if you have a chronic diseases or your immune system is not working properly. People with fungal infections of the feet may have cellulitis that keeps coming back. The cracks in the skin from the fungal infection allows the bacteria entry to the skin. Possible Complications Blood infection (sepsis) Bone infection (osteomyelitis) Inflammation of the lymph vessels (lymphangitis) Inflammation of the heart (endocarditis) Meningitis

Shock Tissue death (gangrene)

When to Contact a Medical Professional Call your health care provider if: You have symptoms of cellulitis You are being treated for cellulitis and you develop new symptoms, such as persistent fever, drowsiness, lethargy, blistering over the cellulitis, or red streaks that spread

Seek medical attention immediately if the cellulitis is on your face. Prevention Protect your skin by: Keeping your skin moist with lotions or ointments to prevent cracking Wearing shoes that fit well and provide enough room for your feet Learning how to trim your nails to avoid harming the skin around them Wearing appropriate protective equipment when participating in work or sports

Whenever you have a break in the skin: Clean the break carefully with soap and water. Apply an antibiotic cream or ointment every day. Cover with a bandage and change it every day until a scab forms. Watch for redness, pain, drainage, or other signs of infection.

Saint Marys University Bayombong, Nueva Vizcaya School of Health Sciences

UNDIFFERENTIATED, SCHIZOPHRENIA

Submitted by: Abuan, Myrtle Acierto, Rizaldy Andres, Christian Ian Azurin, Roxanne Ysabelle Bagalayos, Princess Marie Baliton, Marifel Barlolong, Lawrence Cabansag, May Flor Cajucom, Maria Zyra Lorraine Castaneto, Rosemarie Faye

Submitted to: Mr. Edgar Manood, RN Clinical Instructor

May 2011 I. INTRODUCTION Brief description Schizophrenia is a chronic mental illness that cause altered perception of the world. A person with schizophrenia often responds to events and people in ways that make little sense to others. Characterized by psychiatric reaction which follows: Thought disturbances Withdrawal from reality Regressive behavior Severely impaired interpersonal relationship Etiology Appears to result not from a single cause but from a variety of factors. Cause Genetic factors Imbalance of chemicals in the brain Structural brain abnormalities Abnormalities in the prenatal environment Stressful life events may contribute in the development of schizophren ia Onset Late adolescence or late adulthood Peak of incidence : Male: 15-25 Female: 23-35 Cardinal signs Ambivalence Affect impairment Associative looseness Autism Undifferentiated type of schizophrenia Characteristics Unclassified Mixture of the symptoms Nursing care a. Built trust b. Exhibit passive friendliness attitude for paranoid type c. Let the patient trust one person before engaging to an activity d. Develop patients self esteem e. Let the patient feel that he is accepted and safe f. Maintain trust g. Keep the promises h. Be consistent i. Avoid arguing/talking infront of the patient wherein he could see but can not hear j. Avoid whispering and acting secretively

k. Ask permission from the patient to talk with other person Specific intervention o Delusion of poison/ persecution o Pointers o Simply state the food is safe NEVER taste the food and or eat with the patient (it reinforces the delusion). o Let the patient eat with another patient with the same food. o Give patient food with cover and let him open it. o Let the patient prepare his own food. o Canned food can be given as last resort. o Never mix medications with food and drinks Medication administration Pointers Let him take medication consistently and religiously Let the trusted person give the medication Preparations o the medications should be with the patients presence Check capsules /tablets form of medications under the pillow/bed mattress Administer liquid form of medicine Parental medications should be given carefully Never give the patient placebo II. CLINICAL SUMMARY Name:F.H. Age: 42 Sex: Male Birthday: February 19, 1979 Address: Brgy. Mabatat Basita, Pangasinan Status: Single Religion: Roman Catholic Admitting Physician: Dra. Irish A. Anola Nationality: Filipino Chief complaint: While in jail he experienced body weakness, threw away food because of suspicious feeling of having the food with poison, laugh and cry at some time without any reason. He started these manifestations since 1995 but did not had any consultation. Prenatal history He was a full term baby (9 months old ) and her mother did not take any medications during her pregnancy. The pregnancy was planned and the patient was delivered under normal sponataneous delivery at their house. Early Childhood According to the patient his mother is not present in their house almost of the time during the day. He is full breastfed baby but then the mother during the day is not present so she leaves a bottle of

breastmilk at the refrigerator then its up to the brother who is taking care with the patient to feed the patient . Middle Childhood His mother is very busy in her work so the patient finds someone to rely on and express his feelings but cant find someone to tell such problems. Instead he separates himself from other people making him to be called as loner. He is very close to girls rather than boys. He stated that he refused going to school kasi tinatamad. The patient have close relationship with his brother, they play together in their backyard during afternoon when the environment is not too hot. Late childhood According to him, he wanted to be alone rather than socializing with other people. He doesnt have academic achievement during his school times since he prefers to be out of school. His favorite past time was playing chess and basketball only . he also stated that he had once had a girlfriend, he added that he drinks liquor occasionally and does not taken any prohibited drugs. Adulthood 1. Occupation history Patient was a welder and stated that he enjoyed doing gate and windows made out of steel and does not have any complaints on his job. 2. Marital and relationship history His relationship with his mother is not so close that other has even with his father. He opened up his problem to his brother where in the parents had their eye opener during the situation come that the patient commit a crime due to depression. 3. Educational History Patient was a high school graduate 4. Religion Patient was a roman catholic but then seldom goes to mass during Sundays 5. Social activity He preferred to be alone rather than mingling with other people in the community. II- MENTAL STATUS EXAMINATION A. APPEARANCE Patient is 42 year old male,Asian race,single with a body built of a medium petite.Can stand sit can lie down and was comfortable in posture.He was wearing blue shirt and short.Patients teeth is colored yellow and has tattoo on his left arm and abdomen.

B. BEHAVIOR/MOVEMENTS Patient maintained eye contact,cooperative and follows command,no abnormal movement was noted.Patient posed slowed movemet with arm swingnfreely when walking.Patient was drowsy during interview. C.COMMUNICATION Patient had soft ,slowed clear voice and speak minimally.Patient can also name object when presented to hi m. D.MOOD/AFFECT

Patient has blunted affect.He has no suicidal ideation. E.PERCEPTION He had tactile hallucination F.LEVEL OF CONSCIOUSNESS He is fully aware ,oriented and responsive.He is confius at times.Inappropriate emotions to what he is saying.Neutral mood emotional tone. G.THOUGHT CONTENT His consciousness was disturbed due tonhallucination. H.ORIENTATION He is oriented to name,time and place. I.COGNITIVE FUNCTIONING He is able to make decisions to everyday activities for his self care and self welfare.He is attentive and is able to repeat numbers correctly.Can recall recent,remote and immediate memory.Patient explain the recent and past events of his lifeby stey to step process. III.GORDONS FUNCTION HEALTH PATTERN Functional Health Pattern Pattern Describes Analysis and Interpretation Health Perception/ Health Management Client's perceived pattern of health and well-being and how health is managed. Compliance with medication regimen, use of health-promotion activities such as regular exercise, annual check-ups. Nutritional-Metabolic Pattern of food and fluid consumption relative to metabolic need and pattern; indicators of local nutrient supply. Condition of skin, teeth, hair, nails, mucous membranes; height and weight. Elimination Patterns of excretory function (bowel, bladder, and skin). Includes client's perception of normal" function. Frequency of bowel movements, voiding pattern, pain on urination, appearance of urine and stool. Activity - Exercise Patterns of exercise, activity, leisure, and recreation. Exercise, hobbies. May include cardiovascular and respiratory status, mobility, and activities of daily living. Cognitive-Perceptual Sensory-perceptual and cognitive patterns. Vision, hearing, taste, touch, smell, pain perception and management; cognitive functions such as language, memory, and decision making. Sleep-Rest Patterns of sleep, rest, and relaxation. Client's perception of quality and quantity of sleep and energy, sleep aids, routines client uses. Self-Perception/

Self Concept Client's self-concept pattern and perceptions of self. Body comfort, body image, feeling state, attitudes about self, perception of abilities, objective data such as body posture, eye contact, voice tone. Role-Relationship Client's pattern of role engagements and relationships. Perception of current major roles sand responsibilities (e.g., father, husband, salesman); satisfaction with family, work, or social relationships. Sexuality-Reproductive Patterns of satisfaction and dissatisfaction with sexuality pattern; reproductive pattern. Number and histories of pregnancy and childbirth; difficulties with sexual functioning; satisfaction with sexual relationship. Coping / Stress Tolerance General coping pattern and effective of the pattern in terms of stress tolerance. Client's usual manner of handling stress, available support systems, perceived ability to control or manage situations. Value - Belief Patterns of values, beliefs (including spiritual), and goals that guide client's choices or decisions. Religious affiliation, what client perceives as important in life, value-belief conflicts related to health, special religious practices. IV. PATHOPHYSIOLOGY Neglectful Parenting

Decrease in self esteem (the patient thinks he is not being cared off or he does not feel the love of his parents)

depression

isolation confussion hallucination inconsistent answers

VI. DRUG STUDY DRUG ACTION INDICATION CONTRAINDICATION SIDE/ADVERSE EFFECT NURSING RESPONSIBILITY BRAND NAME: thorazine GENERIC NAME Chlorpromazine Dosage: 100 mg tab TID CLASSIFICATION Therapeutic: Antiemetics Pharmacological: PHENOTHIAZINES

Alters the effect of dopamine in the CNS.Has significant anti cholinergic/alpha adrenergic blocking activity. THERAPEUTIC

Diminished signs/symptoms of psychosis.Relief of nausea and vomiting/intractable hiccups.Decreased symptoms of porphyria. Second line treatment for schizophrenia and psychosis after failure with atypical anti-psychotics. Hypersensitivity Increased Neuroleptic malignant Syndrome SIDE EFFECT Neuroleptic malignant syndrome Extrapyramidal reactions Tardive dyskinesia Blurred vision Dry eyes Hypotension Constipation Dry mouth Anorexia Urinary retention Photosensitivity Pigment changes Rashes Inform patient of possibility of extrapyramidal symptoms and tardive dyskenisia.Instruct patient to report these symptoms immediately to health care professional Advise patient to change positions slowlt to minimize orthostatic hypotension Instruct patient to use frequent mouth rinses ,good oral hygiene and sugarless gum or candy to minimize dry mouth continues VII. NURSING PROCESS ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC EXPLANATION PLANNING INTERVENTION RATIONALE EVALUATION Subjective: May asawat anak ako sa labas as verbalized by the patient. Objective: Answers questions inconsistent Unable to distinguish fantasy from reality Confusion for some time hallucination Altered thought process related to compromised thinking ability Low self esteem

Depression

Hallucination

Short term goal After 20-30 minutes of nursing intervention the patient will be able to: Distinguish reality from fantasy Memory is intact No hallucinations Long term goal After 2-3 months of nursing intervention the patient will be able to: Manifest no signs of altered thinking Establish rapport

Assess level of mental status Present reality

Use therapeutic communication

Involve him to recreational activity To be able to gather appropriate and reliable data from the patient For the purpose of having a baseline data. The patient is having hallucinations The patient is avoidant and make secrets To increase self esteem