RIGHT LOWER LIMB CELLULITIS
P. Sreeja reddy
Hno: 170620882023
Submitted to : Dr. Hajeera fatima
RBVRR Women’s college of pharmacy
INTRODUCTION
Definition : Cellulitis is an acute inflammatory
condition of the dermis and subcutaneous tissue
usually found complicating a wound, ulcer or
dermatosis.
Spreading and pyogenic in nature, it is characterized
by localized pain, erythema, swelling and heat.
The involved area, most commonly on the leg, lacks
These distinctive features create what is known as a
“Peau d’orange “appearance
ETIOLOGY
● Staphylococcus aureus (S. aureus) and Streptococcus
pyogenes (S. pyogenes), or by a wide variety of exogenous
bacteria
● Bacteria gain entry into the body in many ways: breaks in the
skin, burns, insect bites, surgical incisions and intravenous (IV)
catheters are all potential pathways. S. aureus cellulitis starts
from a central localized infection and spreads from there
● Cellulitis is also seen in patients with chronic lymphedema
resulting from elephantiasis, Milroy’s disease or lymph node
dissection such as that associated with mastectomy.
● Haemophilus influenzae was once a major pathogen in facial
cellulitis in young children
● Pasteurella multocida is the pathogen in cellulitis associated
with animal bites,
CLINICAL MANIFESTATIONS
● Fever with chills and sweating
● FatiguePain 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 area of redness
● Muscle aches and joint stiffness from swelling of the tissue over the joint
● Nausea and vomiting
PATHOPHYSIOLOGY
LABORATORY TESTS
1. Cultures should be collected when possible.
2. A Gram stain of fluid obtained by injection and aspiration
of 0.5 mL of saline (using a small 22-gauge needle) into
the advancing edge of the lesion may aid the
microbiologic diagnosis but often yields negative results.
3. Diagnosis usually is made on clinical grounds, i.e., the
appearance of the lesion.
OTHER DIAGNOSTIC TESTS
HISTORY COLLECTION
PHYSICAL EXAMINATION
CBC : complete blood count frequently is performed because
leukocytosis is common.
CULUTURE & SENSITIVITY : Bacteremia may be present in
as many as 30therefore,
blood cultures may be useful for diagnosis in some bacteria
Treatment
SOAP ANALYSIS
SUBJECTIVE DATA
A 70 years old female patient joined in General Medicine
department with Cheif complaints of Fever from the mrng of day
admitted , Right leg swelling , Pain in Right leg , High spike of
chills
, SOB and has past medical history of hypothyroidism and past
medication history contains thyronorm tablets 25micrograms once
daily
HAEMATOLOGY :
OBJECTIVE DATA
Hb : 9.52 g/dl
Rbc count : 3.97 × 10⁶ / mm³
Wbc count : 12.56 × 10³/mm³
Platelet count : 2.68 ×10³/mm³
Haematocrit: 33.4%
BIO CHEMISTRY :
Blood urea : 44 mg/dl
Serum creatinine : 0.80 mg/dl
ELECTROLYTES:
Na+: 136.5 mmol/L
K+:3.05 mmol/L
Ca+² : 1.162 mmol/L
Cl-: 103.2 mmol/L
DIAGNOSIS
1. Physical tests are performed and erythmatous skin with deep lesions are
appeared
2. Blood test and skin test is done
ASSESSMENT
By the thorough study of
Subjective data
1. Swelling of right leg is due to edema
2. High spike of chills is due to elevated body
temperature
Objective data
3. Decreased hb due to low iron in body
4. Increased blood urea is due to dysfunction of kidney
5. and by performing some physical tests it’s been DIAGNOSED as
RIGHT LOWER LIMB CELLULITIS
PLAN
Sno. Brand Generic ROA Dose Frequenc Category
name name y
1. Pantocid Pantoprazole IV 400mg BD Protein pump
inhibitor
2. Inj Clindamycin IV 300mg TID Antibiotic
Dalcinex
3. Inj Ondansetron IV 4ml TID Antuemetic
Emecet
4. Inj Piperacilin& IV 4.5mg TID Antibiotic
pybactum Tazobactum
5. Inj Clindamysin IV 600mg TID Antibiotic
Clindum
6. Inj Vit.B xomplex IV 3ml OD Multivitamin&
Optineuron multimineral
7. Syr Kcl oral PO 200ml OD Kcl
8. Inj Meropenum IV 1g OD Antibiotics
Zaxter
9. Inj. Meropenum IV 1g BD antibiotics
Meonem
10. Inj Gabapentin IV 300mg BD Anticonvuls
Gabatin & ant
methylcobal
amine
11. Tab. Thyroxine PO 25ųg OD Thyroid
Thyronorm solution agents
12. Tab. Amitriplyline PO 25mg OD Antidepress
Tryptomer hydrochlorid ants
e
13. Tab. Paracetamo PO 650mg OD NSAID
Dolo-650 l
14. Inj.mwx Enoxaparin IV 0.4ml OD Anticoagula
solution nt
DRUG INTERACTIONS
Major :
Piperacilin + Enoxaparin ( Piperacilin increases the effect of
Enoxaparin )
Ondansetron + Amitriptylin ( Either increases of other by increase
in serotonin levels )
Monitor closely:
Gabapentin+ Amitriptylin ( synergistic effect )
Pharmacist interventions
● Tab. Tryptophan is given without need
● Tab. Gallatin is given without Need
22
PATIENT COUNSELLING
ABOUT DISEASE : Cellulitis is a common bacterial skin
infection that causes redness, swelling, and pain in the
infected area of the skin. If untreated, it can spread and cause
serious health problems.
ABOUT MEDICATION : Mild cellulitis can be treated
with oral antibiotics, including penicillin, cephalosporins
(e.g., cephalexin), dicloxacillin, or clindamycin. If signs of
systemic infection are present, then intravenous antibiotics
DISCHARGE MEDICATION
Tab. Zocef -CV - 500mg -BD - After food - 5 days
Tab. Dolacin- 600mg -BD - After food - 5 days
Tab. Enzoflam - 1 Tab-BD - After food - 5 days
Tab.Nexpro - 40 mg - OD - Empty stomach - 10 days
Floracamp sachets - 1 sachet to be mixed with a glass of water &
taken after food - 15 days
Province HP - 2 scoops To be mixed with a glass of water or milk
- 15 days before sleep
CARE AT HOME
Home treatments
Over-the-counter creams: Vitamin A or E creams can help reduce the appearance of
skin discoloration and boost overall skin health.
⚫ Lemon juice: Apply lemon juice twice per day to lighten skin areas that have
darkened. This may reduce the appearance of discolored skin patches in six to eight
weeks.
Castor oil: Apply castor oil to discolored areas twice per day, or wear a bandage
soaked in castor oil overnight. This can help smooth the skin and break down
excess melanin.
Vitamin C: Eat foods rich in vitamin C, an essential nutrient for skin health. Fruits
high in vitamin C include cantaloupe, oranges, and pineapple.
THANK YOU …. !!
