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2.  INTRODUCTION
The term cellulitis is commonly used to indicate a non-necrotizing inflammation of the
skin and subcutaneous tissues, a process usually related to acute infection that does not involve
the fascia or muscles. Cellulitis is characterized by localized pain, swelling, tenderness,
erythema, and warmth.
Cellulitis has been classically considered to be an infection without formation of abscess
(nonpurulent), purulent drainage, or ulceration. At times, cellulitis may overlap with other
conditions, so that the macular erythema coexists with nodules, areas of ulceration, and frank
abscess formation (purulent cellulitis) (see Presentation). The following images illustrate some of
these presentations.
Streptococcal species are the most common causes of erysipelas and diffuse cellulitis or
nonpurulent cellulitis that is not associated with a defined portal.S aureus is the usual causative
organism in purulent cellulitis associated with furuncles, carbuncles, or abscesses.
The typical symptoms of cellulitis is an area which is red, hot, and painful. The photos
shown here of cellulitis are of mild cases, and are not representative of earlier stages of the
condition.

3. I. HEALTH HISTORY
A. Demographic (Biographical) Data
A. Client’s Name or Initial: M.E
B. Gender (Sex) : Male
C. Age: 57 years old
D. Admission Date: 08/04/2013
E. Time Admitted: 12:53 pm
F. Admitting Diagnosis: Cellulitis Right leg, Hypertension Stage 2 Uncontrolled
B. Source and Reliability of Information
o The sources of information are the patient’s chart, the staff nurses, and the client
himself,
C. Reasonfor Seeking Care
o The patient experience non-healing wound at his bilateral feet.
D. History of Present Illness
o Patient M.E. was admitted to St. Dominic Medical Center last August 4 2013 with the
chief complaint of non-healing wound at his bilateral feet.
E. Past Medical History
o 2 months prior to admission the patient has history of non-healing wound at his left
lower leg.
F. Family History
 The mother of the patient was deceased because of heart attack and his father is also
deceased.
G. Socio-Economic
o The client didn’t smoke nor drinks alcohol.
o He is a chief in a college institute.
H. Developmental History
 Erick Erickson’s Psychosocial Development Theory
o Stage: Generativity vs. Stagnation(40 to 65 years)
The client loves to be in his work.
“Gustong-gusto koang mag luto” as verbalized by the patient.

4. I. Review of Systems
1. Regional Examination – August 6, 2013
System Normal Findings Actual Findings
 General
BP: 90-140/60-90mmHg
PR: 60-100bpm
RR: 12-20cpm
T: 36-37.5
BP: 140/80 mmHg
PR: 89bpm
RR: 20cpm
T: 36
 Integumentary
Dry skin
(+) Redness and swelling on
the right lower leg
(+) scaly lesion on bilateral
feet
 Head
 Eyes
 Nose
 Ears
 Mouth & Throat:
 Neck
 Breast & Axillae
 Respiratory
 Cardiovascular (+) Hypertension
 Gastrointestinal
 Urinary
 Genitalia
 Musculoskeletal
 Neurologic
 Endocrine
(+) increase blood glucose
level.

5. 2. Laboratory Studies / Diagnostics
CBG Monitoring – August 5, 2013
Exam Time Result Significance
CBG, Hgt, Rbs 2:15 pm 182 mg/dL
The patient has elevated
blood glucose that indicates
hyperglycemia.
Blood Chemistry—August 5, 2013
Exam Reference Result Significance
FBS 74.00-106.00 mg/dL 156.0 mg/dL
The patient has elevated
blood sugar.
Impaired fasting blood
glucose.
HbA1C Test--August 4, 2013
Test Reference Result Significance
HbA1C 4.8-5.9% 6.26%
The patient has elevated
HbA1C which means he is at
risk for Diabetes.

6. J. Functional Assessment
* Health Perception and Health Management
The client has the awareness that he is going to be okay.
* Nutritional and Metabolic Pattern
The client was on the low salt low fat diet, but he loves to eat fatty foods.
* Elimination pattern (while confined)
The patient defecates one time a day and be able to urinate regularly with the color of
light yellow.
* Activities of daily living (ADL) (while confined)
The client verbalized that he can eat independently and can dress himself properly
without a need of any assistance as well as in bathing. He usually sleeps around 9 o’clock in the
evening and wake up at 7am, he also have afternoon nap for two hours. He also loves to cook.
* Activities Tolerance-Exercise pattern (while confined)
Patient was able to ambulate around without assistance;he was able to dress and eat on
his own.
* Sleep rest pattern (while confined)
The client doesn’t have difficulty in sleeping. He normally sleeps at 9 pm and wake up at
7 am, he also sleep during morning and afternoon.
* Cognitive-Perception (while confined)
The patient can speak fluently and understand fully in Tagalog. He is oriented with the
time, people surround him and place. He can answer the questions that were given to him. He is
also aware of his conditions and to his medications.
* Role-Relationship Pattern (while confined)
The client is nice and easy to get along with, he also actively participate to the procedures
that are given to him.

7. II. PATHOPHYSIOLOGY
StaphylococcusAureus
enterstothe open wound
Precipitating Factor:
Open sound of the fight
foot.
Predisposing Factors:
Age
Gender
Redness of the right
lower leg
Infection of connective
tissue
Scaly lesions at the
bilateral feet
Inflammation of dermal
and subcutaneous layer
of the skin

8. III. CONCEPT MAPPING
Key Demographic Data:
Clients initial: M.E.
Age: 57yo
Gender: Male
Assessment of Patient:
Increased blood sugar level
With Hypertension
With scaly lesions at bilateral feet.
Redness of the right lower leg.
Key Assessments:
Bp: 140/ 80
RR: 20
PR: 89
Temp: 36
FBS= 156.0 mg/dL
CBG=182 mg/dL
HbA1C= 6.26%
Problem no. 3
Imbalance Nutrition: More than
Body requirements r/t lifestyle.
Problem no.1
Unstable Blood Glucose level
r/t insulin deficiency.
Problem no. 2
Impaired Skin Integrity r/t slow
wound healing at the bilateral
feet.

9. IV. PROBLEM LIST
a. ACTUAL or active
Problem No. Problem Remarks
1
Unstable Blood glucose level r/t insulin
deficiency.
The patient will be able to
maintain glucose level in
satisfactory range.
2 Impaired Skin Integrity r/t slow wound
healing at the bilateral feet.
The patient will be able to
display timely wound healing.
3 Imbalance Nutrition: More than Body
requirements r/t lifestyle.
The patient will identify
appropriate foods that are
needed by his body.

10. V. NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Evaluation
S: no verbal
cues.
O:
 Vital
signs
BP: 140/80
PR: 89
RR: 20
Temp: 36
 CBG of
182
mg/dL
 FBS of
156.0
mg/dL
 HbA1C
of
6.26%
Unstable
Blood
glucose
level r/t
insulin
deficiency.
After 8 hours of
nursing interventions
the patient will be able
to maintain glucose
level in satisfactory
range.
Independent:
 Monitored vital
signs and
recorded.
 IandO taken
and monitored.
 Encouraged
low salt low fat
diet.
 Assessed
patient
condition.
 Kept rested.
 Encouraged
verbalization of
feelings.
Dependent:
 Monitored
CBG.
After 8 hours of nursing
interventions the patient
wasn’t able to monitor
CBG.

11. Assessment Diagnosis Planning Intervention Evaluation
S:
“Patuyonay
ungsugat,
hindina din
siyamasakit
” as
verbalized
by the
patient.
O:
 Vital
signs
BP:140/80
PR: 89
RR: 20
T: 36
 Elevated
affected
leg.
 With
scaly
lesions
at
bilateral
feet.
 With
redness
at right
lower
leg.
Impaired
Skin
Integrity r/t
slow
wound
healing at
the bilateral
feet.
After 8 hours of
nursing interventions
the patient will display
timely wound healing.
Independent:
 Monitored vital
signs and
recorded.
 IandO taken
and monitored.
 Kept affected
leg elevated.
 Kept rested
 Provide calm
and safe
environment.
 Health teaching
on proper hand
hygiene.
Dependent:
 Administered
medications as
prescribed by
the physician.
After 8 hours of nursing
interventions the patient
displayed timely wound
healing.

12. Assessment Diagnosis Planning Intervention Evaluation
S:
No verbal
cues
O:
 Triceps
skin
fold
 Observ
ed
dysfunc
tional
eating
pattern.
Imbalance
Nutrition:
More than
Body
requiremen
ts r/t
lifestyle.
After 6 hours of
nursing interventions
the patient will identify
appropriate foods that
are needed by his
body.
Independent:
 Assist clients
understanding.
 Discussed
necessity for
decreased
caloric intake
and limited
intake of fats,
salt and sugar
as indicated.
 Encouraged the
client to
maintain a
daily dietary
food intake.
 Discussed the
client about the
appropriate
food selection.
 Encouraged on
low salt low fat
diet.
Dependent:
 Refer to
dietician.
After 6 hours of nursing
interventions the patient
identified appropriate
foods that are needed by
his body.

13. VI. PHARMACOTHERAPEUTICS/MEDECINES
Generic
Name(Brand
Name)
Indication Dosage
& Frequency
Mechanism of
Action
Side Effects Nursing
Responsibilities
Losartan
Potassium
(Cozaar)
Classification:
Angiotensin II
Antagonist
 For patient
with
hypertension.
Reduction in
the risk for
cardiovascular
morbidity and
mortality in
hypertensive
patients.
 50 mg/tab,
1 tab PO OD
blocks
vasoconstrictor
and aldosterone
producing
effects of
angiotensin II
atreceptor sites,
including
vascular
smooth muscle
and the adrenal
glands
 Generally
well
tolerated
 Dizziness
 Monitor for blood
pressure
 Monitor for intake
and output ratios
and daily weight.
 Assess for signs
and symptoms of
Hypotension
 Instruct patient to
have a low fat low
sodium diet
regimen
 Monitor BUN and
serum creatinine
levels
 Monitor for signs
of hyperkalemia

14. Generic
Name(Brand
Name)
Indication
Dosage &
Frequency
Mechanism of
Action
Side Effects Nursing
Responsibilities
Sulbactam+Am
picillin
(Unasyn)
Classification:
Anti-infectives
 For skin and
soft tissue
infections.
 750 mg, IV
Q8
Binds to
bacterial cell
wall, resulting
in cell death.
Addition of
sulbactam
increasesresista
nce to Beta-
lactamases,
enzymes
produced by
bacteria that
may
inactivateampic
illin.
 GI
disturbances
 Skin rashes
 itching
 Assess patient
for infection at
beginning and
throughout
course of
therapy.
 Obtain a history
before initiating
therapy to
determine
previous use
and reactions
topenicillins or
cephalosporin
 Observe patient
for signs and
toms of
Anaphylaxis.
Discontinue the
drug andnotify
the physician
immediately if
these occur.

15. Generic
Name(Brand
Name)
Indication
Dosage &
Frequency
Mechanism of
Action
Side Effects Nursing
Responsibilities
Celecoxib
(Celebrex)
Classification:
Analgesics
 For acute pain
 400mg 1 cap
PO OD
Celebrex is a
nonsteroidal
anti-
inflammatory
drug (NSAID)
that exhibits
anti-
inflammatory,
analgesic and
antipyretic
activities in
animal models.
It inhibits the
prostaglandin
synthesis,
primarily via
the inhibition
of
cyclooxygenas
e-2 (COX-2).
 Dry mouth
 Dysphagia
 Skin
exfoliation
 Take drug with
food or meals if
GI upsetoccurs.
 Take only
theprescribed
dosage; donot
increase dosage.
 You may
experiencethese
side
effects:Dizzines
s, drowsiness

16. VII. ONGOING APPRIASAL
A 57 years old male patient was admitted last August 4, 2013 with a chief
complaint of non-healing wound at his bilateral feet. He was diagnosed with Cellulitis Right
leg, Hypertension Stage 2 Uncontrolled. He underwent several test like CBG monitoring,
Blood Chemistry, Fasting blood sugar, and HbA1C test. His attending physician prescribed
Unasyn as his antibiotic, Losartan, to manage his hypertension and Celecoxib as his
analgesics. As a student nurse, I monitored his vital signs and Intake and output, I also
administered his medications. The client has adequate knowledge about his condition; he also
actively participates in the procedures that are given to him.

17. BIBLIOGRAPGHY
Online Recourses
http://labtestsonline.org/understanding/analytes/glucose/tab/test#what
http://medweb.bham.ac.uk/easdec/prevention/what_is_the_hba1c.htm
http://www.scribd.com/doc/13325843/Common-Lab-ValuesABG-CBG-Urinalysis-Mechanical-Testing
Book Resources
Marilyn E. Doenges, Mary Frances Moorhouse, Alice C. MurrNursing Care Plans 8th
EditionDavi's Nursing Resource Center
Philippine Pharmaceutical Directory 11th Edition