Cellulitis

2. Diagnosis: Cellulitis

3. Condition:

4. Vital signs: tid. Call physician if BP <90/60; T >38.5°C

6. Nursing: Keep affected extremity elevated; warm compresses prn.

7. Diet: Regular, encourage fluids.

8. IV Fluids: Heparin lock with flush q shift.

9. Special Medications: Empiric Therapy Cellulitis

-Nafcillin or oxacillin 1-2 gm IV q4-6h OR

-Cefazolin (Ancef) 1-2 gm IV q8h OR

-Vancomycin 1 gm q12h (1 gm in 250 cc D5W over 1h) OR

-Erythromycin 500 IV/PO q6h OR

-Dicloxacillin 500 mg PO qid; may add penicillin VK, 500 mg PO qid, to increase coverage for streptococcus OR -Cephalexin (Keflex) 500 mg PO qid.

Immunosuppressed, Diabetic Patients, or Ulcerated Lesions:

-Nafcillin or cefazolin and gentamicin or aztreonam. Add clindamycin or metronidazole if septic. -Cefazolin (Ancef) 1-2 gm IV q8h. -Cefoxitin (Mefoxin) 1-2 gm IV q6-8h.

-Gentamicin 2 mg/kg, then 1.5 mg/kg IV q8h or 7 mg/kg in 50 mL of D5W

over 60 min IV q24h OR aztreonam (Azactam) 1-2 gm IV q6h PLUS -Metronidazole (Flagyl) 500 mg IV q8h or clindamycin 900 mg IV q8h. -Ticarcillin/clavulanate (Timentin) (single-drug treatment) 3.1 gm IV q4-6h. -Ampicillin/Sulbactam (Unasyn) (single-drug therapy) 1.5-3.0 gm IV q6h. -Imipenem/cilastatin (Primaxin) (single-drug therapy) 0.5-1 mg IV q6-8h.

10. Symptomatic Medications: -Acetaminophen/codeine (Tylenol #3) 1-2 PO q4-6h prn pain.

11. Extras: Technetium/Gallium scans, Doppler study (ankle-brachial indices)..

12. Labs: CBC, SMA 7, blood C&S x 2. Leading edge aspirate for Gram stain, C&S; UA, antibiotic levels.

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