I will present a brief overview of my case scenario in my presentation. Here, I’ll discuss my clinical findings of the patient based on my objective and subjective examination. Next, I will explain the nursing interventions that I used in managing this patient and give a detailed description of lessons that I learned during this research, after which I will explain different interventions that I would use if I were to care for this patient again. Finally, I’ll explain obstacles that may have or do prevent the provision of evidence-based care for the patient.
My selected patient was a 60-year-old female patient with cellulitis. She presented to the facility with a recurrent history of cellulitis, edema, and hypertension. She also had other co-morbidities, including diabetes, multiple sclerosis, bladder dysfunction, osteoporosis, and decreased bone density. The patient presented with severe pain in her left lower limb, localized swelling, and warmth. To ensure optimal treatment outcomes, I focused on delivering quality and convenient patient care.
To prevent the fast spread of the bacterial infection that causes cellulitis and its complications, which can become life-threatening if left untreated, nurses and other healthcare providers need to identify the signs and symptoms of cellulitis promptly and, after that, initiate the most effective treatment. To help minimize the complications and treat the underlying symptoms, I did the following interventions in the order listed below. Monitoring of the patient’s vital signs to establish if the infection was worsening or stabilizing, administration of incentive spirometry to health-improving the lung capacity, and deep breathing. However, I managed to do this intervention only once. However, I documented it on the patient treatment chart for the next nurse attending to the patient. I did a detailed assessment of the patient’s lower limbs for the clinical symptoms of cellulitis. To determine the prognosis of the disease and to establish if it was only localized in one leg or it was spreading to the other leg, I did close monitoring of the swelling in the leg. Administration of the prescribed medications was my next intervention, and my final intervention was monitoring signs of dehydration (Santer et al., 2018).
Evidence-Based Nursing Care
Better treatment outcomes are always associated with integrating the nursing care plan with the patient’s expectations, clinical experience, and best research evidence (evidence-based practice). Usually, the nursing care plan for cellulitis always begins with a detailed assessment. This includes both subjective and objective examinations. Nurses should always assess the patient to determine their past medical and surgical history, histories of trauma, and co-morbidities, and evaluate for the clinical features of the disease by doing a thorough physical examination. After the assessment, the next step is establishing a nursing diagnosis. The findings from the clinical study and clinical reasoning should always inform this diagnosis.
In this scenario, my nursing diagnosis was impaired tissue integrity, ineffective tissue perfusion due to edema, and severe pain. I, therefore, worked with this diagnosis to formulate the following treatment objectives. Timely treatment of cellulitis with antibiotics and pain medications to control pain, frequent monitoring of the vitals, minimization of related complications, and patient education.
After implementing the treatment plan as outlined, I finalized my patient care by evaluating the effectiveness of the project. I noticed that my patient maintained physical well-being, participated in treatment and preventive programs, and verbalized feelings of enhanced self-esteem (Sullivan et al., 2018).
Lessons Learned From The Research
From this research, I learned that cellulitis is an acute bacterial infection of the skin that spreads below the skin surface and is usually characterized by swelling, warmth (erythema), and pain. Typically, cellulitis can affect any body part; however, it mainly affects the lower limbs, especially near the ankle joint. Two main bacteria are known to cause cellulitis, and these are streptococci and staphylococcus aureus. This infection usually occurs when the bacteria mentioned above invade and release their toxins into the subcutaneous skin. Without prompt intervention, the bacteria can successfully multiply, leading to disease, which then triggers an immune response in the lower limbs and, thus, cellulitis. The entry point into cutaneous skin occurs through skin abrasions, a cut, or skin ulcers (Cannon et al., 2018).
The pathophysiology of cellulitis includes breaks in the skin such as fissures, cuts, insect bites, lacerations, or puncture wounds that cause the entry of bacterial infection into the skin. After the bacterial entry, they produce toxins that cause inflammation. The spread of this infection, however, is always exacerbated by certain pre-existing medical conditions, such as low immunity due to old age. My patient was 60 years old, and according to existing research and pieces of literature, the prevalence of cellulitis is higher in people older than 45 years. The patient had a history of recurrent cellulitis, hypertension, and localized edema. In her medical history, it was noted that she had a high risk of falls. This could potentially expose her to frequent skin injuries such as cuts, which would, in turn, act as a port of entry for the bacteria. Lastly, the patient also had diabetes.
The assessment process is very critical for the diagnosis of cellulitis. To help establish a correct diagnosis and to make a safe and most effective treatment, I learned that nurses ought to have a clear and accurate history taking with a precise timeline. In my patient, I asked the following questions to help me make my diagnosis. When and how did it start? Was it associated with fever, headache, or night sweats? Where did it first manifest, and what history of skin breaches, insect bites, or recent surgery? I also inquired if the patient had a history of existing skin conditions and co-morbidities such as diabetes or hypertension and if she was immunocompromised due to illness or treatment. I learned that the patient was predisposed to cellulitis due to her current medical state, having a history of diabetes, hypertension, multiple sclerosis, bladder dysfunction, and age-related osteoporosis. This weakened her immune system. These factors, alongside the presence of pathogens entry sites in the leg, made it easier for the patient to acquire the infection. I noted that despite being predisposed to the bacteria, improved awareness and management of the skin abrasions might harbor bacteria and thus reduce incidences of cellulitis. For instance, my patient stated that she had a history of multiple sclerosis, hypertension, bladder dysfunction, age-related osteoporosis, localized edema, and general body weakness. On physical examination, the patient had localized swelling, sharp pain in her left lower limb, fever, pus discharge, and flu-like symptoms. The patient, however, could not recall the medications she had been on (Cannon et al., 2018).
What I Might Do Differently If I Were to Care for This Patient Again
To improve patient care and service delivery, nurses must familiarize themselves with evidence-based practice. Since patient care provision requires a multidisciplinary approach, as a nurse attending to this patient, I would reinforce the need for the nurses to familiarize themselves with evidence-based practice by encouraging them to read more literature. I would also advise them to change their cultural course from traditional care “because we always do it like this” notion.
In addition to this, I will do health promotion and patient education to facilitate recovery and prevent re-occurrence. Health promotion also plays an important role in the prevention of cellulitis. Through health promotion, the patient can verbalize knowledge of the treatment regimen, including appropriate exercise and medications and their actions and potential side effects. Patient education will also help patients to identify lifestyle changes needed to increase tissue perfusion.
In my scenario, I advised my patient to gently wash her legs with soap and water daily and apply ointment and protective cream to offer adequate protection to the skin. I also educated the patient on effective ways to watch for signs of infections, such as pus, redness, and pain. In addition, I advised the patient to take extra preventive measures to minimize skin injuries and, finally, to inspect her feet for any daily damage and streaming of toenails and moisturize her skin (Dalal et al., 2017).
Barriers to Evidence-Based Practice
High quality and consistency in service delivery by nurses are highly dependent on their ability to apply evidence-based practice (a problem-solving approach) in their daily routines. This is, however, not the case. While conducting my research, I noticed that many nurses were unfamiliar with the principles of evidence-based practice, thus making them not utilize evidence-based practice effectively. I found out that the failure of nurses to practice evidence-based care was promoted by both human and organizational factors, such as lack of adequate recourses, lack of time to read the new pieces of literature, lack of experienced nursing staff in evidence-based practice, and heavy workload among the nurses.
Cannon, J., Dyer, J., Carpets, J., & Manning, L. (2018). Epidemiology and risk factors for recurrent severe lower limb cellulitis: A longitudinal cohort study. Clinical Microbiology and Infection, 24(10), 1084-1088. https://doi.org/10.1016/j.cmi.2018.01.023
Cannon, J., Raja Karuna, G., Dyer, J., Carpets, J., & Manning, L. (2018). Severe lower limb cellulitis: Defining the epidemiology and risk factors for primary episodes in a population-based case-control study. Clinical Microbiology and Infection, 24(10), 1089-1094. https://doi.org/10.1016/j.cmi.2018.01.024
Chen, L., Deng, H., Cui, H., Fang, J., Zou, Z., Deng, J., Li, Y., Wang, X., & Zhao, L. (2017). Inflammatory responses and inflammation-associated diseases in organs. Nontarget, 9(6), 7204-7218. https://doi.org/10.18632/oncotarget.23208
Collazo’s, J., Fuente, B. D., Garcia, A., Gomez, H., Menendez, C., Enriquez, H., Sanchez, P., Alonso, M., Lopez-Cruz, I., Martin-Regidor, M., Martinez-Alonso, A., Guerra, J., Arturo, A., Blanes, M., Fuente, J. D., & Asensio, V. (2018). 2368. Cellulitis in adult patients: A large, multicenter, observational, prospective study of 606 episodes, and analysis of the factors related to the response to treatment. Open Forum Infectious Diseases, 5(suppl_1), S705-S705. https://doi.org/10.1093/ofid/ofy210.2021
Dalla, A., Skin-Schwartz, M., Mimouna, D., Ray, S., Days, W., Hudak, E., Leibovich, L., & Paul, M. (2017). Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd009758.pub2
Jim, T., Amide, L. N., Gabor, V. N., Toucan, L. D., Kashif, S. S., & Houma, E. O. (2017). Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: A case-control study. BMC Infectious Diseases, 17(1). https://doi.org/10.1186/s12879-017-2519-1
Sinter, M., Lalonde, A., Francis, N. A., Smart, P., Hooper, J., Teasdale, E., Del Mar, C., Chalmers, J. R., & Thomas, K. S. (2018). Management of cellulitis: Current practice and research questions. British Journal of General Practice, 68(677), 595-596. https://doi.org/10.3399/bjgp18x700181
Sullivan, T. (2018, April 1). Diagnosis and management of cellulitis. RCP Journals. https://dx.doi.org/10.7861%2Fclinmedicine.18-2-160
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Oral presentation layout
Your oral presentation near the end of class will allow you to describe your case scenario and what you have learned from your research paper so that it can be shared with the class. Describe how the care you provided lined up with what you researched. What might you do differently if you were to care for this patient again? What obstacles were in your way that may have prevented you or the nurse from providing evidence-based care or within the realm of best practice guidelines?
Oral assignment guidelines
1. Presentations should be between 3-4 minutes in length.
2. You may have 1-2 minutes for questions from classmates afterward that are not included in this time.
3. The presentation must include visual aids or handouts for your classmates. You will have access to AV materials (ex. PowerPoint) if desired. Please let the instructor know ahead of time if there are any more advanced technological requirements for your presentation.
Grading rubric for presentation
Criteria Points possible
Impact of visual aids:
• Visual aids (PowerPoint/poster or pamphlet/handout) were effective, organized, and helpful 0-15
Critical thinking demonstrated by presentation:
• Presentation includes a description of the clinical scenario
• Should include nursing interventions provided
• Describe what they learned from research 0-25
Clarity/connection with audience:
• Ideas were clearly expressed, and sufficient eye contact was maintained with an audience of 0-25
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