Assessment
The assessment process is vital. An accurate, clear history and timeline that details the start of symptoms from the patient and/or carer assists with a correct diagnosis that enables safe and effective treatment.
(Sutherland & Parent, 2017)
- When did it start?
- How did it start/how do you feel?
- Fever/headache/night sweats
- General malaise
- Where did it manifest first?
- Skin condition
- Skin breaches; trauma, insect bites, tinea, recent surgery
- Identify entry site – may be visible but may need to question patient about recent activities such as gardening etc. to identify entry route
- Mark area suspected and check for spreading inflammation or erythema
- Monitor pain level - patient may describe intense pain which increases as infection spreads
- Check for signs of oedema - as infection increases, limbs may become swollen and oedematous
- Check for blistering
- Monitor blood results – CRP will be increased when there is inflammation in soft tissues and white cell count will be raised when infection is present
(Beldon, 2011; Sutherland & Parent, 2017; CKS NICE, 2023)
As part of the comprehensive assessment, comorbidities and risk factors should be taken into consideration.
- Skin conditions of the lower legs such as:
- gravitational eczema
- leg ulcers
- lymphoedema
- tinea
- trauma
- Previous episodes of cellulitis
- Obesity
- Immunocompromised patients
- Chronic disease such as:
- diabetes mellitus
- chronic liver disease
- renal disease
- Pregnancy
(Sutherland & Parent, 2017; PCDS, 2023)