Skin Infections — Cellulitis, Impetigo, Wound Infection — NCLEX Lesson A&P · Assessment · Integumentary · Skin Infections Condition Lesson · NCLEX-PN / NCLEX-RN

Bacteria break the barrier and spread. Cellulitis expands with poorly defined redness. Impetigo crusts honey-colored and highly contagious. Wound infection festers under dressings. All can become sepsis if missed.

In this lesson

Lesson Objectives
Why This Matters
Disease Overview
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Potential Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Differentiate cellulitis, impetigo, and wound infection by cause, appearance, contagiousness, and systemic risk and explain WHY.
Explain how bacterial invasion of epidermis/dermis causes erythema warmth edema pain fever purulent drainage and how impaired barrier and perfusion worsen infection.
Identify early, late, and emergency findings: expanding erythema, honey-crusted lesions, purulent drainage, lymphangitis red streaks, fever hypotension sepsis, necrotizing fasciitis pain out of proportion crepitus.
Prioritize care: cultures before antibiotics if indicated, mark border, elevate, warm vs cool compresses, contact precautions, hand hygiene, wound care moist healing vs infection.
Provide teaching for hygiene, antibiotic adherence, contagion prevention, wound care, and when to seek emergency.

Why This Disease Matters

Prevalence: Cellulitis 14.5 million cases yearly US, 650,000 hospitalizations, $3.7 billion cost. Impetigo most common bacterial skin infection in children 2-5 years, 8.4% of pediatric skin visits, highly contagious. Wound infections 1-3% of surgical incisions, 2% of all wounds, leading cause ED visits. MRSA community-associated skin infections rising 50% of purulent cellulitis.

Patient safety: Cellulitis can progress to necrotizing fasciitis, sepsis, osteomyelitis, endocarditis, lymphangitis. Untreated impetigo → post-streptococcal glomerulonephritis 1-3 weeks later tea/cola urine + periorbital edema + HTN, and rheumatic fever. Wound infection → dehiscence evisceration sepsis. MRSA spreads in household, school, daycare. Inappropriate antibiotics fuel resistance. Missed red streaks lymphangitis = spreading infection.

NCLEX importance: Highly tested infection control and skin. Cellulitis: poorly defined expanding erythema warmth edema tenderness + fever + leukocytosis + mark border + elevate + warm compresses? Actually for cellulitis warm? No, cool compress comfort? Warm may increase circulation for some but for cellulitis elevate and cool? For inflammation warm compresses increase circulation but for cellulitis often warm compress not recommended if acute? Teaching: mark border with pen measure circumference, elevate above heart to reduce edema, antibiotics per culture, no massage, hand hygiene, standard precautions + contact if draining. Impetigo: honey-colored crusts face around mouth nose highly contagious contact precautions, wash lesions with soap water, topical mupirocin if localized, oral if widespread, keep child home 24h after antibiotics, no sharing towels. Wound infection: purulent yellow green drainage foul odor periwound erythema induration warmth swelling fever + cultures before antibiotics but antibiotics within 1hr if sepsis, hand hygiene, sterile technique.

Why nurses encounter them: ED with leg cellulitis, pediatrics impetigo daycare, med-surg post-op wound infection, home health dressing changes, LTC. Nurses prevent spread, assess, mark, teach.

Connecting to prior lessons From A&P: Epidermis avascular barrier, dermis vascular collagen pain receptors. Infection breaks barrier → bacteria invade. From assessment: color redness erythema inflammation, temperature hot localized infection, cap refill, edema pitting, turgor, pain 0-10, Braden moisture risk. Wound healing inflammatory phase redness warmth swelling pain normal but increasing after 3-5 days = infection.

Disease Overview

Condition	What it is	Barrier affected	Core problem
Cellulitis	Acute bacterial infection of dermis and subcutaneous tissue — Streptococcus pyogenes Group A strep and Staphylococcus aureus including MRSA	Dermis + subQ	Bacteria enter break skin → spread through lymphatics → poorly defined expanding erythema warmth edema tenderness fever lymphangitis red streaks risk sepsis necrotizing fasciitis
Impetigo	Highly contagious superficial bacterial infection of epidermis — S. aureus and Strep pyogenes, bullous and non-bullous	Epidermis only superficial	Honey-colored crusts face around mouth nose, bullous form large fragile bullae, itchy not painful, spreads by contact autoinoculation, child 2-5 years, risk post-strep GN 1-3 weeks later
Wound infection	Infection of surgical or traumatic wound — bacteria >10^5, purulent drainage, periwound erythema induration warmth swelling	Epidermis dermis subQ deeper	Contamination → colonization → infection → delayed healing dehiscence evisceration sepsis

Pathophysiology

Normal physiology: Intact skin barrier epidermis avascular + dermis vascular, acid mantle pH 4-6 inhibits bacteria, Langerhans cells immune, sebum antimicrobial, normal flora. Wound healing inflammatory 0-5 days redness warmth swelling pain normal neutrophils macrophages clean. ↓ What goes wrong — Cellulitis: Break in skin cut abrasion insect bite tinea pedis crack between toes → Group A strep and/or S. aureus enter → invade dermis and subQ lymphatics → toxins enzymes spread → inflammatory response vasodilation ↑ blood flow → erythema poorly defined expanding border (WHY lymphatic spread not localized), warmth hot localized increased blood flow, edema swelling fluid leak, pain tenderness nerve irritation, fever systemic cytokines, leukocytosis WBC ↑. Lymphangitis red streaks from site toward lymph nodes = spreading via lymphatics emergency. WHY lower leg most common: poor venous lymphatic drainage edema + tinea pedis cracks. ↓ What goes wrong — Impetigo: S. aureus and Strep pyogenes produce exfoliative toxins → epidermis superficial blisters → rupture → honey-colored crusts dried serum (WHY honey-colored: dried exudate). Highly contagious direct contact fomites autoinoculation scratching spreads. Bullous impetigo S. aureus exfoliative toxin A large fragile bullae. Non-bullous most common small vesicles → rupture → honey crusts. Itchy not painful, face around mouth nose. WHY children 2-5: close contact poor hygiene. Risk post-strep GN 1-3 weeks after Strep pyogenes immune complexes deposit glomerulus → low C3 tea/cola urine periorbital edema HTN. ↓ What goes wrong — Wound infection: Contamination bacteria present, colonization bacteria multiply no systemic signs, infection bacteria >10^5 invade tissue → delayed healing. Surgical site infection within 30 days. Signs purulent yellow green brown drainage foul odor, periwound erythema >0.5cm induration warmth swelling pain increased, wound enlarges, dehiscence edges separate, evisceration organs protrude emergency, fever tachy hypo sepsis. WHY: bacteria produce toxins impair collagen increase metabolic needs. ↓ Progression: Cellulitis → lymphangitis red streaks → bacteremia → sepsis → necrotizing fasciitis pain out of proportion crepitus bullae → osteomyelitis if over bone → endocarditis. Impetigo → post-strep GN 1-3 weeks tea/cola periorbital edema HTN. Wound infection → dehiscence evisceration sepsis.

Risk Factors

Non-modifiable	Modifiable / Preventable	High-risk populations
Age very young impetigo 2-5 and elderly thin fragile poor perfusion, chronic venous insufficiency lymphedema	Break in skin cut abrasion insect bite tinea pedis athlete's foot cracks between toes, poor hygiene, sharing towels razors, nasal carriage S. aureus, obesity edema, diabetes hyperglycemia impairs WBC collagen, vascular disease PVD venous stasis edema, smoking, immunocompromise steroids chemo HIV, IV drug use, poor nutrition protein <0.8g/kg, moisture incontinence MASD, shaving trauma	Children daycare impetigo, athletes wrestling, elderly LTC edema venous insufficiency, diabetics PVD, immunocompromised, homeless poor hygiene, IV drug users, post-op surgical patients

Signs and Symptoms

Category	Finding & WHY
Early — cellulitis	Poorly defined expanding erythema redness (WHY vasodilation inflammatory spread via lymphatics), warmth hot localized (WHY increased blood flow), edema swelling (WHY fluid leak), tenderness pain (WHY nerve irritation), mild fever. WHY lower leg common: venous stasis edema + tinea pedis cracks.
Early — impetigo	Small vesicles → rupture → honey-colored crusts dried serum (WHY dried exudate) around mouth nose face, itchy not painful, bullous form large fragile bullae S. aureus toxin, no fever usually.
Early — wound infection	Increasing pain after 3-5 days normally pain decreasing, purulent yellow green brown drainage (WHY WBCs dead bacteria), foul odor (WHY anaerobic bacteria), periwound erythema >0.5cm induration warmth swelling (WHY inflammation).
Expected — cellulitis	Poorly defined expanding erythema warmth edema tenderness, fever 100.4-102F chills malaise, leukocytosis WBC ↑, lymphadenopathy tender nodes, mark border enlarges. WHY: bacterial toxins spread lymphatics.
Expected — impetigo	Honey-colored crusts face contagious, bullous large bullae, itchy, no scar unless scratched deep, spreads by contact autoinoculation.
Expected — wound infection	Purulent drainage yellow green brown foul odor, periwound erythema induration warmth swelling, wound enlarges, delayed healing, fever, dehiscence edges separate.
Late / worsening	Lymphangitis red streaks from wound toward heart (WHY lymphatic spread) emergency, increasing erythema despite antibiotics, bullae, abscess fluctuant collection needs I&D, fever persists.
Emergency	Necrotizing fasciitis: pain out of proportion + rapid spread + hot erythematous swollen + fever + crepitus + bullae + hypotension tachy confusion oliguria = emergency surgery. Sepsis: fever >101 or hypo <95 tachy >100 tachypnea >22 hypo <90 confusion oliguria wound foul odor purulent. Evisceration: wound dehiscence organs protrude pink loop emergency moist sterile saline dressing no push back. Post-strep GN 1-3 weeks after impetigo Strep: tea/cola urine periorbital edema HTN oliguria BUN/Cr ↑ low C3.

Red flags Red streaks lymphangitis from site toward lymph nodes = spreading infection emergency. Pain out of proportion + crepitus + bullae + rapid spread + hypo + confusion = necrotizing fasciitis emergency surgery. Honey-crusted impetigo highly contagious contact precautions. Wound dehiscence organs protrude = evisceration moist sterile saline dressing no push back call surgeon STAT. Post-strep GN 1-3 weeks after impetigo Strep tea/cola periorbital edema HTN oliguria.

Nursing Assessment

Subjective: onset duration when redness crusts drainage started, location size change expanding, pain 0-10 itch, fever chills, drainage amount color odor, recent break skin cut bite tinea pedis, trauma surgery, sick contacts daycare school, hygiene sharing towels, PMH diabetes PVD venous insufficiency lymphedema prior cellulitis, immunocompromise steroids chemo HIV, allergies meds especially sulfa, tetanus history, nutrition protein intake, smoking alcohol, occupation exposure.

Objective: vitals temp fever infection, HR tachy sepsis pain, BP hypo sepsis, RR SpO2, pain 0-10 itch 0-10, weight BMI, I&O, labs. Skin: color erythema extent poorly defined vs well defined measure circumference, mark border with pen date time to track spread, temperature hot localized, edema pitting 1-4+ location, lesions: cellulitis poorly defined erythema warmth edema tenderness no honey crusts, impetigo honey-colored crusts face bullous large bullae, wound: size LxWxD cm, tissue type granulation red moist healthy slough yellow tan eschar brown black, drainage amount none/scant/moderate/copious color serous clear serosanguineous pink sanguineous red purulent yellow green brown odor, periwound skin erythema induration warmth swelling extent >0.5cm, undermining tunneling, odor, pain before during after dressing change, lymphangitis red streaks from site toward heart, lymphadenopathy tender nodes, pulses cap refill, tinea pedis cracks between toes, Braden if at risk.

Priority / Focused	Why / Action
Mark border + measure circumference + vitals + fever + lymphangitis	Cellulitis expanding poorly defined erythema mark border with pen date time + measure circumference to track spread vs improvement, vitals temp HR BP RR, fever infection, lymphangitis red streaks spreading emergency notify STAT.
Honey-crusted lesions face + contagious	Impetigo honey-colored crusts face around mouth nose highly contagious contact precautions hand hygiene, wash lesions soap water, keep child home 24h after antibiotics, no sharing towels.
Purulent drainage + periwound erythema + fever	Wound infection purulent yellow green brown foul odor periwound erythema induration warmth swelling wound enlarges delayed healing fever, cultures before antibiotics per protocol, sterile technique, I&O daily weight, BUN/Cr.
Emergency pain out of proportion + crepitus + bullae + hypo + confusion + evisceration	Necrotizing fasciitis pain out of proportion rapid spread crepitus bullae hypo confusion oliguria emergency surgery, evisceration wound dehiscence organs protrude pink loop moist sterile saline dressing no push back NPO notify surgeon STAT rapid response.

Diagnostic Tests

Test	Purpose / Why / Findings / Nursing
Wound culture and Gram stain + Blood cultures if fever sepsis	Purpose identify organism Strep vs Staph vs MRSA. Why ordered: purulent drainage fever expanding erythema not improving 24-48h on antibiotics. Expected no growth colonization may be present. Abnormal S. aureus Strep pyogenes MRSA. Prep clean wound before culture per facility swab viable tissue not slough/eschar no antiseptic before culture, blood cultures 2 sets different sites before antibiotics but antibiotics within 1hr if sepsis. Nursing label time send ASAP.
Mark border + Photos + Measurement	Purpose track spread vs improvement. Mark erythema border with pen date time, measure circumference same location, photos per facility. No prep. Nursing same lighting distance.
US Doppler if concern DVT vs cellulitis + X-ray if osteomyelitis	Doppler to rule out DVT leg red swollen painful — cellulitis can mimic DVT but DVT needs anticoagulation cellulitis needs antibiotics elevate both but differentiate. X-ray MRI if osteomyelitis Stage 4 bone visible. Prep NPO if contrast.

Laboratory Tests

Lab	Purpose / Normal / Abnormal / Trend / Priority
CBC WBC 5-10k, CRP <1mg/dL, ESR <20, Procalcitonin <0.5	Purpose infection inflammation. WBC high infection cellulitis wound infection, CRP ESR high inflammation, procalcitonin high bacterial infection sepsis. Trend decreasing with antibiotics good. Priority WBC high + fever + hypo + oliguria = sepsis notify STAT.
Glucose 70-140 HbA1c <7% albumin 3.5-5.0	Glucose high hyperglycemia impairs WBC collagen infection risk, albumin low malnutrition delayed healing. Priority glucose >180 impairs healing need control, albumin low needs nutrition consult protein 1.2-1.5g/kg.
BUN/Cr, C3 complement low post-strep GN, ASO titer high post-strep	If post-strep impetigo 1-3 weeks later tea/cola urine periorbital edema HTN oliguria BUN/Cr ↑ low C3 ASO high = post-strep GN, notify provider.

Medications

Class / Meds	Mechanism & Nursing/Teaching
Antibiotics cellulitis: Cephalexin (Keflex) 1st gen cephalosporin for non-purulent cellulitis Strep/MSSA, Dicloxacillin for MSSA, Clindamycin if MRSA risk or penicillin allergy, TMP-SMX or Doxycycline if purulent MRSA, Vancomycin IV if severe MRSA	Mechanism: kills bacteria cell wall synthesis. Indication: cellulitis expanding erythema warmth edema fever. Side: rash allergy, GI upset C. diff diarrhea, with cephalosporins cross allergy penicillin, clindamycin C. diff high risk, TMP-SMX rash hyperkalemia sulfa allergy, doxycycline photosensitivity GI upset not in <8yo, vancomycin nephrotoxic ototoxic red man syndrome infuse slowly. Nursing: cultures before antibiotics if purulent wound infection fever but don't delay cellulitis if mild, mark border measure, elevate above heart reduces edema, finish full course even if better, monitor allergy rash, labs WBC, teach.
Impetigo topical: Mupirocin 2% ointment or Retapamulin for localized, oral Cephalexin Dicloxacillin Clindamycin if widespread/bullous	Mechanism: topical kills S. aureus Strep locally. Indication: localized non-bullous impetigo few lesions. Nursing: wash lesions with soap water gently remove crusts before applying per order, apply small amount, hand hygiene gloves, contact precautions until 24h after antibiotics, keep child home 24h after antibiotics, no sharing towels razors, cut nails no scratching, monitor for irritation.
Wound infection: Per culture, systemic antibiotics if systemic signs, topical per order, debridement per order if slough/eschar	Mechanism: systemic kills bacteria if fever purulent periwound erythema, topical for colonization not enough if systemic. Nursing: wound and blood cultures before antibiotics per protocol if fever sepsis, sterile technique dressing change, measure LxWxD drainage, moist healing if not infected but if infected may need more frequent changes per order, pain 0-10 before during after, I&O daily weight BUN/Cr, monitor for dehiscence evisceration.
Pain: Acetaminophen, NSAIDs if no contraindication, opioids for severe per order	Mechanism: controls pain during dressing change WHY pain increases stress impairs healing. Nursing: pain 0-10 before during after, give 30min before dressing change per order, non-pharm distraction, monitor RR sedation.

Nursing Interventions — Prioritized

Priority	Intervention & WHY
Circulation / Infection & Sepsis	Vitals q4h or q15min if fever/hypotension/sepsis, temp fever infection, HR tachy sepsis pain, BP hypo sepsis, RR SpO2, I&O hourly if sepsis, daily weight, labs WBC CRP lactate BUN/Cr. Mark border of erythema with pen date time + measure circumference same spot to track spread vs improvement — WHY cellulitis poorly defined expanding border via lymphatics needs objective tracking. Elevate affected limb above heart level WHY reduces edema improves venous lymphatic return reduces pain swelling, no dependency. Cool compresses for comfort if cellulitis? Warm compresses increase circulation may help localized abscess but for cellulitis cool compress comfort avoid heat that may spread infection per some protocols — follow provider, generally cool compress for comfort elevate. Hand hygiene before/after standard precautions + contact precautions if draining purulent wound infection impetigo until 24h after antibiotics. Cultures wound and blood before antibiotics if fever purulent wound infection sepsis per protocol but antibiotics within 1hr if sepsis per protocol. Monitor lymphangitis red streaks from site toward heart = spreading infection emergency notify STAT. Monitor for necrotizing fasciitis pain out of proportion + rapid spread + crepitus + bullae + hypo + confusion + oliguria emergency surgery. Check tinea pedis cracks between toes treat to prevent recurrence cellulitis.
Safety — Contagion & Wound care	Impetigo honey-colored crusts highly contagious contact precautions until 24h after antibiotics, wash lesions with soap water gently remove crusts before topical mupirocin per order, keep child home 24h after antibiotics, no sharing towels razors, cut nails no scratching autoinoculation, laundry hot water. Wound infection sterile technique dressing change per order, measure LxWxD drainage amount color odor periwound erythema induration warmth, moist healing if not infected but if infected may need more frequent changes per order, no wet-to-dry unless ordered, protect periwound skin prep, offload pressure if pressure injury infected, monitor dehiscence evisceration if surgical wound edges separate pink loop organs protrude = evisceration emergency moist sterile saline dressing no push back NPO notify surgeon STAT rapid response.
Comfort	Pain 0-10 before during after dressing change, itch 0-10 impetigo, give analgesic 30min before dressing change per order, non-pharm distraction deep breathing, cool compress for comfort itch, elevate, loose clothing.
Education / Interdisciplinary	Wound care nurse, infectious disease if MRSA recurrent, dietitian protein 1.2-1.5g/kg for healing if wound, pharmacy renal dosing, PT/OT mobility elevation. Teach hygiene handwashing, no scratching, finish antibiotics, contagion prevention.

Potential Complications

Complication	Early signs	Nursing response / Emergency
Cellulitis → lymphangitis → bacteremia → sepsis → necrotizing fasciitis → osteomyelitis	Red streaks lymphangitis from site toward heart, increasing erythema despite antibiotics, bullae, abscess fluctuant, fever >101 tachy >100 tachypnea >22 hypo <90 confusion oliguria <30, pain out of proportion crepitus bullae rapid spread	Vitals q15min O2 large-bore IV cultures wound and blood before antibiotics but antibiotics within 1hr if sepsis lactate I&O hourly daily weight offload elevate, labs WBC CRP, mark border measure, notify provider/rapid response, prepare surgery if necrotizing fasciitis pain out of proportion crepitus bullae emergency surgery, X-ray MRI if osteomyelitis.
Impetigo → post-streptococcal GN 1-3 weeks + rheumatic fever	1-3 weeks after Strep impetigo tea/cola urine periorbital edema HTN oliguria BUN/Cr ↑ low C3 ASO high, fever joint pain	Vitals BP I&O daily weight edema lung sounds BUN/Cr C3 ASO UA RBCs RBC casts protein <3.5g, low Na fluid restriction diuretics ACE per order, notify provider.
Wound infection → dehiscence evisceration sepsis	Wound edges separate dehiscence, organs protrude pink loop evisceration, increasing pain foul odor purulent drainage periwound erythema fever hypo confusion oliguria	Evisceration emergency moist sterile saline dressing no push back NPO notify surgeon STAT rapid response O2 IV fluids, cultures before antibiotics but antibiotics within 1hr if sepsis, I&O hourly daily weight labs.

Patient Education

Disease process: Cellulitis dermis subQ bacterial infection Group A strep Staph including MRSA via break skin → poorly defined expanding redness warmth swelling tenderness fever lymphangitis red streaks risk sepsis. Impetigo superficial epidermis highly contagious honey-colored crusts face around mouth nose itchy spreads by contact autoinoculation. Wound infection bacteria >10^5 purulent drainage foul odor periwound erythema induration warmth fever delayed healing dehiscence evisceration.
Lifestyle: Hand hygiene before/after wound care, wash hands 20 sec, no sharing towels razors, cut nails no scratching, treat tinea pedis cracks between toes to prevent cellulitis recurrence, manage diabetes glucose <180 HbA1c <7, edema control elevate legs compression per order, quit smoking, nutrition protein 1.2-1.5g/kg for wound healing.
Med adherence: Finish full antibiotic course even if feeling better in 2 days to prevent recurrence resistance, topical mupirocin wash lesions soap water remove crusts before applying per order small amount, oral antibiotics per order, monitor rash allergy, C. diff diarrhea report, photosensitivity doxycycline sunscreen.
Home care: Mark border with pen date time measure circumference track spread, elevate affected limb above heart to reduce edema, cool compress for comfort if cellulitis per provider, warm compress may help abscess per provider, wash impetigo lesions soap water gently remove crusts, contact precautions until 24h after antibiotics keep child home 24h after antibiotics, laundry hot water, no picking scratching, wound care sterile technique per order measure LxWxD drainage amount color odor periwound, protect periwound skin prep, change per order, no tight clothing, monitor for red streaks.
Follow-up: Wound care nurse, infectious disease if MRSA recurrent, labs WBC, return if no improvement 24-48h on antibiotics or worsening erythema fever.
Warning / Emergency: Red streaks lymphangitis from site toward heart = spreading infection emergency, pain out of proportion + crepitus + bullae + rapid spread + hypotension confusion oliguria = necrotizing fasciitis emergency surgery call 911, wound dehiscence organs protrude pink loop = evisceration moist sterile saline dressing no push back NPO call surgeon STAT, fever >101 chills foul odor purulent periwound erythema hypotension confusion oliguria = sepsis, 1-3 weeks after Strep impetigo tea/cola urine periorbital edema HTN oliguria = post-strep GN.

Clinical Judgment (NCSBN CJMM)

Recognize Cues: 45yo male diabetes obesity with left lower leg poorly defined expanding erythema warmth edema tenderness 10x15cm, fever 101.2F HR 102 BP 108/68 RR 20 SpO2 96% RA, pain 6/10, history tinea pedis cracks between toes, BMI 32, glucose 210 high, WBC 12k high, no bullae no crepitus no red streaks yet, no purulent drainage, no honey crusts, left leg edema 2+ pitting, pulses present cap refill 2 sec.
Analyze Cues: Lower leg cellulitis non-purulent Group A strep Strep pyogenes and/or MSSA likely via tinea pedis cracks break skin, poorly defined expanding erythema warmth edema tenderness fever WBC high infection, diabetes hyperglycemia impairs WBC collagen risk recurrence, obesity edema venous stasis risk, no red streaks lymphangitis yet but monitor spreading emergency, no bullae crepitus pain out of proportion so not necrotizing fasciitis yet, no purulent drainage so non-purulent cellulitis vs purulent abscess MRSA, no honey crusts so not impetigo, no wound dehiscence.
Prioritize Hypotheses: #1 Cellulitis left lower leg with risk lymphangitis sepsis necrotizing fasciitis. #2 Risk for recurrence due to tinea pedis diabetes edema obesity. #3 Knowledge deficit hygiene foot care.
Generate Solutions: Vitals q4h temp HR BP RR SpO2, I&O daily weight, labs WBC glucose HbA1c BUN/Cr, mark border erythema with pen date time measure circumference same spot to track spread vs improvement, elevate left leg above heart reduces edema improves venous lymphatic return, cool compress for comfort per provider, cultures? Non-purulent cellulitis often no wound culture needed but blood cultures if fever systemic, antibiotics cephalexin per order for non-purulent cellulitis Strep/MSSA finish full course, treat tinea pedis antifungal per order to prevent recurrence, glucose control insulin per order <180, nutrition consult protein, hand hygiene standard precautions, monitor lymphangitis red streaks from site toward heart spreading emergency, monitor necrotizing fasciitis pain out of proportion crepitus bullae hypo confusion oliguria emergency surgery, no massage, DVT prophylaxis? Doppler if concern DVT vs cellulitis, teach.
Take Action: Notify provider, mark border 10x15cm date time photo per facility, elevate left leg above heart pillow, cool compress for comfort per order, cephalexin 500mg q6h per order after allergy check finish full course, glucose check insulin per order, treat tinea pedis miconazole per order, vitals I&O daily weight, labs, educate hygiene no scratching handwashing.
Evaluate Outcomes: After 48h erythema 10x15→6x8cm decreasing border not expanding, warmth edema tenderness decreased, pain 6→2, temp 101.2→99F, HR 102→84, WBC 12k→8k, glucose 210→150, no red streaks no bullae no crepitus no hypotension no confusion, UOP adequate. Continue antibiotics finish course, continue elevation, treat tinea pedis, foot care teaching, follow-up. No post-strep GN because cellulitis Strep but monitor tea/cola periorbital edema HTN oliguria 1-3 weeks.

Clinical Connections — commonly confused on NCLEX

Feature	Cellulitis	Impetigo	Wound Infection	Necrotizing Fasciitis
Cause	Group A Strep pyogenes + S. aureus including MRSA via break skin	S. aureus + Strep pyogenes superficial epidermis honey crusts	Bacteria >10^5 contamination colonization → infection surgical traumatic	Group A Strep + polymicrobial rapid spread along fascia
Assessment	Poorly defined expanding erythema warmth edema tenderness fever leukocytosis mark border lower leg common, no honey crusts, no purulent unless abscess, lymphangitis red streaks emergency	Honey-colored crusts face around mouth nose highly contagious itchy not painful bullous large bullae child 2-5, no deep erythema warmth edema unless cellulitis secondary	Purulent yellow green brown foul odor periwound erythema >0.5cm induration warmth swelling pain increased after 3-5 days delayed healing dehiscence evisceration organs protrude emergency	Pain out of proportion + rapid spread + hot erythematous swollen + fever + crepitus + bullae + hypo tachy confusion oliguria emergency surgery
Diagnostics	Clinical, mark border measure circumference, CBC WBC ↑, blood cultures if fever, no wound culture if non-purulent, US Doppler to rule out DVT	Clinical honey crusts, culture if needed, contact precautions	Wound culture Gram stain viable tissue before antibiotics, CBC WBC ↑ CRP, X-ray MRI if osteomyelitis	Clinical emergency, labs WBC ↑ lactate high, blood cultures before antibiotics but antibiotics within 1hr if sepsis, CT/MRI gas in fascia, surgery gold standard
Treatment	Mark border measure, elevate above heart, cool compress comfort per provider, antibiotics cephalexin for non-purulent Strep/MSSA TMP-SMX/doxy if purulent MRSA vancomycin if severe per culture finish full course, treat tinea pedis to prevent recurrence, no massage	Contact precautions until 24h after antibiotics, wash lesions soap water remove crusts, topical mupirocin localized non-bullous, oral if widespread/bullous, keep child home 24h after antibiotics no sharing towels, cut nails no scratching, laundry hot water	Sterile technique dressing change per order measure LxWxD drainage periwound, cultures before antibiotics if systemic signs, systemic antibiotics per culture if systemic signs, moist healing if not infected, debridement per order if slough/eschar, monitor dehiscence evisceration moist sterile saline dressing no push back NPO surgeon STAT, offload	Emergency surgery debridement fasciotomy, rapid response O2 large-bore IV fluids 30mL/kg if sepsis cultures before antibiotics but antibiotics within 1hr if sepsis broad-spectrum, ICU
Priority nursing	Mark border date time measure circumference track spread vs improvement, vitals q4h temp HR BP, elevate above heart, I&O daily weight, labs WBC glucose, hand hygiene standard precautions, monitor red streaks lymphangitis spreading emergency, pain 0-10, teach finish antibiotics	Contact precautions until 24h after antibiotics, hand hygiene, wash lesions soap water, topical mupirocin per order, keep home 24h after antibiotics, no sharing towels, monitor post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria	Sterile technique, measure drainage periwound, cultures before antibiotics if fever sepsis, elevate, pain 0-10, I&O daily weight, monitor dehiscence evisceration emergency moist saline no push back, labs WBC, teach wound care	Rapid response O2 IV fluids, pain out of proportion emergency, mark border, labs, prepare surgery, NPO

NCLEX High-Yield Review — What the NCLEX Wants You to Know

Cellulitis = poorly defined expanding erythema warmth edema tenderness fever + mark border with pen date time + measure circumference + elevate above heart + cool compress comfort per provider + antibiotics cephalexin for non-purulent TMP-SMX/doxy if purulent MRSA + finish full course + treat tinea pedis cracks
Red streaks lymphangitis from site toward heart = spreading infection emergency notify STAT — pain out of proportion + crepitus + bullae + rapid spread + hypo confusion oliguria = necrotizing fasciitis emergency surgery
Impetigo = honey-colored crusts face around mouth nose highly contagious contact precautions until 24h after antibiotics + wash lesions soap water remove crusts + topical mupirocin localized + oral if widespread + keep child home 24h after antibiotics + no sharing towels + cut nails no scratching + post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria low C3
Wound infection = purulent yellow green brown foul odor + periwound erythema >0.5cm induration warmth swelling + increasing pain after 3-5 days + fever + delayed healing + cultures before antibiotics but antibiotics within 1hr if sepsis + sterile technique + measure LxWxD drainage periwound + monitor dehiscence evisceration organs protrude pink loop moist sterile saline dressing no push back NPO surgeon STAT
Hand hygiene before/after standard + contact if draining + no massage cellulitis + elevate above heart + no ice butter toothpaste
MRSA purulent cellulitis/abscess: TMP-SMX or doxycycline or clindamycin per culture, vancomycin IV if severe, contact precautions, decolonization per order

Common distractors: Confusing well-defined erysipelas raised border vs cellulitis poorly defined. Thinking warm compresses always for cellulitis — follow provider cool for comfort elevate is key. Missing red streaks lymphangitis emergency. Not marking border measuring circumference. Thinking impetigo not contagious — highly contagious contact precautions until 24h after antibiotics. Forgetting post-strep GN 1-3 weeks after Strep impetigo tea/cola periorbital edema HTN. Thinking wound infection needs only topical — needs systemic if systemic signs cultures before antibiotics. Missing evisceration emergency moist sterile saline no push back NPO surgeon STAT.

Memory Aids

Cellulitis: poorly defined expanding redness warmth edema tenderness fever + mark border date time + elevate above heart — Poorly defined Expanding = lymphatic spread
Red streaks lymphangitis = spreading emergency — Red streaks to heart = emergency
Impetigo honey-colored crusts face contagious contact precautions until 24h after antibiotics wash lesions soap water remove crusts mupirocin keep home 24h — Honey crusts = contagious
Wound infection: purulent yellow green brown foul odor + periwound erythema induration warmth swelling + increasing pain after 3-5 days + fever = infection cultures before antibiotics but antibiotics within 1hr if sepsis
Necrotizing fasciitis: pain out of proportion + crepitus + bullae + rapid spread + hypo = emergency surgery
Evisceration organs protrude pink loop = moist sterile saline no push back NPO surgeon STAT rapid response

Case Study

Patient: Mr. Smith 55M diabetes obesity with left lower leg poorly defined expanding erythema 12x18cm warmth edema tenderness pain 5/10, fever 101.0F HR 100 BP 110/70 RR 20 SpO2 97% RA, history tinea pedis cracks between toes, BMI 33 glucose 220 high, WBC 13k high, no red streaks no bullae no crepitus, no purulent drainage, no honey crusts, no wound dehiscence, pulses present cap refill 2 sec, left leg edema 2+ pitting.

Step 1 Recognize Cues: Cellulitis left lower leg poorly defined expanding erythema warmth edema tenderness fever WBC high, diabetes hyperglycemia impairs WBC collagen obesity edema venous stasis, tinea pedis cracks break skin entry, no red streaks lymphangitis yet, no bullae crepitus pain out of proportion necrotizing fasciitis, no purulent drainage so non-purulent cellulitis Group A Strep MSSA likely vs MRSA purulent, no honey crusts impetigo, no wound infection dehiscence.

Step 2 Analyze Cues: Cellulitis dermis subQ bacterial infection via tinea pedis cracks, poorly defined expanding border lymphatic spread, warmth edema tenderness inflammation, fever WBC high systemic, diabetes hyperglycemia obesity edema risk recurrence, risk lymphangitis spreading bacteremia sepsis necrotizing fasciitis if not treated, no evisceration.

Step 3 Prioritize: #1 Cellulitis infection with risk lymphangitis sepsis necrotizing fasciitis. #2 Risk recurrence due to tinea pedis diabetes edema obesity. #3 Knowledge deficit foot care hygiene.

Step 4 Plan: Vitals q4h temp HR BP RR SpO2, I&O daily weight, labs WBC CRP glucose HbA1c BUN/Cr, mark border erythema with pen date time measure circumference same spot track spread vs improvement, elevate left leg above heart reduces edema, cool compress comfort per provider, antibiotics cephalexin per order for non-purulent Strep/MSSA finish full course, treat tinea pedis antifungal per order, glucose control insulin per order <180, nutrition consult protein, hand hygiene standard precautions, monitor red streaks lymphangitis spreading emergency, monitor necrotizing fasciitis pain out of proportion crepitus bullae hypo confusion oliguria emergency surgery, no massage, Doppler if concern DVT vs cellulitis, teach.

Step 5 Take Action: Notify provider, mark border 12x18cm date time photo per facility, elevate left leg above heart pillow, cool compress per order, cephalexin 500mg q6h per order after allergy check, glucose check insulin per order, tinea pedis miconazole per order, vitals I&O daily weight, labs, educate handwashing no scratching.

Step 6 Evaluate & Discharge: After 48h erythema 12x18→7x10cm decreasing, warmth edema tenderness decreased pain 5→2, temp 101→99F HR 100→84 WBC 13k→8k glucose 220→150, no red streaks no bullae no crepitus no hypotension, UOP adequate. Continue antibiotics finish full course even if better in 2 days, continue elevation, treat tinea pedis, foot care wash feet dry between toes cotton socks change daily no barefoot, manage diabetes glucose <180, edema control elevate compression per order weight loss, hygiene handwashing no sharing towels, when to seek emergency red streaks spreading increasing erythema fever foul odor purulent hypotension confusion oliguria pain out of proportion crepitus bullae rapid spread wound dehiscence organs protrude. Follow-up wound care infectious disease if recurrent dietitian. No post-strep GN yet but teach tea/cola periorbital edema HTN oliguria 1-3 weeks after Strep impetigo.

NCLEX Practice Questions

1. A client has left lower leg poorly defined expanding erythema warmth edema tenderness fever 101.2F. What is priority action?

Massage leg to improve circulation and apply heat
Keep leg dependent and encourage walking only
Mark border of erythema with pen date time, measure circumference, elevate leg above heart, vitals q4h temp HR BP, monitor red streaks lymphangitis spreading emergency, antibiotics per order cephalexin for non-purulent cellulitis finish full course, treat tinea pedis cracks
Apply tight compression bandage and leave

Rationale

Answer: 3. Why 3 correct: Cellulitis poorly defined expanding erythema warmth edema tenderness fever needs mark border date time measure circumference track spread vs improvement, elevate above heart reduces edema improves venous lymphatic return, vitals temp HR BP, monitor red streaks lymphangitis spreading emergency notify STAT, antibiotics cephalexin for non-purulent Strep/MSSA finish course, treat tinea pedis cracks entry to prevent recurrence. Why others wrong: 1. Massage spreads infection heat may spread infection. 2. Dependent walking increases edema pain. 4. Tight compression without Doppler may worsen arterial insufficiency.

2. A 4-year-old in daycare has honey-colored crusts around mouth and nose, itchy, no fever. What should the nurse teach parents?

Not contagious no precautions needed
Apply ice and keep crusts
Give oral steroids only
Impetigo highly contagious contact precautions until 24h after antibiotics, wash lesions with soap water gently remove crusts, topical mupirocin per order if localized, keep child home 24h after antibiotics, no sharing towels razors, cut nails no scratching, laundry hot water, monitor post-strep GN 1-3 weeks tea/cola periorbital edema HTN

Rationale

Answer: 4. Why 4 correct: Impetigo honey-colored crusts face highly contagious contact precautions until 24h after antibiotics, wash lesions soap water remove crusts before topical mupirocin per order, keep home 24h after antibiotics no sharing towels cut nails no scratching autoinoculation laundry hot water, monitor post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria low C3. Why others wrong: 1. Not contagious false highly contagious contact precautions needed. 2. Ice not treatment keep crusts spreads infection. 3. Steroids not treatment need antibiotics topical/systemic.

3. A post-op day 4 surgical wound has purulent yellow green foul odor drainage, periwound erythema induration warmth swelling, increasing pain, fever 101.4F, wound edges intact no dehiscence. What is priority?

Wound and blood cultures before antibiotics if fever sepsis per protocol but antibiotics within 1hr if sepsis, vitals q4h temp HR BP RR SpO2 I&O daily weight labs WBC CRP, sterile technique dressing change per order measure LxWxD drainage periwound erythema, elevate if extremity, pain 0-10, notify provider, monitor dehiscence evisceration
Document and continue routine dressing
Apply donut cushion and massage wound
Remove sutures immediately

Rationale

Answer: 1. Why 1 correct: Wound infection purulent yellow green foul odor periwound erythema induration warmth swelling increasing pain fever needs cultures wound and blood before antibiotics if fever sepsis per protocol but antibiotics within 1hr if sepsis vitals I&O daily weight labs WBC CRP sterile technique measure drainage periwound elevate pain notify provider monitor dehiscence evisceration. Why others wrong: 2. Document only delays infection treatment. 3. Donut massage worsens infection pressure injury. 4. Remove sutures without order may cause dehiscence.

4. A client with cellulitis has red streaks from leg toward groin, fever 101.6F, tachy 110, hypotension 90/60, confusion, oliguria 20mL/hr. What is priority?

Continue oral antibiotics and elevate leg
Apply warm compress only
Rapid response, vitals q15min, O2, large-bore IV, wound and blood cultures before antibiotics but antibiotics within 1hr if sepsis, lactate, I&O hourly, elevate leg above heart, labs WBC CRP lactate BUN/Cr, mark border, notify provider STAT, prepare fluids vasopressors
Discharge home

Rationale

Answer: 3. Why 3 correct: Red streaks lymphangitis = spreading via lymphatics + fever tachy hypotension confusion oliguria = bacteremia sepsis emergency needs rapid response vitals q15min O2 large-bore IV cultures before antibiotics but antibiotics within 1hr if sepsis lactate I&O hourly elevate leg labs notify STAT fluids vasopressors. Why others wrong: 1. Oral antibiotics elevate insufficient hypotension sepsis needs IV. 2. Warm compress only insufficient sepsis. 4. Discharge unsafe sepsis.

5. A post-op abdominal wound dehiscence with organs protruding pink loop is seen. What is priority?

Push organs back and apply tight bandage
Give oral fluids and encourage ambulation
Leave open to air dry
Evisceration emergency — moist sterile saline dressing no push back, NPO, notify surgeon STAT, rapid response, O2, vitals q15min, large-bore IV, I&O hourly, no oral intake, keep supine knees flexed to reduce tension

Rationale

Answer: 4. Why 4 correct: Evisceration organs protrude pink loop emergency needs moist sterile saline dressing no push back NPO notify surgeon STAT rapid response O2 vitals q15min large-bore IV I&O hourly supine knees flexed reduce tension. WHY pushing back causes infection damage. Why others wrong: 1. Push back tight bandage causes infection damage. 2. Oral fluids ambulation worsens evisceration. 3. Open to air dry causes desiccation infection.

6. SATA. Which are expected findings in cellulitis? Select all that apply.

Honey-colored crusts around mouth nose highly contagious itchy
Pain out of proportion + crepitus + bullae + rapid spread + hypo confusion oliguria
Poorly defined expanding erythema warmth edema tenderness fever leukocytosis WBC ↑ mark border lower leg common
Purulent yellow green brown foul odor drainage periwound erythema induration warmth swelling fever wound enlarges
Lymphangitis red streaks from site toward heart + tender lymphadenopathy + fever

Rationale

Answers: 3, 5. Why these: Cellulitis poorly defined expanding erythema warmth edema tenderness fever leukocytosis mark border lower leg common lymphangitis red streaks from site toward heart tender lymphadenopathy spreading via lymphatics. Why others not cellulitis but other: 1. Honey-colored crusts contagious = impetigo. 2. Pain out of proportion crepitus bullae rapid spread hypo confusion oliguria = necrotizing fasciitis emergency. 4. Purulent foul odor periwound erythema wound enlarges = wound infection.

7. SATA. Which are appropriate for impetigo care? Select all that apply.

Massage lesions and apply tight bandage
Contact precautions until 24h after antibiotics, hand hygiene, wash lesions with soap water gently remove crusts before topical mupirocin per order
Keep child home 24h after antibiotics, no sharing towels razors, cut nails no scratching, laundry hot water
Mark border of erythema with pen date time and elevate above heart
Monitor post-streptococcal GN 1-3 weeks after Strep impetigo tea/cola urine periorbital edema HTN oliguria BUN/Cr ↑ low C3 ASO high

Rationale

Answers: 2, 3, 5. Why these: Impetigo contact precautions until 24h after antibiotics hand hygiene wash lesions soap water remove crusts mupirocin per order keep home 24h after antibiotics no sharing towels cut nails no scratching laundry hot water monitor post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria BUN/Cr low C3 ASO high. Why others wrong: 1. Massage tight bandage worsens spreads infection. 4. Mark border elevate is cellulitis not impetigo.

8. Priority. The nurse has four clients. Who should be seen first?

Client with honey-colored crusts around mouth afebrile stable vitals
Client with cellulitis + pain out of proportion + crepitus + bullae + rapid spread + fever 102F + hypotension 86/54 + tachy 118 + confusion + oliguria 15mL/hr
Client with leg cellulitis 5x7cm stable afebrile no red streaks stable vitals
Client with surgical wound healing no drainage afebrile stable

Rationale

Answer: 2. Why 2 first: Pain out of proportion crepitus bullae rapid spread fever hypotension tachy confusion oliguria = necrotizing fasciitis emergency surgery sepsis needs rapid response O2 IV fluids cultures before antibiotics but antibiotics within 1hr if sepsis. Why others later: 1. Impetigo honey crusts stable needs contact precautions topical. 3. Leg cellulitis stable needs mark border elevate antibiotics. 4. Healing wound stable routine.

9. Delegation. Which task can the RN delegate to LPN/VN for a client with cellulitis?

Assess for necrotizing fasciitis and decide on surgery
Interpret wound culture and prescribe antibiotics
Teach initial diagnosis of cellulitis and order antibiotics
Check vitals I&O daily weight measure circumference report erythema warmth edema pain fever red streaks lymphangitis bullae crepitus and change dressing per order and reinforce elevation hand hygiene per plan

Rationale

Answer: 4. Why 4 delegatable: LPN/VN can check vitals I&O daily weight measure circumference report erythema warmth edema pain fever red streaks bullae crepitus change dressing per order reinforce elevation hand hygiene per plan. Why others RN only: 1. Assess necrotizing fasciitis decide surgery RN/provider. 2. Interpret culture prescribe antibiotics provider/RN. 3. Teach initial diagnosis order antibiotics provider/RN.

10. NGN Case Study. A 50-year-old male diabetes obesity left lower leg poorly defined expanding erythema 15x20cm warmth edema tenderness pain 6/10, fever 101.0F HR 104 BP 108/68 RR 20 SpO2 97% RA, history tinea pedis cracks between toes, BMI 34 glucose 230 high, WBC 14k high, no red streaks no bullae no crepitus, no purulent drainage, no honey crusts, no wound dehiscence, pulses present cap refill 2 sec, left leg edema 2+ pitting, UOP adequate.

a) What condition and cues support it? b) What are 3 priority actions and why? c) What indicates improvement and what teaching to prevent recurrence?

Model answer

a) Non-purulent cellulitis left lower leg Group A Strep/MSSA: Poorly defined expanding erythema 15x20cm warmth edema tenderness pain fever WBC high infection dermis subQ, via tinea pedis cracks break skin entry lower leg common venous stasis edema, diabetes hyperglycemia obesity edema risk, no red streaks lymphangitis yet no bullae crepitus pain out of proportion so not necrotizing fasciitis, no purulent drainage so non-purulent vs purulent MRSA abscess, no honey crusts so not impetigo, no wound dehiscence evisceration.

b) Priorities: 1) Infection control and tracking — vitals q4h temp HR BP RR SpO2, mark border erythema with pen date time measure circumference same spot track spread vs improvement, elevate left leg above heart reduces edema improves venous lymphatic return, cool compress comfort per provider, labs WBC CRP glucose HbA1c BUN/Cr, I&O daily weight, hand hygiene standard precautions, monitor red streaks lymphangitis spreading emergency + necrotizing fasciitis pain out of proportion crepitus bullae hypo confusion oliguria emergency surgery. 2) Antibiotics + treat tinea pedis + glucose control — antibiotics cephalexin per order for non-purulent Strep/MSSA finish full course, blood cultures if fever systemic per protocol but antibiotics within 1hr if sepsis, treat tinea pedis antifungal miconazole per order to prevent recurrence, glucose control insulin per order <180 hyperglycemia impairs WBC collagen, nutrition consult protein 1.2-1.5g/kg for healing if wound. 3) Education prevention — hygiene handwashing no scratching no sharing towels, foot care wash feet dry between toes cotton socks change daily no barefoot, edema control elevate compression per order weight loss, diabetes management glucose <180, smoking cessation.

c) Improvement: Erythema 15x20→8x10cm decreasing border not expanding, warmth edema tenderness decreased pain 6→2, temp 101→99F HR 104→84 WBC 14k→8k glucose 230→150, no red streaks no bullae no crepitus no hypotension no confusion UOP adequate. Teaching: finish full antibiotic course even if better in 2 days to prevent recurrence resistance, mark border measure circumference track, elevate above heart, cool compress comfort, wash feet daily dry between toes treat tinea pedis antifungal per order, no scratching cut nails, no sharing towels razors, hand hygiene, manage diabetes glucose <180 HbA1c <7 edema elevate compression weight loss, when to seek emergency red streaks spreading increasing erythema fever foul odor purulent hypotension confusion oliguria pain out of proportion crepitus bullae rapid spread wound dehiscence organs protrude pink loop moist sterile saline no push back NPO surgeon STAT, and post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria. Follow-up wound care infectious disease if recurrent dietitian.

Key Takeaways

Cellulitis = poorly defined expanding erythema warmth edema tenderness fever leukocytosis + mark border with pen date time + measure circumference + elevate above heart + cool compress comfort per provider + antibiotics cephalexin for non-purulent Strep/MSSA TMP-SMX/doxy if purulent MRSA + finish full course + treat tinea pedis cracks.
Red streaks lymphangitis from site toward heart = spreading infection emergency notify STAT; pain out of proportion + crepitus + bullae + rapid spread + hypo confusion oliguria = necrotizing fasciitis emergency surgery.
Impetigo = honey-colored crusts face around mouth nose highly contagious contact precautions until 24h after antibiotics + wash lesions soap water remove crusts + topical mupirocin localized + keep child home 24h after antibiotics + no sharing towels + post-strep GN 1-3 weeks tea/cola periorbital edema HTN oliguria low C3.
Wound infection = purulent yellow green brown foul odor + periwound erythema >0.5cm induration warmth swelling + increasing pain after 3-5 days + fever + delayed healing + cultures before antibiotics but antibiotics within 1hr if sepsis + sterile technique + monitor dehiscence evisceration moist sterile saline no push back NPO surgeon STAT.
Hand hygiene standard + contact if draining, no massage cellulitis, elevate above heart, no ice butter toothpaste, nutrition protein 1.2-1.5g/kg for wound healing, glucose <180.

References

Stevens, D. L., Bisno, A. L., Chambers, H. F., et al. (2014). Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clinical Infectious Diseases, 59(2), e10-e52.
Jarvis, C. (2020). Physical examination and health assessment (8th ed.). Elsevier.
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2020). Medical-surgical nursing (11th ed.). Elsevier.
Centers for Disease Control and Prevention. (2023). Guideline for hand hygiene and isolation precautions: Contact precautions.
Baddour, L. M. (2023). Cellulitis and skin abscess: Epidemiology and clinical features. UpToDate.
Hartman-Adams, H., Banvard, C., & Juckett, G. (2014). Impetigo: Diagnosis and treatment. American Family Physician, 90(4), 229-235.
Silvestri, L. A., & Silvestri, A. E. (2023). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier.
Assessment Technologies Institute. (2023). ATI RN fundamentals and medical-surgical review modules (12th ed.). ATI Nursing Education.

Skin Infections

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