Cellulitis: Signs, Exam, and Diagnosis (Pediatric Nursing)

00:00 So, what are the signs and symptoms of cellulitis? This depends on the site of the infection.

00:06 Typically it's redness that begins to increase in size and the skin can become swollen. The patient will have pain to palpation so I always warn them I'm going to press on this but I'm going to press lightly. The patient will have warmth at the site of infection and they may have a fever and fatigue. Now this is a common pediatric problem and it's called periorbital or orbital cellulitis. Let's learn about these conditions. The less serious is periorbital or preseptal and this is an infection around the eye that is anterior to the orbit. It's going to spread to the eyelid and can infect the sinuses and it can even spread deeper. These patients won't have any eye bulging or vision symptoms so you want to do a visual acuity if it's age appropriate. And fever is uncommon. These children do not look sick. This is very common in the pediatric population after a dog bite or an injury around the eye. Now you can see this child has periorbital or preseptal cellulitis. This is an opportunity for a lot of education and there needs to be a really low threshold to send your patient to the hospital. I always instruct parents to look for signs and symptoms of worsening and these children should be brought right away for a recheck. I often call parents the next day too and see how the child is progressing. So, we start these children on oral antibiotics and remember they need close follow-up because it takes these oral antibiotics 24-48 hours to even start to work. So if the child worsens in the meantime, they need to go to the hospital. Now let's talk about orbital cellulitis. This is a true medical emergency and this is where the eye is involved. The child may have painful eye movements, vision changes, and actual bulging of the eye. These children will be febrile and they look toxic. These kids look really sick. A CAT scan can be useful to look deep into the face and the treatment requires IV antibiotics and inpatient management. This can lead to vision loss or death. So, in orbital cellulitis which is more serious, we see the rapid onset. These children have fever and they need to see an ophthalmologist urgently. So now let's talk about the exam of the patient with cellulitis. First, you want to collect a health history and look at your patient's vital signs. Then you do a thorough head, eyes, ears, nose, and throat exam and progress down to a cardiac and respiratory assessment. Next, you will look at their skin. You want to measure the redness, the size of the erythema and this is done in centimeters. And if the patient has an abscess, you measure the size of that as well. And now this is a good opportunity to outline the red region with a surgical marker and I always remind my patients that the redness will likely extend beyond the border so it will continue to grow in size for the first 24-48 hours while these antibiotics are starting to work and then it should begin receding. If this involves a finger or a musculoskeletal joint, you're going to do a full MSK exam and that includes inspection, palpation, assessing the range of motion, strength, and the assessment of any joint involvement. You also want to do a lymph exam. The diagnosis of cellulitis is usually based on the history and physical exam. If an abscess is also present, it's usually caused by Staph aureus bacteria. Wound cultures and blood cultures are not usually helpful.