DMC COLLEGE FOUNDATION, INC.

College of Nursing
Sta. Filomena, Dipolog City

A Case Study On

Abscess and Cellulitis (L) Leg Knee Joint

SUBMITTED TO:

MS. JESSIBEL L. LOS BANOS, RN.

SUBMITTED BY:

CRISTINE ANN A. PINILI

BSN III – ERICKSON | GROUP B

Date Submitted:

March 8, 2025

1
 INTRODUCTION

Infections affecting the musculoskeletal system can lead to serious complications, particularly
when they involve critical weight-bearing joints like the knee. Cellulitis with abscess formation in
the left knee joint represents a severe condition that requires prompt medical intervention to
prevent complications such as septic arthritis, deep tissue involvement, or systemic infection.

This case study examines a patient diagnosed with cellulitis and an abscess in the left knee,
focusing on the knee joint's anatomy and physiology, the infection's pathophysiology, clinical
manifestations, diagnostic approaches, and treatment strategies. Cellulitis is a bacterial infection
of the skin that targets the dermis and subcutaneous tissues, most commonly caused by
Staphylococcus aureus or Streptococcus species. An abscess signifies a localized accumulation of
pus, reflecting the body's immune response to the infection. Together, these conditions result in
significant pain, swelling, redness, and functional limitations of the affected joint.

The left knee joint's crucial role in mobility and weight-bearing amplifies the concerns associated
with infections in this area. If left untreated, the infection can spread to deeper structures such as
the synovial fluid and cartilage, leading to septic arthritis and potential joint destruction. Through
an in-depth examination of this case, we aim to elucidate the risk factors, diagnostic methods, and
therapeutic options that ensure effective patient management and recovery.

Signs and Symptoms:

•Redness and warmth over the left knee and foot

•Swelling and tenderness in the affected area

•Pus drainage from the abscess site

• Fever (38.5°C) and chills

•Fatigue and general malaise

•Difficulty bearing weight on the affected leg

2
Causes:

Bacterial Infection

- The most common cause of cellulitis and abscesses is Staphylococcus aureus or

Streptococcus bacteria, which can enter the skin through a break, cut, or wound.

Skin Trauma or Injury

- Small cuts, insect bites, or previous wounds on the foot could have served as entry points
for bacteria.

Compromised Immune System

- Conditions such as diabetes (as in Mr. John D.’s case) can impair the immune response,
making it easier for infections to develop and spread.

Poor Circulation

- Peripheral vascular disease, often associated with diabetes, can lead to delayed healing and
increased infection risk.

Risk Factors:

Diabetes Mellitus – Impaired wound healing and increased susceptibility to infections.

Obesity – Increases skin friction and risk of skin breakdown.

Poor Hygiene – Unclean skin can harbor bacteria, leading to infection.

Recent Surgery or Injections – Any invasive procedure can introduce bacteria into the
skin.

Weakened Immune System – Conditions like cancer, HIV, or prolonged steroid use increase the
risk.

Diagnostic Tests:

Physical Examination – Assess the extent of redness, swelling, and tenderness.

Complete Blood Count (CBC) – Elevated white blood cell (WBC) count indicates infection.

Blood Culture – Identifies bacterial presence in the bloodstream if sepsis is suspected.

Wound Culture and Sensitivity Test – Determines the causative organism and appropriate
antibiotics.

3
Medical Management:

1. Antibiotic Therapy

-Start with IV broad-spectrum antibiotics (e.g., Cefazolin or Clindamycin) until culture results
determine the best-targeted therapy.

- Transition to oral antibiotics (e.g., Amoxicillin-Clavulanate) for continued home management.

2. Abscess Drainage

- Incision and drainage (I&D) if the abscess is large, painful, or not responding to antibiotics.

- Cleanse the wound thoroughly to prevent reinfection.

3. Pain and Symptom Management

- Administer NSAIDs (e.g., Ibuprofen) or Acetaminophen for pain and fever reduction.

- Elevate the leg to reduce swelling.

- Encourage hydration and proper nutrition for wound healing.

Surgical Management: Drainage and Debridement of Left Knee Abscess

Indications:

- Presence of a localized or septic abscess in the knee

- Signs of infection (pain, swelling, erythema, warmth, fever)
- Failure of conservative management (antibiotics, aspiration)
- Concern for underlying joint involvement (septic arthritis)

Preoperative Preparation

- Imaging: X-ray, ultrasound, or MRI to assess abscess extent and rule out osteomyelitis or
septic arthritis
- Laboratory Tests: CBC, CRP, ESR, blood cultures if systemic infection suspected
- Antibiotics: Empirical broad-spectrum IV antibiotics, adjusted based on culture results
- Anesthesia: Local, regional, or general anesthesia depending on the extent of the procedure.

Surgical Procedure

1. Patient Positioning: Supine with knee slightly flexed for optimal access
2. Incision & Exposure:
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 a. Longitudinal incision over the most fluctuant or dependent area of the abscess
b. Blunt and sharp dissection to reach the abscess cavity
3. Drainage:
a. Aspiration of purulent material for culture and sensitivity
b. Copious irrigation with saline or antibiotic solution
4. Debridement:
a. Removal of necrotic tissue, fibrinous debris, or infected synovium
b. Assessment of joint involvement (if suspected, arthrotomy or arthroscopy may be
required)
5. Drain Placement (if needed):
a. Passive (Penrose drain) or active (negative-pressure
drain) to prevent reaccumulation.
6. Closure:
a. Primary closure in non-complicated cases
b. Delayed closure or packing in cases with extensive infection
7. Sterile Dressing & Immobilization:
a. Knee immobilizer or limited movement depending on severity

Postoperative Management

 IV Antibiotics: Based on culture results

 Pain Management: NSAIDs, opioids as needed
 Wound Care: Regular dressing changes, monitoring for signs of reinfection
 Physical Therapy: To prevent stiffness and restore function once infection resolves
 Follow-up: Serial inflammatory markers, repeat imaging if needed

Nursing Interventions:

Perioperative Nursing Interventions (Pre-Operative Phase)

Goal: Prepare the patient physically and emotionally for surgery while preventing complications.

1. Assessment:
- Evaluate vital signs (fever, tachycardia, hypotension in severe infection).
- Assess pain level, swelling, erythema, and range of motion in the affected knee.
- Review allergies (especially to antibiotics or anesthesia).
- Obtain a detailed history of infection, comorbidities (diabetes, immunosuppression, etc.).

2. Diagnostic Preparation:

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 - Ensure laboratory tests are done: CBC, ESR, CRP, blood cultures.
- Verify imaging results (X-ray, ultrasound, or MRI) to assess the abscess extent.

3. Preoperative Care:
- Administer prescribed IV antibiotics (broad-spectrum, later adjusted per culture results).
- Maintain NPO status as per facility protocol (usually 6-8 hours before surgery).
- Educate the patient about the procedure, expected outcomes, and post-op care.
- Perform skin preparation (cleansing with antiseptic, hair removal if needed).
- Obtain informed consent (ensure the patient understands risks and benefits).

Intraoperative Nursing Interventions

Goal: Maintain sterility, assist the surgical team, and ensure patient safety.

4. Patient Positioning:
- Place patient supine with the affected knee slightly flexed for better access.
- Apply padding to prevent pressure injuries.

2. Aseptic Technique:
- Ensure sterile field is maintained throughout the procedure.
- Assist with instrument passing and provide additional supplies as needed.

3. Monitoring:
- Continuously monitor vital signs (BP, HR, oxygen saturation, temperature).
- Observe for allergic reactions (anesthesia or antibiotics).
- Monitor estimated blood loss and report excessive bleeding.

4. Documentation:
- Record time of incision, drainage amount, type of exudate, and medications given.
- Note specimens sent for culture and sensitivity testing.

Postoperative Nursing Interventions

Goal: Prevent complications, manage pain, and promote healing.

Immediate Post-Op (PACU)

1. Monitor Vital Signs:

- Watch for signs of infection, hypovolemia, or sepsis.

6
 - Check for post-op bleeding, swelling, or drainage at the surgical site.

2. Pain Management:
- Administer prescribed analgesics (NSAIDs or opioids if needed).
- Elevate the affected leg and apply cold therapy (if ordered) to reduce swelling.

3. Wound Care & Drain Management:

- Inspect the surgical site and drainage system (if placed) regularly.
- Reinforce dressing changes per protocol to prevent contamination.

4. Monitor for Complications:

- Watch for signs of recurrent infection (redness, pus, fever, chills).
- Assess for DVT (deep vein thrombosis) due to immobility.
- Ensure adequate hydration and electrolyte balance.

Ongoing Postoperative Care

5. Antibiotic Therapy:
- Continue IV antibiotics per culture results.
- Monitor for adverse reactions to antibiotics.
2. Early Mobilization & Physical Therapy:
- Encourage ROM exercises as tolerated to prevent stiffness.
- Educate on gradual weight-bearing and activity restrictions.
3. Patient Education:
- Teach wound care techniques and signs of infection before discharge.
- Instruct on the importance of completing the antibiotic course.
- Encourage follow-up visits for suture removal or wound assessment.

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 TABLE OF CONTENTS

FRONT PAGE 1

INTRODUCTION 2-7

Signs and Symptoms 2

Risk Factors 3

Diagnostic Test 3

Medical Management 3-5

Nursing Interventions 5-7

TABLE OF CONTENTS 8

ANATOMY AND PHYSIOLOGY 9

TERMINOLOGIES 11

PATIENT PROFILE 12

PHYSICAL ASSESSMENT 14-16

LABS 16-18

GORDONS 19-21

NCP 24-26

MEDICATION 27-33

PATHOPHYSIOLOGY 22-23

ACKNOWLEDGEMENT 34

RELATED LEARNING 35

8
ANATOMY AND PHYSIOLOGY

9
The knee joint is one of the largest and most complex joints in the body. It connects the femur
(thigh bone) to the tibia (shin bone) and is crucial for weight-bearing and movement.

Components of the Knee Joint

Bones: The knee joint is formed by three bones:

- Femur: The thigh bone that forms the upper part of the knee joint.
- Tibia: The shin bone that forms the lower part of the knee joint.
- Patella: The kneecap that sits in front of the knee joint, providing protection and
improving leverage for the thigh muscles. –

Cartilage: The knee contains two types of cartilage:

- Articular Cartilage: Covers the ends of the femur, tibia, and back of the patella, allowing
smooth movement of the joint.
- Menisci: Two crescent-shaped pieces of fibrocartilage (medial and lateral menisci) that act
as shock absorbers and help distribute weight across the knee joint.

Ligaments: The knee joint is stabilized by four main ligaments:

- Anterior Cruciate Ligament (ACL): Prevents the tibia from sliding out in front
of the femur.
- Posterior Cruciate Ligament (PCL): Prevents the tibia from sliding backward under the
femur.
- Medial Collateral Ligament (MCL): Provides stability to the inner knee.
- Lateral Collateral Ligament (LCL): Provides stability to the outer knee.

Tendons: Connect muscles to bones and help in knee movement:

- Quadriceps Tendon: Connects the quadriceps muscles to the patella.

- Patellar Tendon: Connects the patella to the tibia.

Bursae: Fluid-filled sacs that reduce friction and cushion pressure points between bones,
tendons, and muscles around the knee.

Physiology of the Knee Joint

The knee joint is a synovial joint, characterized by the presence of synovial fluid within
the joint capsule, which allows for smooth and pain-free movement. The primary functions of the
knee joint include: - Mobility: The knee joint enables movements such as flexion (bending) and
extension (straightening), as well as slight internal and external rotation. - Weight-Bearing: The
knee supports the weight of the body during activities such as walking, running, and standing. -
Shock Absorption: The menisci and cartilage help absorb and distribute forces during movement,
protecting the bones from wear and tear. - Stability: The ligaments and muscles around the knee
provide stability and prevent excessive or abnormal movements that could lead to injury.

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 TERMINOLOGIES

1.Cellulitis: A bacterial skin infection that affects the dermis and subcutaneous tissues,
often caused by Staphylococcus aureus or Streptococcus species.

2.Abscess: A localized collection of pus within the tissue, resulting from the body's
immune response to infection.

3.Septic Arthritis: A serious joint infection that can occur when bacteria or other
infectious agents spread to a joint, leading to inflammation and potential destruction of the
joint.

4.Synovial Fluid: A viscous fluid found in the cavities of synovial joints, providing
lubrication to reduce friction during movement.

5.Subcutaneous Tissue: The layer of tissue directly beneath the skin (dermis), which
contains fat and connective tissues.

6.Dermis: The inner layer of the two main layers of the skin, located beneath the
epidermis, containing connective tissues, hair follicles, and sweat glands.

7.Pathophysiology: The study of the disordered physiological processes associated with

disease or injury.

8.Clinical Presentation: The set of signs and symptoms observed in a patient during a
medical examination.

9.Diagnostic Approaches: Methods used by healthcare professionals to determine the cause

of a patient's symptoms and reach a diagnosis.

10.Management Strategies: The treatment plans and interventions used to address and
manage a patient's condition, including medications, therapies, and surgical procedures.

11.Weight-Bearing Joint: A joint that supports the weight of the body, such as the knee, hip,
or ankle.

12.Deep Tissue Involvement: The spread of infection from the skin and subcutaneous
tissues into deeper structures, such as muscles and bones.

13.Systemic Infection: An infection that has spread throughout the body, affecting
multiple organs and systems.

14.Immune Response: The body's defense mechanism against infections and

foreign substances, involving various cells and proteins.

15.Redness (Erythema): A common sign of infection or inflammation, characterized by a

red appearance of the skin.

16.Swelling (Edema): The buildup of fluid in tissues, causing them to become swollen
and often painful.

17.Functional Impairment: The reduction or loss of the ability to perform normal

movements and activities due to pain, weakness, or other factors.

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 PATIENT'S PROFILE

HOSPITAL: Zamboanga del Norte Medical Center- Surgical Ward

NAME: Patient X

AGE: 13YO

SEX: Male

BIRTHDATE: January 14,2012

BIRTHPLACE: Sindangan, ZDN

OCCUPATION: None

ADDRESS: Maras, Sindangan, ZDN

CIVIL STATUS: Child

RELIGION: Roman Catholic

NATIONALITY: Filipino

DATE OF ADMISSION: February 17,2025

TIME OF ADMISSION: 2:05PM

ADMITTING PHYSICIAN: Dr. Minerva D. Nami Camota

ADMITTING DIAGNOSIS: Bacterial Cellulitis L Leg secondary to trauma

CHIEF OF COMPLAINT: Left leg swelling with fever

FINAL DIAGNOSIS: Abscess and Cellulitis Left Knee Joint

HISTORY OF PRESENT ILLNESS:

The patient was fetching water when he slipped and injured his left knee joint. Initially, he
experienced mild pain and swelling, which gradually worsened over the next two days. The
affected area became red, swollen, and tender with pus formation and difficulty in movement.

On the day of admission, he developed a low-grade fever (38.2C), chills and fatigue. Concerned
about the worsening swelling and pus drainage, his mother brought him to the hospital, where he
was diagnosed with abscess and cellulitis at the left knee joint and admitted for antibiotic therapy,
wound care and pain management.

PATIENT PAST MEDICAL RECORD: None

12
 GENOGRAM

Interpretation:

This genogram represents a family consisting of two parents and their three children. The father,
who is 45 years old, has hypertension and is represented by a blue circle, while the mother, who is
43 years old, is depicted by an orange square. Together, they have three children: a 13-year-old
son, a 13-year-old daughter, and a 10-year-old daughter. The son, represented by a red circle, is
marked as a patient, indicating that he has a medical condition that requires attention. Given that
the father has hypertension, there may be a hereditary health risk that could affect the children.
The mother and the two daughters do not have any indicated health conditions. This genogram
provides a clear overview of the family structure, gender, age, and medical history, which can be
useful in understanding potential genetic health risks and tracking medical concerns within the
family.

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 PHYSICAL ASSESSMENT

General Assessment: The patient is awake and alert. Vital signs are as follows:
Temperature: 36.1°C, Pulse Rate: 146 bpm, SpO2: 99%, Respiratory Rate: 15 cpm, Blood
Pressure:100/70 mmHg.

BODY PARTS FINDINGS

Skin  General: Dry, with no presence of lesions and masses

 Hair is minimally present on both hands and legs

Head  Head is symmetric

 No signs of lesions or masses

Face  Pale in color

 No signs of lesions or masses

Eyes  (+) PERRLA (Pupils Equal, Round, Reactive to Light and

Accommodation)

 No presence of discharges

Ears  The external ears are symmetrical, with no signs of swelling,

tenderness, or discharge. The tympanic membranes are intact. The
patient responds appropriately to conversational speech, indicating
no apparent hearing deficits. No reports of tinnitus, ear pain, or
vertigo.

Nose  The nose appears symmetrical with no visible deformities. The

nasal mucosa is pink and moist, with no signs of inflammation or
excessive discharge. No nasal flaring or congestion noted. The
patient denies difficulty breathing through the nose. No epistaxis
(nosebleeds) reported.

Mouth  Lips are brown in color, moist, and intact, with no visible lesions
or cracks. Oral mucosa appears healthy, with no signs of ulcers,
thrush, or abnormal growths. The tongue is midline, and the
patient demonstrates clear articulation when speaking. No dental

14
 caries observed, and gums appear firm with no signs of bleeding.
The patient denies difficulty swallowing or any pain when eating.

Neck  The trachea is midline, with no visible swelling or masses. No

lymphadenopathy or tenderness noted upon palpation. The patient
exhibits full range of motion (ROM) of the neck, with no
complaints of stiffness or pain. No jugular vein distention (JVD)
observed. The thyroid gland is non-palpable with no visible
enlargement.

Chest  The chest is symmetrical, with normal respiratory effort. No use of

accessory muscles noted. Breath sounds are clear bilaterally, with
no wheezing, crackles, or abnormal lung sounds upon auscultation.
The patient denies cough, dyspnea, or chest pain. No visible scars,
bruises, or deformities on the chest wall.

Abdomen  The abdomen appears flat and symmetrical, with no visible

distension, scars, or abnormal pulsations. Bowel sounds are
present and active in all four quadrants. No tenderness, guarding,
or masses detected upon palpation.

Lower  The left knee appears swollen, with mild to moderate erythema
Extremities (redness) surrounding the joint. The patient reports pain upon
movement with a pain scale of 7/10, with stiffness and difficulty
bearing weight on the affected side. Upon palpation, warmth and
tenderness are noted around the knee joint. Range of motion is
limited, with discomfort reported during flexion and extension. No
visible deformities, but mild muscle atrophy is present due to
reduced mobility.

Upper  Shoulders: symmetric, no lesions, masses, tenderness, swelling,

Extremities and deformity; presence of tattoos is visible.

 Elbow: symmetric, no lesions, masses, tenderness, swelling, and

deformity.

 Wrists: symmetric, no lesions, masses, tenderness, swelling, and

deformity.

 Fingers: no lesions, masses, tenderness, swelling, and deformity

 Fingernails: CRT of 2 seconds

15
 Musculoskeletal  Pain on left leg during ROM
System  Pain on knee joint when flex

 Positive joint pain on left leg knee upon knee flexion

LABORATORY TEST

BIOCHEMISTRY

Patient Name: X Specimen No.: 25007156

Age: 13 Ward: Surgical Ward
Gender: Male Date Sample Received: 2-17-2025
Requesting Physician: Dr. Minerva D. Nami Camota
Report Date & Time: February 17,2025 2:05PM

ELECTROLYTES

EXAMINATION RESULT FLAG NORMAL RANGE

SODIUM 130.6 LOW 135.0-145.0 mmo/L
POTASSIUM 3.72 3.5-5.1 mmo/L
CHLORIDE
IONIZED CALCIUM
REMARKS ER SAMPLE

Interpretation:
The patient's sodium level is 130.6 mmol/L, which is below the normal range (135-145
mmol/L), indicating hyponatremia. This could be due to fluid imbalances, dehydration, or an
underlying medical condition. Potassium is within the normal range at 3.72 mmol/L
(normal: 3.5-5.1 mmol/L). However, chloride and ionized calcium levels are not reported,
which could provide additional insights into the electrolyte balance.

16
 BIOCHEMISTRY

TEST RESULT UNIT NORMAL RANGE

CRP 13.39 High mg/dl 45 – 84

Interpretation:
The C-reactive protein (CRP) level is 13.39 mg/dL, which is elevated (normal: 4.5-8.4 mg/dL).
This suggests the presence of an inflammatory or infectious process in the body, which may
indicate an acute infection, autoimmune disorder, or another underlying inflammatory condition.

COAGULATION TEST

EXAMINATION RESULT NORMAL RANGE

*Protime
Control 13.9 secs
Patient 18.2 secs N.V.: 11-15 secs
% Activity 55% N.V.: 70-120%
INR
APTT: 35.4secs N.V.: 28-34 secs
Patient 1.09 0.0-100
Ratio

Interpretation:
The prothrombin time (PT) for the patient is 18.2 seconds (normal: 11-15 seconds), and the
activity percentage is 55% (normal: 70-120%), suggesting a potential clotting disorder or liver
dysfunction. The activated partial thromboplastin time (APTT) is 35.4 seconds, which is
slightly prolonged (normal: 28-34 seconds), possibly indicating an increased risk of bleeding
tendencies. The INR and ratio remain within expected limits. These findings may warrant further
investigation into clotting factor deficiencies or liver function impairment.

17
 HEMATOLOGY

TEST RESULT UNIT NORMAL RANGE

Complete Blood
Count
Red Blood Cells 4.09 x10^12/L 4.50-6.20
Hemoglobin 10.3 g/dl 13.0-18.0
Hematocrit 31.7 % 40-60
White Blood Cells 22.76 x10^9/L 4-10
Platelet Count 159 x10^3/uL 170-400
MCV 77.5 fL 81-89
MCH 25.2 Pg 26-30
MCHC 32.5 g/dL 28-32
RDW 16.5 % 12.1-16.2
MPV 8.25 7.4-10.4
Differential Count
Segmenters 83.59 % 55-65
Lymphocytes 12.58 % 25-35
Monocytes 2.37 % 3-6
Eosinophils 0.2 % 2-4
Basophils 1.26 % 0-5
Other Test
Blood type “B” RH POSITIVE

Interpretation:

The complete blood count (CBC) shows signs of anemia, with a hemoglobin level of 10.3
g/dL (normal: 13-18 g/dL) and hematocrit of 31.7% (normal: 40-60%). This suggests
possible iron deficiency, chronic disease-related anemia, or another underlying cause.
Additionally, the white blood cell count (WBC) is significantly elevated at 22.76 x10⁹/L
(normal: 4-10 x10⁹/L), indicating a possible infection or inflammatory response.

The platelet count is slightly low at 159 x10³/μL (normal: 170-400 x10³/μL), which, combined
with coagulation abnormalities, may increase the risk of bleeding.

In the differential count, segmented neutrophils are elevated at 83.59% (normal: 55-65%),
while lymphocytes are reduced at 12.58% (normal: 25-35%). This pattern is commonly
associated with a bacterial infection or acute stress response.

18
 GORDON'S HEALTH PATTERN

FUNCTIONAL PRIOR TO DURING

HEALTH STATUS HOSPITALIZATION HOSPITALIZATION

Health Perception/ The child may not have recognized Under medical care, the child and
Health the seriousness of the infection, parents are educated about proper
Management possibly ignoring early signs like wound care, the importance of
redness and pain. Parents may finishing antibiotics, and signs of
have
worsening infection.
initially treated it at home with
herbal like turmeric extract.

Nutritional- The patient had good appetite and The patient has decreased
Metabolic ate regular meals without any appetite due to pain and
issues. Diet combined mainly of discomfort. Food intake
has
fish and occasionally meat, along
reduced and the patient is eating
with rice and vegetables.
less than usual/ Needs
encouragement to eat to maintain
proper nutrition.

Bowel Elimination The patient had regular bowel Due to decreased mobility and
movements and urination patterns reduced food intake. The patient
with no issues. No history of has had fewer bowl movements.
constipation or diarrhea. Urination remains normal and
uses diaper for convenience as
ambulation is difficult and
painful.

Activity- Exercise The patient was not into extreme Limited mobility due to pain and
sports but enjoyed running swelling in the left knee. Unable
occasionally. Preferred E-sports to bear weight on the
over physical activities.

Cognitive- Experiencing significant pain that Pain is managed with medication

Perceptual affects concentration in school and and non -pharmacologic methods
daily activities. May not understand (distraction, deep breathing). The
the full content of the infection

19
 child and parents are educated on
treatment and recovery

Sleep-Rest The patient had a regular sleep During sleeping due to pain and
schedule, usually sleeping soundly discomfort in the affected knee,
by 8:00PM and would wake up
frequent awakenings at night,
3:00A-4:00Am to start preparing possibly needing repositioning or
for school. Felt well-rested and had pain relief. May require pain
no difficulty falling asleep or management or relaxation
staying asleep. techniques to improve sleep
quality.

Self- Perception/ The patient felt comfortable and The patient feels frustrated and
Self Concept confident in daily activities. Had no limited due to pain and restricted
issues interacting with friends and movements. May experience
enjoyed playing outside. Engaged boredom or sadness from being
in social activities and had a unable to play outside or interact
positive self-image. with friends as usual.

Role/ Relationship The patient had a good relationship The patient may feel isolated or
with family, with open disconnected from usual social
communication and mutual activities. Parents are more
understanding. Followed parent's involved in care, which may
instructions and was generally
cause frustrations due to
obedient. Had a stable social circle, dependence.
choosing to avoid troublemakers to
precent conflicts.

Sexuality- The patient was circumcised at 11 No current issue related to

Reproductive years old. No concerns or issues sexuality and reproductive
related to sexuality and health. May experience
development. Age appropriate slight

understanding of body changes. discomfort due to prolonged bed

rest and hygiene concerns.

Coping Stress The patient coped with stress by Fells frustrated and restless due
Tolerance playing on the phone, such as to pain and limited mobility. Still
mobile games or watching uses phone for distraction but
videos.

20
 Did not show significant signs of may need additional emotional
stress or anxiety. support.

Value- belief The parent’s family is Roman May rely in faith for comfort and
Catholic. Occasionally attends hope during illness. Might
church, but it was mostly the express questions or concerns
mother who’s more active in about recovery and well-being.
religious practices. The Family may offer prayers for
patient
healing and guidance.
believed in God but was not highly
religious.

21
PATHOPHYSIOLOGY

22
Interpretation:

Cellulitis is a bacterial skin infection that occurs when bacteria enter through breaks in the skin,
such as cracks, wounds from surgery, or trauma. While our skin naturally has bacteria, some of
these—like Staphylococcus aureus or Streptococcus pyogenes—can be harmful under the right
conditions. Certain factors, such as poor skin hygiene, environmental exposure, or instrumentation
(like IV lines or injections), can further increase the risk of infection.

Once bacteria bypass the skin barrier, the immune system tries to fight off the invaders. However,
if the bacteria are too strong or the immune system is weakened, the infection can spread deeper
into the skin and subcutaneous fat, leading to cellulitis. The body responds by sending immune
cells to the infected area, causing pain, redness, swelling, and warmth—the classic signs of
inflammation. In some cases, fluid-filled blisters (vesicles or bullae) may also form.

If the infection spreads beyond the skin, it can enter the lymphatic system, leading to
lymphadenitis (swollen lymph nodes) or ascending lymphangitis (infection traveling through
lymph vessels). If bacteria invade the bloodstream (bacteremia), it can trigger a widespread
immune response, leading to fever, chills, malaise, and even sepsis, a life-threatening condition.
In severe cases, the infection can spread to distant organs, causing endocarditis (infection of
the heart lining) or osteomyelitis (bone infection).

In more advanced stages, the accumulation of pus (bacteria, white blood cells, and dead skin
tissue) can lead to the formation of abscesses, requiring drainage or antibiotics.

23
 NURSING CARE PLAN

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATI

ON
DIAGNOSIS

Subjective: Acute pain After 8 hours Independent: After the 8

related to of nursing hours of
Patient infectious 1. Assess - Regular pain nursing
intervention
verbalized process pain level assessment intervention
the patient
“sakit kayo and using pain to monitor , the goal
will:
akong tuhod, di inflammatory scal q4H. effectiveness was met as
ko ka lakaw” response to 1.Demonstrate of evidenced
abscess and non- interventions by:
Reporting warm
cellulitis, as pharmacologic - Deep Patient
sensation on the 2. Encourage
evidenced by breathing report of
left knee procedure to deep
pain scale of help pain scale
reduce pain breathing
Pain scale of 7/10, guarding modulate 3/10
e.g., deep and
7/10 behavior, pain Less
limited breathing relaxation guarding,
Objective: exercises, perceptio more
mobility technique. n. mobile
and verbal proper turning 3. Apply
Guarding - Warm affected
complaints of and warm
behavior, compress area.
limited pain positioning. compress promotes Patient
mobility, facial as ordered drainage and satisfactoril
2. Report
grimacing when to promote enhance y
pain is
affected area is drainage demonstrate
relieved or blood
touched. and blood nonpharmac
controlled circulation to
flow. affected area. ologic
Demonstrates
3. Pain - techniques
proper To promote
positioning scale to alleviate
non pain.
techniques to reduce to at 4. Provide pharmacolog Takes
minimize pain least 5/10 comfort ical medication
and discomfort measures,
4. intervention. religiously.
Notable quiet
Demonstrate
increase in v/s diversion environme
activities to nt and
RR: 25cpm
alleviate calm
PR:130bpm discomfort activities.

5. Dependent: - To maintain
Cooperate acceptable
5. Administer
with level of
prescribed pain.
pharmacologic
analgesic Notify
interventions.
physician if
any adverse
reaction
occurs.

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ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Impaired skin After 8 hours Independent: After the 8 hours

Integrity of nursing nursing intervention,
Patient related to intervention, -Assess the skin -To ensure the goal was met as
verbalized tissue the patient condition at early detection evidenced by:
“nabalaka ko breakdown will: regular of disease
aning pagmula and swelling intervals. progression. 1. Patient showed a
ug paghubag sa as evidenced 1. Verbalize decrease redness and
-Encourage the -Reduces swelling with no
parte nga nay by redness, understandin
g patient to rest and edema to help further skin
samad” swelling, and elevate the
of the proper reduce further breakdown on the
warm to affected limb.
Objective: touch on the skin care damage to the area.
affected area. techniques. -Educate patient tissue.
-Skin appeared 2. Agrees to
2. on the possible -To help
erythematous, cooperate with
Demonstrate surgical and condition the
swollen and planned surgical and
infection medical patient
warm to touch. medical
control and intervention that
psychologically procedure if there
-patient prevention. may be done to
restore skin for the possible will be any.
experienced
interventions.
tenderness upon 3. integrity. 3. Satisfactorily
palpation. Satisfactorily -So patient may demonstrate on how
perform - Demonstrate to
learn from to do proper skin and
wound and the patient the
someone
skin care proper skin and wound care.
wound care knowledgeable
techniques.
techniques. about the
4. Show techniques.
improvement Dependent:
on its skin -Administer
integrity topical treatments -Help reduce
specially on such as local infection.
the affected antibacterial
area. ointments as
5.Coopera prescribed.
te with
surgical
management
to restore the
integrity of
the damaged
tissues.

25
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Risk for After the 8 Independent: After 8 hours of

infection related hours nursing nursing
Patient to bacterial intervention, the 1. Monitor signs -ensures that intervention,
verbalized invasion of the patient will: of systemic any goal was
“nabalaka ko skin and infection – complication partially met as
aning pagmula subcutaneous 1. Show no Temperature, will be evidenced by:
ug paghubag sa tissues. signs of level of identified and
akong samad” systemic consciousness, intervened 1. The
infection signs of promptly. patient’s vital
Objective: septicemia. signs
2. - To reduce
Demonstrate remained within
-Erythematous 2. spread of
techniques to Implement the normal
infection to limits.
-Presence of prevent contact other parts of
damaged tissue infection. precautions the body and 2. Wound
to prevent
-warm to touch 3.Be able healing was
prevent spread of introducing
to identify noted with no
-exposed to infection additional
behaviors and signs of further
external pathogens.
practices that wound
environmen deterioration
t may cause . -Rest helps
infection. the damaged 3. WBC count
-abscess 3. Encourage tissue recover remain elevated
formation 4.Complia rest and reduce faster. indicating an
nt with the physical
Lab result: infection.
medication activities. -Helps
WBC: regimen to prevent
22.76 prevent further Depende further spread
x10^9/L nt: of bacteria
infection.
that will
4.Administe
5.Reduced cause further
r antibacterial
level of WBC in infection.
medications as
the
ordered.
next blood
works. 5.Perform
wound care as
ordered.

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 ACKNOWLEDGEMENT

The completion of this study will not be possible without the help and assistance behind this
study. The contribution is sincerely and immensely acknowledged.

I would like to extend my deepest gratitude to those who have supported me throughout the
journey of completing this case study on Cellulitis and Abscess of the Left Knee Joint.

First and foremost, I am profoundly thankful to my instructor, Ms. Jessibel L. Los Banos. Your
unwavering support, insightful guidance, and genuine dedication to my growth have been nothing
short of inspiring. Your belief in my capabilities has been a driving force behind this endeavor.
Words cannot fully express the depth of my appreciation for your mentorship and encouragement,
which have been pivotal in shaping not only this study but also my academic and personal
development.

I am also sincerely grateful to my peers and colleagues. Our collaborative efforts, stimulating
discussions, and shared experiences have greatly enriched my understanding of this medical
condition. Your camaraderie and support have been invaluable throughout this journey.

A special note of thanks to the healthcare professionals involved in this study. Your commitment
to excellence in patient care and your willingness to share your expertise have greatly enhanced
the quality of this research. Your dedication serves as a constant source of inspiration for all of us
in the medical field.

I would also like to extend my heartfelt gratitude to God, for providing me with the strength,
wisdom, and perseverance to complete this study. Your guidance and blessings have been my
source of inspiration and motivation throughout this journey.

Lastly, I am deeply appreciative of my family and loved ones. Your unwavering support,
encouragement, and understanding have been my pillars of strength. Your belief in me has
provided the motivation to persevere and succeed.

This case study is a testament to the collective efforts, dedication, and support of everyone
involved. Thank you for being an integral part of this journey.

CRISTINE ANN A. PINILI

STUDENT NURSE- BATCH 2026

34
REFERENCES:

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse's Pocket Guide (16 ed.).
Philadelphia, Pennsylvania: F.A Davis Company.

Hinkle, & K. Cheever,Brunner & Suddarth's Textbook of Medical-Surgical Nursing Philadelphia:

Wolters Kluwer.

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