A patient with a localized skin infection is prescribed cephalexin. Which of the following statements indicates that the patient understands the medication instructions?

B) 'I should take the full course of antibiotics, even if I feel better.'

A) 'I will take the antibiotic until my symptoms improve.'

B) 'I should take the full course of antibiotics, even if I feel better.'

C) 'I can stop taking the antibiotic if I don't have a fever.'

D) 'I need to take the antibiotic on an empty stomach.'

A patient with a localized skin infection on the left lower leg is prescribed cephalexin. Which of the following nursing interventions is MOST important to teach the patient to ensure effective management of her condition?

C) Monitor for any signs of allergic reaction, such as rash or difficulty breathing.

A) Take the medication on an empty stomach to increase absorption.

B) Discontinue the medication as soon as symptoms improve to avoid side effects.

C) Monitor for any signs of allergic reaction, such as rash or difficulty breathing.

D) Avoid using any topical ointments on the affected area until the infection clears.

What is the most appropriate nursing action if a patient on cephalexin reports mild itching without any visible rash?

A) Reassure the patient that itching is a common side effect and continue monitoring

B) Immediately discontinue the antibiotic and report to the physician

C) Advise the patient to take an antihistamine and skip the next dose of the antibiotic

D) Apply a topical steroid cream to the affected area to relieve itching

What is the priority nursing action when a patient on cephalexin reports mild itching without any visible rash or hives?

C) Monitor the patient for any signs of rash or hives and advise to report if they occur

A) Discontinue the antibiotic immediately

B) Advise the patient to apply an over-the-counter antihistamine cream

C) Monitor the patient for any signs of rash or hives and advise to report if they occur

D) Increase the dose of cephalexin to reduce bacterial resistance

During the follow-up appointment, which finding indicates that the patient is responding well to the treatment for her leg condition?

C) The patient's C-reactive protein level has decreased.

A) The erythematous area has increased to 5 cm in diameter.

B) The patient reports a pain level of 6 out of 10.

C) The patient's C-reactive protein level has decreased.

D) The patient has developed a rash and hives.

Which action is most important for the nurse to emphasize to the patient to ensure continued improvement in her condition?

B) Complete the full course of antibiotics

C) Apply a topical antihistamine for itching

D) Schedule daily walks to increase circulation

Which of the following actions should the nurse emphasize to the patient to support continued recovery and prevent recurrence of her leg infection?

B) Maintaining proper hydration

C) Discontinuing skin care practices

A patient has successfully completed a course of antibiotics for a leg infection and is showing signs of recovery. Which ongoing self-care measure should the nurse emphasize during the follow-up visit to support continued healing?

B) Continue with regular leg elevation.

A) Apply a warm compress to the leg daily.

B) Continue with regular leg elevation.

C) Restrict fluid intake to reduce swelling.

D) Perform vigorous leg exercises daily.

A patient has successfully completed treatment for a lower leg infection and reports no symptoms. What is the most important advice the nurse should give the patient to prevent recurrence?

A) Continue good skin hygiene and monitor for symptoms

B) Increase physical activity to improve circulation

C) Apply topical antibiotics daily as a preventive measure

D) Schedule frequent follow-up appointments for monitoring

What is the primary reason for encouraging the patient to maintain good skin hygiene and monitor for the recurrence of symptoms after recovery from a leg infection?

C) To reduce the risk of reinfection or complications

A) To prevent the spread of infection to others

B) To ensure personal comfort and cleanliness

C) To reduce the risk of reinfection or complications

D) To avoid the need for future medical check-ups

leg infection - Nursing Case Study

Pathophysiology

• Primary mechanism: Bacteria enter through a break in the skin, such as a cut or ulcer, leading to infection as the immune system responds to eliminate the pathogen.

• Secondary mechanism: Inflammation occurs as white blood cells rush to the site, causing redness, warmth, swelling, and pain. This response helps to contain the infection but can also damage surrounding tissues.

• Key complication: If untreated, the infection can spread to deeper tissues, potentially leading to cellulitis, which requires more intensive treatment to prevent further complications.

Patient Profile

Demographics:

42-year-old female, office worker

History:

• Key past medical history: Previously healthy, no chronic conditions

• Current medications: None

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild redness and swelling on left lower leg

• Key symptoms: Slight pain, warmth, and tenderness in affected area

• Vital signs: Temperature 98.6°F, Heart rate 76 bpm, Blood pressure 118/72 mmHg, Respiratory rate 16 breaths per minute

Section 1

Initial assessment findings reveal that the patient’s left lower leg exhibits a well-demarcated area of erythema approximately 4 cm in diameter. The skin in this region is warm to the touch, and the patient reports a pain level of 3 out of 10, which she describes as a dull ache. There is no evidence of purulent discharge or open sores, but a small, healed cut is noted on the surface. The patient denies any systemic symptoms such as fever, chills, or malaise. Capillary refill in the toes is less than 2 seconds, and pedal pulses are palpable and strong, indicating good perfusion to the extremity.

A complete blood count is ordered to assess for signs of infection or inflammation. The results show a white blood cell count of 8,000 cells/mcL, which is within the normal range, suggesting that the infection is localized and has not triggered a systemic response. C-reactive protein levels are slightly elevated, indicating a mild inflammatory process. An ultrasound of the affected area is performed to rule out deeper involvement like an abscess or thrombophlebitis, and results show no abnormalities other than superficial soft tissue swelling.

The patient is advised to begin a course of oral antibiotics, excluding penicillin due to her allergy, and is prescribed cephalexin, a cephalosporin antibiotic. She is also instructed to rest and elevate her leg to reduce swelling and is advised on proper wound care to prevent further infection. Follow-up is scheduled in five days to reassess the infection’s progression and ensure that the treatment is effective. If symptoms worsen or new symptoms arise, the patient is instructed to seek medical attention promptly.

Section 2

During the follow-up appointment five days later, the patient reports minimal changes in her symptoms. She continues to experience a dull ache in her left lower leg, with a pain level of 2 out of 10, suggesting slight improvement. Upon examination, the erythematous area remains approximately 4 cm in diameter, but the warmth has decreased slightly, indicating a potential positive response to the antibiotic therapy. The skin around the affected area appears less tense, and the patient notes that she has been diligent in resting and elevating her leg as advised. Her vital signs remain stable, with a blood pressure of 118/76 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and temperature of 98.4°F, confirming the absence of systemic infection.

A repeated complete blood count shows a stable white blood cell count of 8,200 cells/mcL, further supporting the localized nature of the infection. The C-reactive protein level has decreased slightly, aligning with clinical improvements. Despite these positive indicators, the patient mentions a new sensation of mild itching around the affected area, which might suggest a common side effect of cephalexin or an early sign of an allergic reaction. The nurse checks for any signs of rash or hives but finds none.

Given the improvement in the clinical and laboratory indicators, the treatment plan continues with cephalexin and supportive care. However, the patient is advised to monitor the itching closely and report any escalation or signs of a rash, which would necessitate a reevaluation of the antibiotic regimen. The nurse also reinforces the importance of continued leg elevation and proper wound care. The patient is scheduled for another follow-up in one week to ensure continued progress and reassess the management plan if necessary.

Section 3

One week later, during the follow-up appointment, the patient reports a noticeable improvement in her symptoms. The dull ache in her left lower leg has reduced significantly, with her pain level now at 1 out of 10. The erythematous area has decreased to 3 cm in diameter, and the skin appears less inflamed. The patient has been consistent with her resting and leg elevation routine and has adhered to the cephalexin regimen. Her vital signs remain stable, with a blood pressure of 116/74 mmHg, heart rate of 76 beats per minute, respiratory rate of 16 breaths per minute, and temperature of 98.2°F. These findings suggest a continued positive response to the current treatment plan.

Laboratory results show a further decrease in the C-reactive protein level, indicating reduced inflammation, and the white blood cell count remains within the normal range at 7,900 cells/mcL. However, the patient continues to experience mild itching, which has not escalated, and there are still no signs of a rash or hives. The nurse reassures the patient that the itching is likely a mild side effect of the antibiotic and not an allergic reaction, but advises her to remain vigilant and report any new symptoms.

The nurse emphasizes the importance of maintaining the current treatment protocol, including the completion of the antibiotic course, continued leg elevation, and proper skin care. The patient is encouraged by her progress and expresses confidence in the treatment plan. She is scheduled for another follow-up in one week to ensure that her condition continues to improve and to determine if any adjustments to her care plan are necessary.

Section 4

One week later, during the scheduled follow-up appointment, the patient presents with a continued positive trajectory in her recovery. The erythematous area on her left lower leg has further reduced to 1.5 cm in diameter. Her pain level remains minimal, consistently reported at 1 out of 10, and she describes the leg as feeling "almost back to normal." The mild itching persists, but there are still no signs of worsening or additional skin changes such as rash or hives. The patient confirms she has completed her course of cephalexin as prescribed and has been diligent in adhering to the recommended leg elevation and rest.

Vital signs during this visit are stable: blood pressure is 118/76 mmHg, heart rate is 74 beats per minute, respiratory rate is 16 breaths per minute, and her temperature is 98.1°F. Laboratory tests reveal that her C-reactive protein levels have normalized, indicating a resolution of inflammation, and her white blood cell count remains stable at 7,800 cells/mcL. These findings suggest that the leg infection is responding well to the treatment, with no new complications arising.

The nurse discusses with the patient the importance of continuing with proper skin care and monitoring for any unusual symptoms, despite the significant improvement. Although the course of antibiotics is complete, the nurse reminds the patient to maintain practices that support her recovery, such as regular leg elevation and hydration. The patient is reassured by her progress and expresses gratitude for the clarity of the treatment plan. She is advised to return for a follow-up in two weeks to ensure sustained recovery and to confirm that no new issues have developed.

Section 5

Two weeks after the most recent follow-up appointment, the patient returns for her scheduled check-up. She mentions that the itching has completely subsided, and the erythematous area on her left lower leg has further reduced to less than 1 cm in diameter. Her pain level is now reported as 0 out of 10, and she confidently states that her leg feels "completely back to normal." The patient has continued to follow the nurse's advice on skin care and leg elevation, and she reports feeling well overall.

During this visit, the nurse conducts a thorough assessment and finds that the patient's vital signs remain within normal limits: blood pressure is 116/74 mmHg, heart rate is 72 beats per minute, respiratory rate is 16 breaths per minute, and her temperature is 98.0°F. A physical examination of the leg reveals healthy skin with no signs of redness, swelling, or tenderness. Laboratory tests confirm stable inflammatory markers, with a C-reactive protein level of 0.5 mg/L and a white blood cell count of 7,600 cells/mcL, both indicating continued resolution of the infection.

The nurse discusses the positive outcome with the patient, emphasizing the importance of continuing good skin hygiene and monitoring for any recurrence of symptoms. The patient is advised to maintain her healthy lifestyle choices, including adequate hydration and balanced nutrition, to support her overall well-being. Reassured by her steady recovery, the patient is discharged from regular follow-ups but is encouraged to contact the clinic should any concerns arise in the future. This marks the successful conclusion of her treatment journey, with a focus on prevention and health maintenance moving forward.