Physical examination of the affected regions of the skin is necessary. Individuals with cellulitis are likely to have a reddened region of the skin, swelling as well as intense pain (Brown & Watson, 2022). Brant experiences pain in his right leg, in a reddened region that is swollen.
The affected area should be thoroughly checked for any signs of skin disintegration. Variations in temperature in the area should be monitored along with signs of an abscess (Sutherland & Parent, 2017). Brant revealed that he was bit by a mosquito on the reddened area.
This being a seemingly severe case, the physician may order complete blood count (CBC) testing. This will help measure blood count levels (Bennett et al., 2020). A CBC will allow the physician to make an accurate early diagnosis of a wide range of medical conditions.
The physician may also order a C-reactive protein (CRP) test, which is a blood test for inflammation. This would be a necessity since Brant has broken skin because of a mosquito bite (Sutherland & Parent, 2017). Brant’s case is an event of major systemic disturbance since there is a manifestation of chills and acute disorientation.
Priority diagnostic criteria for Brant would include assessing the occurrence of erythematous inflammation in the basal dermis and subcutaneous tissue. Redness, swelling, and pain are all signs of cellulitis (Sutherland & Parent, 2017). Erythema must be present in order to make the diagnosis.
The location and nature of broken skin should also be assessed. For cellulitis to be diagnosed, the patient’s skin must be checked for micro-abrasions resulting from insect bites (Brown & Watson, 2022). Lower limbs are commonly affected.
Brant’s positioning and movement should be adjusted. To reduce swelling in the areas facing downward, Brant’s feet and arms should be propped up on cushions while he lays on his back (Zariquiey-Esteva & Santa-Candela, 2017). If Brant stands for a long time, speedy blood flow to the heart may be hindered, which could cause low blood pressure.
Brant may also need to be placed on his side in the recovery position, particularly whenever he feels nauseated or feels like vomiting. From the assessment, he feels nauseated and weak and has vomited on numerous occasions (Zariquiey-Esteva & Santa-Candela, 2017). This will help avoid low blood pressure.
When germs break through the skin, “cytokines” and “neutrophils” are released into the bloodstream to fight them off. This causes cellulitis, which is characterized by redness, warmth, swelling, and pain (Brown & Watson, 2022, para 5). This appears to have been the case for Brant. He was bitten by a mosquito, which broke his skin, allowing bacteria (Streptococcus pyogenes) to penetrate the area. An outbreak of redness and swelling occurred when “cytokines and neutrophils” were drawn to the area of the skin to fight against the bacteria (Brown & Watson, 2022, para 5).
The leucocyte count increased to 15. This is outside of the reference range (4.0–11.0). An excessive immune reaction to an acute inflammation and parasite infection is likely to have induced increased leucocyte levels (Agnello et al., 2021). An increase in leucocyte count is a normal response to infection or inflammation in the bone marrow.
Venous blood lactate (4) is also above the reference range (1.3). Blood lactate concentrations in healthy individuals are generally modest (Asati et al., 2018). This could indicate that Brant’s condition has escalated to tissue hypoxia (Agnello et al., 2021). Extensive exposure to hypoxia damages tissue, leading to death.
The hemoglobin count (189) is above the normal range (140-164). This should not be the case. In sepsis, hemoglobin count decreases due to a functional iron deficit, which is also caused by the infected area’s decreased production of hemopoietin (Agnello et al., 2021). Normally, inflammation inhibits RBC production, leading to decreased hemoglobin.
Plasma potassium increased to 7.0. This is beyond the ordinary reference range (3.5-5.2 mEq/L), even in cases of bacterial infection. It could indicate that Brant’s condition could be critical, as the infection may have led to hyperkalemia (extreme levels of potassium) (Tongyoo et al., 2018). Hence, Brant needs immediate medical attention.
References
Agnello, L., Giglio, R. V., Bivona, G., Scazzone, C., Gambino, C. M., Iacona, A., Ciaccio, A. M., Lo Sasso, B., & Ciaccio, M. (2021). The value of a complete blood count (CBC) for sepsis diagnosis and prognosis. Diagnostics, 11(10), 1881. Web.
Asati, A., Gupta, R. & Behera, D. (2018). To determine blood lactate levels in patients with sepsis admitted to a respiratory intensive care unit and to correlate with their hospital outcomes. Critical Care and Emergency Medicine, 4(2), 1-12.
Bennett, S., S., Harris, N., Chaffin, J. & Beal, S. (2020). Educational case: Hematologic and immunologic response to allergic rhinitis with other causes of leukocytosis. Academic Pathology, 7, 1-5.
Brown, B. & Watson, K. (2022). Cellulitis. StatPearls Publishing. Web.
Sutherland, M. & Parent, A. (2017). Cellulitis: Assessment, diagnosis and management. Dermatological Nursing, 16(4), 24-28. Web.
Tongyoo, S., Viarasilpa, T. & Permikul, C. (2018). Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit. Journal of International Medical Research, 46(3), 1254–1262. Web.
Zariquiey-Esteva, G. & Santa-Candela, P. (2017). A case report: Nursing interventions on a patient with anaphylactic shock in ICU. Enfermería Intensiva, 28(2), 80-91.