Cellulitis Resources

This article critically analyses the process of clinical decision-making (CDM) and associated theories that contribute to safe clinical judgement, allowing trainee advanced clinical practitioners (tACPs) to expand their knowledge, skills and attitude to CDM at an advanced level. The case included is from the author’s own clinical practice and is a reflective
piece involving CDM which embraces the four pillars of advanced practice. The relevant professional, legal and ethical issues that assist tACPs to follow the ‘Code of Conduct’ (Nursing and Midwifery Council [NMC], 2018) are also discussed in relation to this complex CDM case.

When patients present with red lower legs, the cause is often assumed to be cellulitis or erysipelas. There are, however, several alternative conditions which mimic the clinical signs of cellulitis or erysipelas, which can lead to misdiagnosis. It is important that the cause is correctly diagnosed to prevent inappropriate prescribing of antibiotics. This article discusses the different potential causes of ‘red legs’, in addition to cellulitis and erysipelas, together with clinical signs and symptoms to enable general practice nurses (GPNs) to differentiate between them and implement appropriate treatments

Lymphoedema is a debilitating condition that results in significant discomfort for patients and has no cure. However, with careful assessment and accurate diagnosis, appropriate treatment can relieve symptoms such as swelling and pain and improve patients’ quality of life. This article outlines the physiology of lymphoedema, before exploring the assessment and treatment measures, which include compression therapy to reduce oedema, skin care, manual manipulation of lymph fluid and exercise.

There has been an increase in non-cancer-related cases of lymphoedema across the UK and there is a need to raise awareness of this chronic non-curable condition (Williams, 2003; Keen, 2008). Lymphoedema can be effectively managed in primary care; however, frontline clinicians should have an understanding of the difference between lymphoedema and other lower limb conditions, especially with regards to lower limb lymphoedema. There are also gaps in knowledge around the practice of managing poorly drained interstitial fluid, which need to be addressed. However, for management to be effective, a patient-centred approach needs to be established with patients directing their care. As the management of lymphoedema involves patients doing exercises, it impacts on their day-to-day lives. Slight modifications, such as personal massage to improve lymphatic drainage, skin care to improve skin texture and theraband exercises to aid mobility, may need to be considered as part of the management process and, as the medical model on its own is not effective in managing this condition, patients may need to be referred to a team of specialist practitioners.