Diagnosis: Cellulitis (Infection) of the 2nd Digit (Right Hand)
infection
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1.1. **Etiology**
1.1.1. - Introduction of bacteria into the skin from a minor injury during moving.
1.1.2. - Bacterial infection from an open wound (likely Staphylococcus aureus or Streptococcus species).
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2.1. **Pathogenesis**
2.1.1. - The wound became infected, leading to inflammation of the skin and underlying tissue.
2.1.1.1. - The immune system response triggered erythema, warmth, and purulent drainage as part of the body's reaction to the infection.
2.1.1.1.1. - Infection worsened due to delayed medical intervention and ongoing physical activity.
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3.1. **Risk Factors**
3.1.1. - Lack of immediate medical care (self-care with hydrogen peroxide and Neosporin without professional wound assessment).
3.1.2. - Advanced age (65 years old) compromising immune response.
3.1.3. - Use of **Etanercept (Enbrel)** for rheumatoid arthritis, which suppresses the immune system, increasing susceptibility to infection.
3.1.4. - Recent trauma to the skin (injury during moving).
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4.1. **Clinical Manifestations**
4.1.1. - **Wound**: 4 cm x 1 cm x 2 cm lesion with purulent drainage, erythema, and warmth.
4.1.2. - **Pain**: Throbbing, sharp pain, worsened by movement, rated 8/10.
4.1.3. - Vital Signs
4.1.3.1. Temp 98.9°F
4.1.3.2. BP 134/80 mmHg
4.1.3.3. RR 18
4.1.3.4. HR 85 Bpm (higher than baseline)
4.1.4. - **Warmth**: The affected area is warm to the touch.
4.1.5. - **Redness and swelling**: Extends approximately 4 cm around the wound.
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5.1. **Comorbidities & Complications**
5.1.1. - **Rheumatoid Arthritis (RA)**: Managed with Etanercept, an immunosuppressant that may delay wound healing and increase infection risk.
5.1.2. - **Cataracts**: Previous surgery but not currently a factor in the infection.
5.1.3. - **Potential for Sepsis**: If the infection spreads, there is a risk of sepsis, particularly in immunocompromised patients.
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6.1. **Medications**
6.1.1. - **Ibuprofen** 600 mg PO QID for pain and inflammation.
6.1.2. - **Hydrocodone/Acetaminophen (Vicodin)** 5 mg/500 mg PO PRN Q4H for moderate to severe pain.
6.1.3. - **Cephalexin (Keflex)** 250 mg PO Q6H for 10 days as an antibiotic to treat cellulitis.
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7.1. **Other Treatments**
7.1.1. - **Wound Care**: Clean wound twice daily with antibacterial soap and water, apply a bandaid after patting the area dry.
7.1.2. - **Elevation**: Elevate the right hand 4 times daily for 20 minutes to reduce swelling.
7.1.3. - **Temperature Monitoring**: Check temperature twice daily and seek medical help if the temperature exceeds 99°F.
7.1.4. - **Return to Urgent Care/ER**: If the pain increases, drainage worsens, redness spreads, or a fever of 100°F develops.
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8.1. Diagnostic Tests
8.1.1. - **Wound Culture**: Sample of purulent drainage sent to the lab for culture/sensitivity to determine the causative bacteria and appropriate antibiotic.
8.1.1.1. - **Results Expected**: In 3 days.