The patient’s temperature should be monitored as well as any reduction in erythema, pain and oedema to ensure that treatment is effective. Different antibiotics may be required and hospital admission may be necessary if cellulitis does not resolve. It is important to remember that pyrexia may be masked in older adults because the febrile response is impaired. An older patient with a severe infection may only display a mildfever (Roghmann et al2001), therefore temperature may not prove an effective means of monitoring this population group. It is vital that all baseline symptoms are recorded, monitored and observed so that any alteration can be noted. To observe if cellulitis is spreading it is important that the area of erythema is marked with an indelible pen and that the circumference of the leg is measured. This will allow patients and healthcare professionals to assess if the cellulitis is continuing to spread or is resolving with treatment. Older patients can also become dehydrated easily as a result of infection and possible high levels of exudate loss. It is important to encourage the uptake of more fluids than usual to replace any loss. Urine should be the colour of straw, which for most people will mean drinking more than they usually do (Ellins 2006). Cellulitis is a painful condition and analgesics need to be taken on a regular basis. Elevation of the limb will encourage reduction of swelling, but further medical advice will be required if erythema continues to spread. Accurate record-keeping is essential and healthcare professionals should document the site of cellulitis, which leg is affected and any measurements taken to provide comparative baseline data. The HAMMMER acronym (Beasley 2010) is a helpful tool for patients and healthcare professionals, enabling deterioration to be detected early and necessary therapy to be commenced. The HAMMMER acronym involves consideration of the following:
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Hydrate –drink plenty of fluids, two litres per day if possible.
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Analgesia –take pain relief on a regular basis.
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Monitor pyrexia –is the temperature still rising?
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Mark off the area –is the redness spreading?
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Measure the circumference of the limb – is the leg increasing in size?
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Elevate the limb –reduce swelling if possible.
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Record the site –accurate documentation.