Assess for signs of decreased tissue perfusion. Activate your 30 day free trialto continue reading. Learn how your comment data is processed. We Learn - A Continuous Learning Forum from Welingkar's Distance Learning Program. Nature. It can get worse quickly, so if you develop signs or symptoms of. Congestive Heart Failure. These patients may benefit from prophylaxis with erythromycin, penicillin, or clindamycin (Cleocin).5,7, Periorbital cellulitis is caused by the same organisms that cause other forms of cellulitis and is treated with warm soaks, oral antibiotics, and close follow-up.8 Children with periorbital or orbital cellulitis often have underlying sinusitis.9 If the child is febrile and appears toxic, blood cultures should be performed and lumbar puncture considered. Use lukewarm water, mild soap, or non-soap cleaners to avoid irritations. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Cystic Fibrosis Nursing NCLEX Review and Nursing Care Plan, Type 2 Diabetes Nursing Diagnosis and Care Plan, Hyperthyroidism Nursing Diagnosis and Nursing Care Plan. For it reduces the risk of infection. The skin is considered the biggest organ of the body in terms of surface area. Determine if there are any aggravating factors. [online] Available at: , Mayo Clinic. Educate the patient and caregiver about proper skin hygiene through washing the skin with soap and water. Cellulitis NCLEX Review and Nursing Care Plans. Mayo Clinic. Keep skin moisturized with a lotion or cream as dry, flaky skin is more likely to crack. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. Read More Imbalanced Nutrition: Less Than Body Requirements Nursing Diagnosis & Care PlanContinue. In some cases, the patient and nurses keep on dealing with this crisis, in the same way in which they have given out with the same trouble before. This is the best way to assess if redness is continuing to spread. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Apply corticosteroids over the affected skin as prescribed by the physician. Circulation . The patient should be seen the following day to reassess disease progression. Activate your 30 day free trialto continue reading. Associated systemic symptoms or fever rarely exist. Nursing Management of IV Infiltration. Blank Nursing Care Plan_CS (Cheat Sheet) Outline Pathophysiology Cellulitis is a common deep bacterial skin infection that causes redness, swelling, and pain in the affected area of the skin (usually the arms and legs). Immediate treatment can help prevent the spread of cellulitis. Do not give fallacious reassurance. If untreated, can spread and cause serious health problems. Cellulitis commonly occurs near breaks in the skin, such as surgical wounds, trauma, tinea infections (Figure 1), or ulcerations, but occasionally presents in skin that appears normal. The major nursing care plan goals for a child with hypospadias and/or epispadias are: Child will experience decreased pain as evidenced by infrequent crying episodes and exhibit normal sleeping pattern. Everything from hydration, to metabolism to self-care. We've encountered a problem, please try again. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Also, constant scratching of the lesions will lead to thickening of the surface. Interventions are aimed at prevention. INTRODUCTIO N CHANDLER CLASSIFICATION . Fashion, make-up, and accessories may take away the attention from the skin lesion. Using a skin marker, mark the edges of the cellulitic area and observe for its shrinkage or spread. Cellulitis is a bacterial subcutaneous skin infection. 2. Cellulitis vs necrotizing soft tissue infection, Dental Management of Adrenal Insufficiency Slides, Perio restorative interelationship(periodontics), Complication and management of tooth extraction or exodontia, CARBUNCLE, MODALITIES OF TREATMENT CASE REPORT, SSR Institute of International Journal of Life Sciences. Desired Outcome: The client will sustain adequate peripheral perfusion, as evidenced by strong pulses, skin is warm to touch, with a normal capillary refill, and wounds are healed. Cellulitis is a common diagnosis nurses will become familiar with in the inpatient setting. Nursing Interventions and Rationales 1. Activate your 30 day free trialto continue reading. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. In cases of cellulitis, they may have a specific characteristic pattern of skin changes and lesions. Gangrene. If this happens, other vital organs like the brain will be affected as well. H\n0GM:@ 5OGD`n8,*utS'wD%wm$ mqxZiO'?|0^YQ;A{{u*C%xNr)Mm|;^\>\MePCqU g`\Yk+WW\7+W-yK=:c 5kkWL_`p72%5sd725 5 5Xc[f)o^R`e#R#{!,aY Hot tub folliculitis is caused by Pseudomonas aeruginosa contamination of under-treated water in a hot tub or whirlpool. Cellulitis therefore. Brisk drying may result in irritation to the skin and may aggravate the itch-scratch cycle. Bacterial organisms enter a compromised skin barrier and cause infection. Animal bites, insect stings, recent surgery, puncture wounds, or even microscopic skin tears can contribute for cellulitis to happen. (e.g. Antibiotics are needed to treat cellulitis. Hot water in long bathing and showering may cause dry skin and can trigger itching. The nurse may assess the presence of comorbid conditions that may increase the risk of cellulitis. Educate the patient about the aggravating factors that should be avoided. Free access to premium services like Tuneln, Mubi and more. Take Time To Do Your Research Congestive Heart . By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. LEVELS OF MANAGEMENT. If the infection is a toxin-producing, phage group II, type 71 Staphylococcus (the same toxin seen in Staphylococcus scalded skin syndrome, a medical emergency where large sheets of the upper epidermis slough off), large bullae will form as the toxin produces intradermal cleavage.18 Otherwise, smaller bullae develop and the honey-crusted lesions predominate. Importance. Medication including norepinephrine can lead to distal ischemia and kidney failure. Antibiotics are used empirically with consideration for resistance patterns. The patients current health status and health history provide information about the possible cause of nausea and vomiting. Pale nail beds are an indication of poor perfusion. When is. What is the extent of the problem? Promote interconnection between the patient, family members, and members of the rehabilitation group. These lesions typically resolve spontaneously. We've encountered a problem, please try again. Now customize the name of a clipboard to store your clips. Get advice from 111 now if: your skin is painful, hot and swollen Early treatment with antibiotics can stop cellulitis becoming more serious. If the patient cannot cognitively comprehend not scratching, apply gloves or mittens to protect the skin. 2021. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. Looks like youve clipped this slide to already. A Brief Comparison Between Acupuncture And Physiotherapy, Everything You Need To Know About PRP Dark Circle, Samitivej Childrens Emergency Clinic in Bangkok, Thailand. Buy on Amazon. For all women out there, it is important to remember that, being able to have the most beautiful body is something that, you will always about. Do Clear Plastic Aligners Adjust The Extraction Of Front Teeth? 4. This develops positive behavior and promotes the opportunity to settle goals and plans according to reality. She earned her BSN at Western Governors University. Some medications side effects may act as appetite stimulants, and others might cause a decrease in appetite. Cellulitis is when there is a local skin and soft tissue bacterial infection. Patients who cannot care for themselves (paraplegia, dementia, brain injury) may not be aware of skin breakdown or cannot assess their skin themselves. Oxygen saturation should be at a satisfactory level to guarantee an adequate oxygen supply. this topic describes indetail regarding the cellulitis, its causes and the management Siva Nanda Reddy Follow Staff Nurse RN Advertisement Advertisement Recommended Cellulitis - Treatment Areej Abu Hanieh 11.8k views 23 slides Skin and Soft Tissue Infections Nireshan Naidoo 8.1k views 70 slides Cellulitis Albert Blesson 1.2k views 18 slides Diagnosing and managing lower limb cellulitis | Nursing Times EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG We use cookies to personalize and improve your experience on our site. 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Nursing care, as found in patients' hospital records were predominantly on medication administration (98.0%), vital signs assessment (90.5%) and patient assessment (53%). This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Assess access to care and support.Assess if the patient isnt able to seek treatment due to a lack of accessible providers, transportation issues, or financial barriers. Results: Of the 236 cases of cellulitis identified from a study of hospital records, 202 were included in the study. Put limitations on maladaptive behavior. Cellulitis Nursing Diagnosis Cellulitis Care Plans Pathophysiology: Cellulitis is an infection of the skin (epidermis and dermis) or underlying soft tissues (hypodermis); it can spread rapidly and be life-threatening. -Making sure the patient is receiving adequate nutrition and hydration. By Steffy Alen Health acute pain cellulitis nursing diagnosis, acute pain related to cellulitis care plan, altered primary defenses, care plan for contact dermatitis, cellulitis bed rest, cellulitis nclex, cellulitis therapeutic procedures, complications for cellulitis, impaired skin integrity nursing diagnosis, ineffective tissue perfusion . View Nursing Care Plan For Cellulitis PPTs online, safely and virus-free! Uveitis (Classification, Panuveitis, Endophthalmitis, Panophthalmitis, Synech Common eye conditions in General Practice, MANIFESTACIONES OCULARES DE ENFERMEDADES SISTEMICAS, Investigation of GI infection outbreak in Nursing Hostel.pptx, Cell-Division-Mitosis-Biology-Lecture-PowerPoint-VCBCct.ppsx, How to lose weight fast and easily (HOW NOT TO DIET), sociology3healthbehaviour-190406154029.pdf, APPLIED ASPECTS OF CAST PARTIAL DENTURE DESIGNING.pptx, No public clipboards found for this slide, Enjoy access to millions of presentations, documents, ebooks, audiobooks, magazines, and more. To determine the severity of cellulitis and any affected areas that require special attention or wound care. 3. Guide the patients in determining the ways to improve their appearance. Also. Changes or worsening in these lung sounds may indicate a decline in ventilation. Looks like youve clipped this slide to already. In severe forms of cellulitis, deep tissues like the muscle and bone may be infected and would require surgical removal of the necrotized and dead tissues. If cellulitis is a recurrent issue identify a caregiver or family member that can accept the teaching and manage the care and follow-up of the patient. The nonbullous type predominates and presents with an erosion (sore), cluster of erosions, or small vesicles or pustules that have an adherent or oozing honey-yellow crust. Cellulitis is preventable and can be easily managed if identified early with prompt treatment. 1.1 Managing cellulitis and erysipelas Treatment 1.1.1 To ensure that cellulitis and erysipelas are treated appropriately, exclude other causes of skin redness such as: an inflammatory reaction to an immunisation or an insect bite or a non-infectious cause such as chronic venous insufficiency. Teach the patient about the signs and symptoms of infection and when to inform their healthcare provider. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. 2. Cellulitis often occurs in the lower leg but can affect the arms, face, and other areas. The client will participate in the treatment program and prevention management. 4. [Updated 2021 Jul 31]. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. Pulses are an indicative property of sufficient perfusion to the specific body part. Cellulitis is a painful, erythematous infection of the dermis and subcutaneous tissues that is characterized by warmth, edema, and advancing borders (Table 1). Of note, there is increasing concern regarding the rise in S. aureus MICs to vancomycin. By accepting, you agree to the updated privacy policy. extremes of age, immunocompromised status), Blood cultures to detect for the specific organism causing the cellulitis, CBC basic laboratory test to determine blood count levels for proper management, Creatinine to assess baseline kidney function and guide for antibiotic dosing, bicarbonate, creatine phosphokinase to assess for latent muscle injuries caused by infection, C-reactive protein (CRP) laboratory marker for inflammation, Ultrasound to detect hidden sources of infection (occult abscess) and can lead to proper management. [online] Available at: . Atypical presentations of erythema nodosum leprosum: a case report and litera Allergic and Immunologic Diseases of Oral Cavity. Patients due to negative self-image may attempt to conceal their skin lesions. Cellulitis causes redness and swelling to the skin that can worsen into blisters and abscesses if untreated. A study13 of children with perianal cellulitis found a mean age of onset of 4.25 years. Studies16,17 now indicate that both forms of impetigo are primarily caused by S. aureus with Streptococcus usually being involved in the nonbullous form. Abstract. The area may or may not be covered with a dressing to prevent further damage. The presentation, etiology, and current management of these diseases are presented. 1Dermatology Sister and Specialist Nurse in Cellulitis and Lymphoedema management, Norfolk and Norwich University Hospital. 3. Treatment of cellulitis involves using a variety or combination of antibiotics. Stay sensible and constructive in times of treatment, in health awareness, and putting up goals in restriction. Patients are categorized based on their clinical appearance. Cellulitis is a potentially severe infection in the deeper layers of the skin and the tissue beneath. For peripheral arterial disease (PAD), shiny skin, hair loss, thick nails, pallor, cool to touch the skin, decrease or absence of pulses, sharp-rest pain with intermittent claudication, necrosis in ulcers. Patients with a restricted amount of fluid intake secondary to a cardiac reserve are limited. Cellulitis is a skin infection that's treated with antibiotics. Monitor the patients amount of intake and output, color of the urine, and its clarity. Free access to premium services like Tuneln, Mubi and more. Keep track of the patients fluid balance. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage. If there is recurrence, the presence of an abscess should be considered, with needle aspiration of the site for bacteriology being more accurate than a skin swab.14, Erysipelas (Figure 3), also known as St. Anthony's fire, usually presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking (Table 1). In this study guide, learn more about diphtheria, its pathophysiology, causes, signs and symptoms, nursing care management, and . Free access to premium services like Tuneln, Mubi and more. Assess health history.Patients with diabetes and neuropathy may not feel when their skin has been cut. Prevent the use of occlusive dressing over the affected site. By accepting, you agree to the updated privacy policy. https://www.cdc.gov/groupastrep/diseases-public/Cellulitis.html, https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762, https://emedicine.medscape.com/article/214222-overview, https://www.ncbi.nlm.nih.gov/books/NBK556072/, Small Bowel Obstruction Nursing Diagnosis & Care Plan, Hyperlipidemia Nursing Diagnosis & Care Plan, Injury to the skin (cuts, burns, puncture wounds), Skin conditions (eczema, chickenpox, shingles), Poor hygiene practices when getting a tattoo or piercing, Patient will not experience worsening cellulitis as evidenced by erythema localized to one area, Patient will display skin healing without the formation of blisters or abscesses. A photograph should be taken for baseline comparison. Normal capillary refill time should not exceed 3 seconds for nail beds. The answer is D. The patient has extensive involvement of his lower extremity with drainage and history of CKD requiring HD and thus will need IV antibiotics. Often lung sounds contribute to disclosing the source of poor ventilation. Please read our disclaimer. If the condition does not improve after a few days, have the patient contact their provider for a change in treatment. Parent will experience less anxiety. Clean the wound according to the Doctors advice. Copyright 2002 by the American Academy of Family Physicians. 2Dermatology Staff Nurse, Norfolk and Norwich University Hospital. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected . Dos and Donts on how to care for Knee Joints, Post Surgery or Chronic Illness and more. The pain should be managed with appropriate analgesia such as a nonsteroidal anti-inflammatory drug (NSAID) or a weak opioid combined with an NSAID or acetaminophen in an appropriate quantity to. (2020). Blood cultures or needle aspiration may be ordered to pinpoint a specific pathogen. Erysipelas is caused almost exclusively by beta-hemolytic streptococcus and thus can be treated with standard dosages of oral or intravenous penicillin. Common sites are the legs and face.15 Most cases do not have an inciting wound or skin lesion and are preceded by influenza-like symptoms. The nurse should monitor closely for systemic signs of infection. Additionally, vomiting that often ensues from nausea may cause dehydration due to fluid loss. All of these infections are typically diagnosed by clinical presentation and treated empirically. Now customize the name of a clipboard to store your clips. Prepare the patient for surgery as indicated. It's most often caused by group A Streptococcus and Staphylococcus aureus bacteria. N.H.L.Municipal Medical College, Do not sell or share my personal information, 1. Patients often require education about this condition if they lack an understanding of potential causes, how their comorbidities influence skin infections, and why treatment is so important. Your Guide To The Various Types Of Life Insurance, Lifeguard Certification is Important to Work Professionally | ALA. What is the Significance of Certified Lifeguard Training and Lifeguard Recertification? Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. We've encountered a problem, please try again. Patients with diabetes must inspect their feet and lower legs daily for open areas. Reduced urine output may be a sign of Decreased perfusion of the kidneys. The incidence of erysipelas is rising, especially in young children, the elderly, persons with diabetes, alcoholic persons, and patients with compromised immune systems or lymphedema.6. 18. The SlideShare family just got bigger. Stable blood pressure and mean arterial pressure of at least 65 is advisable to ensure an adequate perfusion of organs and tissues. Surgical resection. cellulitis observed surrounding the whole foot, Presence of disproportionate pain versus examination results, Violaceous bullae non-pruritic and non-erythematous blisters, Injury presence of skin breakdown like abrasions and lacerations, Weakened immune system pre-existing conditions like, Skin conditions other skin conditions like, Blood infection. 2. Streptococcal glomerulonephritis usually resolves spontaneously although acute symptoms and problems may occur.22, Impetigo can be spread by direct person-to-person contact, so appropriate hygiene is warranted. Monitor lab work.It will be expected for the WBC and CRP to be elevated. Document accurately to allow for ongoing assessment. Wound and skin breakout require detailed and accurate documentation to monitor the healing process and the effectiveness of the treatment rendered. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. ORBITAL CELLULITIS Orbital cellulitis is inflammation of eye tissues behind the orbital septum Refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood When it affects the rear of the eye, it is known as retro-orbital cellulitis. The patients pain was reduced at the affected site and can move conveniently with lesser discomfort. After all, having a beautiful body is connected to your self esteem. Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species. Hair loss and brittle nails are because of reduced blood flow to the hair follicles and nails. The pathogen is usually S. aureus. What Types of Oral Problems Require Emergency Dental Care? Patients are also more at risk for cellulitis when they are overweight, have chronic swelling (lymphedema), and conditions affecting circulation such as peripheral vascular disease. 1. Nursing Care Plan for Cellulitis - Free download as Word Doc (.doc / .docx), PDF File (.pdf), Text File (.txt) or read online for free. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Cellulitis can quickly become life-threatening so the nurse must monitor vital signs, lab work, and the skin for complications. Extraction of the affected tooth may be required. The nursing interventions for a patient with pertussis include: Educate about coughing and breathing. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. You can read the details below. 1. The wound may be packed (usually with iodoform gauze) to encourage further drainage. Click here to review the details. Click here to review the details. Virginia Mason Internal Medicine Residency, Cellulitis vs necrotizing soft tissue infection, Skin, Soft Tissue, & Bone Infections Symposia - The CRUDEM Foundation, Surgical infections: over view and brief management, Difference between steven johnson syndrome , toxic epidermal. There is an increased risk for infection with open skin lesions. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. . Dizziness. Assess for contributing conditions.Chronic conditions such as diabetes or a suppressed immune system can complicate an infectious process as well as predispose the patient to worsening infection. Nursing Care Plan for: Cellulitis. Do not sell or share my personal information. The predilection for the very young can be remembered by the common lay misnomer, infant tigo. Impetigo usually appears in areas where there is a break in the skin, such as a wound, herpes simplex infection, or maceration associated with angular cheilitis (Figure 4), but Staphylococcus aureus can directly invade the skin and cause a de novo infection.6. Typically, the furuncle will develop into a fluctuant mass and eventually open to the skin surface, allowing the purulent contents to drain, either spontaneously or following incision of the furuncle. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Certain wound care techniques such as packing, debridement, and incision and drainage are also painful. It can be treated as severe acne with isotretinoin (Accutane), but use of isotretinoin is associated with major side effects, including birth defects.26. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Advise the patient and caregiver to prevent scratching the affected areas. St. Louis, MO: Elsevier. Wounds must be recorded accurately including length, width, and depth with detailed information of drainage, peri-wound area, odor, and any tunneling or undermining. Changes in lifestyle are recommended to lower the risk of triggers. Get ideas for your own presentations. How Often Are You in Need of Massage Therapy? Objectives and methods: A management protocol for specialist nurses was developed for ambulatory management of uncomplicated cellulitis requiring initial intravenous (iv) antibiotic therapy. He will need to be renally dosed with his dialysis sessions. Nausea often causes patients to avoid eating or drinking adequate amounts of fluids. Examine the areas of irritants and in contact with allergens. Check for skin lesions. The most common form is superficial folliculitis that manifests as a tender or painless pustule that heals without scarring.24 The hair shaft will frequently be seen in the center of the pustule. Cellulitis is an infection of the skin (epidermis and dermis) or underlying soft tissues (hypodermis); it can spread rapidly and be life-threatening. All Rights Reserved. In cellulitis, opportunistic bacteria seep inside a break on the skin, causing inflammation to its deep layers. Looks like youve clipped this slide to already. Express positivity and care in daily activities. Cellulitis is a skin infection caused by bacteria that enter through a cut, bite, or other type of wound, or through cracked, dry skin. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. Medscape Reference. 4. Concept. 2. Cellulitis is a potentially serious bacterial infection that develops in the deep layers of the skin, below the epidermis. Patients may have a fever and an elevated white blood cell count. As health care providers, we need to acknowledge the clients reaction to the changes in their skin, especially those that are visible due to inflammation reaction. DEFINITION OF MANAGEMENT Management is the process and agency which directs and guides the operations of an organisation in realising established aims. #}0si Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. [feft.fVf5Dgxe\8zoE}}8AyFB~ ` endstream endobj 650 0 obj <> endobj 651 0 obj <> endobj 652 0 obj <>stream Educate the patient and caregiver about proper skin hygiene through washing it with soap and water. SUMMARY Cellulitis manifests as erythema, edema, and warmth. Retrieved April 27, 2022, from, Herchline, T. E., & Stuart, M. (2019, June 14). Presenting signs and symptoms of glomerulonephritis include edema and hypertension; about one third of patients have smoky or tea-colored urine. If the patient has diabetes, an immunocompromising disease, or persistent inflammation, blood cultures or aspiration (some physicians inject sterile nonpreserved saline before aspiration) of the area of maximal inflammation may be useful.24 For infection in patients without diabetes, empiric treatment with a penicillinase-resistant penicillin, first-generation cephalosporin, amoxicillin-clavulanate (Augmentin), macrolide, or fluoroquinolone (adults only) is appropriate.5 Limited disease can be treated orally, but more extensive disease requires parenteral therapy. . Antibiotics should be maintained for at least three days after the resolution of acute inflammation.5 Adjunctive therapy includes the following: cool compresses; appropriate analgesics for pain; tetanus immunization; and immobilization and elevation of the affected extremity.6, A parenteral second- or third-generation cephalosporin (with or without an aminoglycoside) should be considered in patients who have diabetes, immunocompromised patients, those with unresponsive infections, or in young children.5 The patient may also require a plain radiograph of the area or surgical debridement to evaluate for gas gangrene, osteomyelitis, or necrotizing fasciitis.6, Recurrent episodes of cellulitis or undergoing surgery, such as mastectomy with lymph node dissection, can compromise venous or lymphatic circulation and cause dermal fibrosis, lymphedema, epidermal thickening, and repeated episodes of cellulitis.

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