BACHELOR NURSING ASSIGNMENT.

Running head: BACHELOR NURSING ASSIGNMENT 1
Bachelor Nursing Assignment
Student’s Name
Institutional Affiliation

BACHELOR NURSING ASSIGNMENT 2
Introduction
` The essay is based on a case scenario of Mrs. Gina Bacci from Italy who is 49 years old
and was admitted to a hospital two weeks ago for surgery following complications from a right
foot ulcer. She underwent a partial amputation of the forefoot and the great and first toes. After
being discharged seven days ago, she visits the hospital for wound assessment and management.
By using the clinical reasoning cycle, the essay will discuss the pathophysiology and causes of
the wound status along with identifying the main nursing priorities of care for the patient. Also, it
will cover the appropriate and safe nursing management of the patient during this time.
Based on the case study, critically analyze and discuss the underlying pathophysiology and
causes of the patient’s post-operative wound status.
On admission, Gina admits that she has not been taking her medications because she
sometimes forgets and doesn’t think that she needs to take all of them. Furthermore, when her
wound is examined an island film dressing along the incisional wound is noted which is wet
from serous exudate output. The wound also has dehiscence along the suture line, and some
sloughy tissue is identified. Moreover, the surrounding skin is warm and dark pink and painful to
touch.
From her medical history, she has obesity, Peripheral Vascular Disease (PVD) and Type
2 Diabetes which was diagnosed six years ago. Because of her worsening diabetes, during her
admission to the hospital, she is commenced on insulin. When her vital signs are taken, some are
normal such as pulse 88 bpm regular, Respiratory Rate 18 bpm, blood pressure of 120/70mmHg
and SpO2 at 97% but the others are very high such as temperature of 37.8° C and blood glucose
level of 12.6mmol/L.

BACHELOR NURSING ASSIGNMENT 3
From this information, diabetes leads to high blood glucose level which affects the nerves
and results in reduced blood circulation making it strenuous for blood required for skin repair to
extend areas of the body with wounds (Malone, 2016). This could cause the wounds to heal
slowly and increase risks of bacterial infections. Moreover, when blood sugar levels remain too
high, the function of white blood cells is compromised. The impairment of white blood cells
along with less effective immune responses in the inflammation phase of wound healing
increases the infection risk. Also, diabetes does not permit the body to effectively handle
glucose. Therefore, maintaining an optimal blood glucose level is a challenge; hence body's
ability to fight infections becomes lower (Van Niekerk, Davis & Engelbrecht, 2017).
According to the state of the patient, in the process of healing, the post-operative wound
was fighting invading bacteria to the site which is indicated by the warmth around the wound and
the high temperatures. Bacteria had started colonizing the wound, and because of the high blood
sugar level, the body's immune system was inefficient in fighting the germs. Wound infections
happen when microbes outcompete the patient’s natural immune system causing a series of
systemic along with local inflammatory responses (Pickard, Zeng, Caruso & Núñez, 2017).
After a surgical procedure, skin is the common cause of bacterial infections. Methicillin-
sensitive Staphylococcus aureus (MSSA) and Methicillin-sensitive Staphylococcus aureus
(MRSA) are bacteria spread by contact (Boswihi & Udo, 2018). MSSA and MRSA live with
other microbes on the skin of an individual, and when things are contacted to the person, the
organisms are spread. Post-operative wounds can tolerate some degree of harm from the host
locally and a specific amount of bacterial flora. The microbial flora and the wound state are
reticular, and if either of these outpaces an endurable threshold, an infection may develop. The
limit may be affected by comorbidities such as type 2 diabetes.