Case Study: Nursing Management of Surgical Wound Complications

This case study discusses the nursing management of surgical wound complications, including factors that contribute to complications and appropriate care strategies. It focuses on the case of Mrs. Bacci and her underlying pathophysiology, wound status, and nursing priorities. The study also highlights the importance of preventing infection and managing pain for effective wound healing.

Running head: CASE STUDY 1
Case Study
Student’s Name
University Affiliation

CASE STUDY 2
Case Study
There are several factors that may contribute or increase the chances of surgical wound
complications such as macro vascular and micro vascular disorders, age, obesity and
malnutrition most common to diabetic individuals (Tsourdi, Barthel, Rietzsch, Reichel &
Bornstein, 2013). This explains why best nursing care is required to patients with such
conditions.
This paper includes the case study of Mrs Bacci by critically discussing the underlying
pathophysiology and wound status of Mrs Bacci. Besides, the paper identifies the primary
nursing priorities of care and appropriate and safe nursing management for Mrs Bacci’s current
condition.
Based on the case study, there are several pathophysiology processes that Mrs Bacci is going
through. Such pathophysiological processes include a high blood pressure of 120/70mmHg and a
high reading temperature of 37.8 degrees Celsius. Besides, her feet and toes are cool to touch
with a capillary refill of two to three seconds.
She also seems to be having fever which makes her to feel cold. Besides, when assessed, her
pulse is 88 bpm regular, RR18bpm and SpO2 is 97percent on RA. Furthermore, when examined
by the doctor, her dressing wound was wet with some exudate output. The wound has some
dehiscence along the suture line and there is some sloughy tissue and the surrounding skin is
warm, dark pink and painful to touch.
The physiological effects that Gina is going through are as a result of the vascular and
inflammatory response. Also, the age of Gina and her history of having diabetes ii disorder,

CASE STUDY 3
obesity and peripheral vascular disease impact his condition by complicating the process of
surgical wound healing.
The vascular response process of a wound involves the process where the damaged ends of
the blood vessels constrict to limit or reduce the rate of blood flow and initiate the clotting
process. A blood clot which consists of a fibrin mesh is formed in the process. The function of
the blood clot is to trap the blood cells and seal the wound. Blood vessels surrounding the wound
also occur and other growth factors are released. The released growth factors are utilized in
attracting white blood cells and inflammatory stage chemicals. This process explains why Mrs
Bacci’s feet are cool to touch with a capillary refill of 2 to three seconds.
Inflammatory in wound healing involves an increase in blood flow and amassing of fluid
prompting to the development of delicate soft tissue around the injury as on account of Bacci.
The phase also involves signs of erythema, oedema and heat. Pain and restriction of movement
also occur which is as a result of exerted pressure on the sensory nerve. This explains why
Bacci’s wound is wet from exudate and her wound is painful when touched
Some people especially those with diabetes, those who sand smoke and have a condition that
affects the immune system have high chances of increased risk of wound infections. Like in this
case, Mrs Gina Bacci has a history of diabetes and her diabetes condition has been worsening.
Besides she has a history of peripheral vascular disease and obesity which weakens her immune
system (Gibbons & Shaw, 2012). This explains why Gina has been having complications in her
would after surgery. This history explains why Gina’s wound status is worsening thus the need
for more attention.

CASE STUDY 4
There are certain factors that may lead to the risk of postoperative wound complications
(Mills, 2017). These factors include the part of the body involved in the surgery, the type of
surgery and kinds of medications given. Other factors include the use of immunosuppressive
agents like prednisolone and methotrexate, tobacco smoking, peripheral vascular disorder, poorly
controlled diabetes and immunosuppressive disorders (Bertesteanu et al., 2014).
According to (Bertesteanu et al., 2014), immunosuppressive diseases and the use of
immunosuppressive agents like methotrexate restrain the inflammatory process thereby delaying
the process of wound healing. Besides poorly controlled diabetes is understood to impair the
initial inflammatory response and suppresses the function of neutrophil and phagocyte thereby
slowing down the process of wound healing. Furthermore, the peripheral vascular disorder is
known to inhibit the oxygen delivery to the tissue and poor nutrition is understood to slow down
the metabolic processes thereby reducing the rate of collagen synthesis. For these reasons, it is
important for the caring nurse to manage these factors to prevent surgical wound complications.
Basing on the facts from the case study on the condition of Mrs Gina Bacci’s wound; there
are several nursing priorities of care that an effective nurse is supposed to provide to the patient
for quick recovery. These priorities may include making sure the client to eats a balanced diet,
watching for infection, maintaining the normal elimination patterns of the wound and controlling
the pain of the client for a quick recovery. However there are many priorities a nurse will
prioritize on, the two main priorities include ensuring the client eats a balanced diet and watch
for infection.
First nutrition will be highly prioritized by a nurse based as a patient’s metabolic needs are
high. A nurse is supposed to ensure the electrolyte levels of Mrs Gina Bacci are balanced. Eating

CASE STUDY 5
a nutritious diet with high levels of protein, zinc and vitamin C will play a critical role in patients
wound healing process (Humphers, Shibuya, Fluhman & Jupiter, 2014). Food rich in vitamin c
that a nurse may ensure the client eats daily include green vegetables, citrus fruits, Brussels
sprouts and broccoli. Besides, a nurse may ensure the patient eats diets with milk and meat
products as they are rich in zinc and protein which are helpful in wound healing. A nurse may
also recommend the patient with nutritional supplements and multivitamins depending on the
client’s condition (Quain & Khardori, 2015).
Secondly, a nurse should prioritize on making sure that the wound is not infected by bacteria
as infection of the wound will delay the process of wound healing for the client. This will be
done by occasionally cleansing and dressing the wound (Sandy, Carville & Leslie, 2015).
Cleansing of the wound occasionally will help to clear all the debris such as excess exudates like
in the case of the client which may delay the wound healing process. A nurse may use the
recommended process of cleaning wound by gentle irrigation of the wound with either warm
water or sterile saline via a syringe. Wound cleansing sometimes may be a form of interference
of wound healing thus the nurse is supposed to ensure it is not done frequently as excessive
cleansing may injure the wound thereby delaying its healing process. Furthermore, dressing of
the wound is critical as it will maintain a moist wound environment thereby promoting wound
healing.
The appropriate surgical wound management in the post-operative period especially to
patients with the diabetic disease is very important to prevent complications, wound dehiscence
and wound infection. Like as in the case study, Mrs Bacci has a history of diabetes, obesity and
peripheral vascular disease besides being 49 years old. This means that Mrs Gina Bacci has high
chances of having surgical wound complication and thus appropriate and safe nursing of this

CASE STUDY 6
client will play an important role not only for quick recovery but also to ensure there are no
wound complications that may be associated with her conditions. When managing wounds of
patients with such conditions physicians should not only aim at treating the wound but also
preventing the complications linked with the conditions.
Preventing surgery wound infection will be appropriate and safe nursing management. This
will involve appropriate cleansing, caring of the skin and management of moisture. A good
understanding of the phases of wound healing and healing by intention will help play a critical
role in understanding the rationale and significance of postoperative surgical wound management
(Vowden, 2017).
Considering the case, Gina’s wound has some dehiscence and some sloughy tissue and her
wound is painful to touch. This means that she needs serious pain management for her to feel
comfortable. The nurse or physician should consider a frequent assessment of pain to relieve
pain. A nurse may do this by rating the scales of her pain for comparison and change of
medications (Sarabahi, 2012). The widely used pain management scales in healthcare settings is
numeric rating scales. It has a high accuracy in identifying the patient’s pain. Other scales that a
nurse may consider include visual analogue scale and verbal pain rating which measures the pain
intensity.
After assessing the pain intensity, the physician may make a decision on the right
medication to provide depending on the pain intensity (Perry, Faan, Potter, Faan & Ostendorf,
2019). Depending on the severity of the wound, the physician may order the patient to use non-
steroidal anti-inflammatory drugs, antibiotics among other drugs which are linked with pain
relief. Changing of the wound dressing is also important in pain management. Besides relieving

CASE STUDY 7
surgical wound pain, changing of dressing wound also plays a critical role in the wound healing
process (King, Stellar, Blevins & Shah, 2014).
Another appropriate and safe nursing management of surgical wound is prevention from
infection (Lewis et al., 2016). Wound infection occurs when microbes out compete the immune
system of the patient resulting in a systematic inflammatory response thereby infecting the skin.
The possible infections after surgery include germs and bacteria like streptococcus (Bryant &
Nix, 2015). The infection can be through being in contact with contaminated air, instrument or
contaminated hands. To prevent wound contamination, the nurse is supposed to clean the skin
with antiseptics and perform surgical debridement of all dead tissues (Boateng & Catanzano,
2015). A nurse may also include wound irrigation by the use of saline. If the wound is infected,
the nurse may prescribe the patient with antibiotics such as Amoxicillin, Augmentin or
cephalexin (Pierpont, Dinh, Salas, Johnson, Wright, Robson & Payne, 2014).
Furthermore, frequent assessment of insulin for effective insulin therapy is the appropriate
and safe nursing management of the client’s condition. This will help in the improvement of the
client’s glucose level thereby playing a significant role in the wound healing process (Holt,
2012).
There are certain factors that may lead to the risk of post-operative wound complications as
in the case of Gina. These factors include the part of the body involved in the surgery, the type of
surgery and kinds of medications given. Other factors include the use of immunosuppressive
agents like prednisolone and methotrexate, peripheral vascular disorder, poorly controlled
diabetes and immunosuppressive disorders and the age of the patient. These factors are the main

CASE STUDY 8
reason for the conditions Gina is going through and therefore needs appropriate nursing
management for a quality outcome (Awad, 2012).
In conclusion, there are several nursing priorities of care that a good physician is supposed to
provide to the patient for quick recovery. These priorities may include making sure the client to
eats a balanced diet, watching for infection, maintaining the normal elimination patterns of the
wound and controlling the pain of the client for quick recovery (Davidson, 2015).

CASE STUDY 9
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CASE STUDY 11
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CASE STUDY 12
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