Case Study Analysis

Running head: CASE STUDY ANALYSIS 1
Case study analysis
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CASE STUDY ANALYSIS 2
Case study Analysis
Introduction
In a certain case study, there was a patient by the name Mrs. Gina who has been diabetic
for some time presented at the General practitioner with complains about her wound. On
assessment, the wound had abnormal features such as a film dressing along the incisional wound.
Besides, the wound was dark pink in color and was painful on touch. The wound also had a
sloughy tissue and was wet due to the serous exudate output. These features clearly indicates a
nursing problem. Within the framework of this essay, there will be an analysis of the
pathophysiology of the presenting problem, the nursing health problem and the management of
the same.
Pathophysiology
After thorough examination of the wound, it was established that the wound had an island
film dressing along the incisional wound. The wound was also wet due to the serous exudate
output. Furthermore, the wound also had dehiscence along the suture line characterized by
sloughy tissues (Amin & Doupis, 2016). The surrounding skin to the wound was warm and dark
pink in color. Finally, the wound was painful to touch. This clearly indicates that there was an
underlying health care problem.
There are different theories behind the pathophysiology of the appearance of the wound.
They include both intrinsic and the extrinsic factors. The extrinsic factors are repeated trauma or
mechanical stress. Studies indicate that repeated stress on the wound is likely to lead to
dehiscence and rupture of sutures (Andrews, Houdek, & Kiemele, 2015). In this case, the wound
was on the foot and chances that the patient was exerting mechanical stress on it during
movement were very high. This eventually contributed to the features that were observed at the

CASE STUDY ANALYSIS 3
wound. The intrinsic factors on the other hand are quite complex. It involves an interplay
between different factors such as hyperglycemia, growth factors and different enzymes.
Hyperglycemia, a common condition in Type 2 diabetes leads to formation of advanced
glycation end products (AGEs).These products stimulate formation of the inflammatory
molecules known as TNF- , IL-1.These factors on the other hand impairs the process of collagen
synthesis. Another study propose that exposure to high levels of glucose results in changes in
cellular morphology, reduced proliferation and abnormalities in the differentiation of
keratinocytes (Arsanjani Shirazi, Nasiri, & Yazdanpanah, 2016). Another mechanism that
explains the pathophysiology of the wound status is immunosuppression. Studies indicate that
patients with diabetes tend to experience immunosuppression and this alters the process of
chemotaxis, phagocytosis, bacterial killing and low heat shock protein expression which play an
important role in the early healing stages of the wound (Bus et al., 2016). Consequently,
immunosuppression affects leukocyte infiltration and would fluid IL-6 which play important role
in the late inflammatory phase of the wound healing process. Furthermore, there is also an
impaired pattern of cytokine appearance at the wound. Research indicate that cytokines are
usually secreted by different cell types and their functions include regulating proliferation of
cells, differentiation, their migration and finally their metabolism (Forsythe & Hinchliffe, 2016).
In patients with diabetic ulcers, there is usually abnormal expression of growth factors. In the
event that the cytokines and the growth factors are trapped by different macromolecules such as
Albumin and fibrinogen at the wound, the healing process of the wound is subsequently altered.
Another mechanism behind the appearance of the wound status is increased degradation
of growth factors in wound fluids of diabetic patients. According to research, patients with
diabetic ulcer have elevated levels of Insulin Degrading enzyme (IDE).These enzymes are