Nursing Case Study Analysis (Gian Bacci)

Running head: CASE STUDY ANALYSIS
NURSING CASE STUDY ANALYSIS (GIAN BACCI)
Name of the student
Name of the university
Author note

1CASE STUDY ANALYSIS
Introduction
Post-operative care process is one of the crucial phases of healthcare intervention as
care process for patients suffering from post-operative wounds and incision requires
continuous monitoring observation and evaluation for their wounds (Bellelli et al., 2014).
This assignment discusses about one such patient Gina Bacci (49) who has undergone a
surgery for her diabetic foot ulcer and as intervention; the healthcare professionals have
amputated her forefoot. Hence, the primary aim of this assignment is to provide a
pathophysiological description of her wound status and in this aspect tow nursing priorities
for the patient would be discussed. Finally, with handling and management strategies of her
wound, the risk of her wound infection and preventive measurements would be discussed.
Underlying pathophysiology and causes of her current post-operative wound status
The provided case study of Mrs. Gina Bacci (49) mentions about her post-operative
care process. She undergone her forefoot amputation surgery 2 weeks ago due to her diabetic
foot ulcer condition and was discharged after her surgery. However, 2 weeks later she has
visited the outpatient service of the healthcare facility for her sore, red- swollen and painful
wound condition. Upon primary observation, it was seen that her wound is swollen and
reddish with broken sutures and sloughy tissues coming out of the incision site. Further, it
was also seen that the wound of the patient is leaking serous exudates and is painful.
Therefore, to understand the pathophysiology associated to the wound health and risk of
infection for Mrs. Bacci, the immunological steps of wound healing should be discussed. As
per Olczyk, Mencner and Komosinska-Vassev (2014), there are three steps of wound healing
such as inflammation, proliferation and maturation, through which every wound progresses to
heal. As per Zhao et al. (2017), Mrs. Bacci’s wound appeared red and swollen, it could be the
natural inflammation technique of the body to prevent the occurrence of wound infection. In

2CASE STUDY ANALYSIS
this situation, through the blood, white blood cells, macrophages and other immunogical cells
are transferred to the incision site and with the help of these components such as fibrin
protein, macrophages and blood cells, the body fastens the wound healing mechanism (Broz
et al., 2014). The second phase of the wound healing is proliferation, in which due to
mechanical and physical stress and depression, healing of the wound is affected. In the case
study, it is seen that Mrs. Bacci is overweight and hence as per Jairam et al. (2017), there is
chance of mechanical pressure due to the overweight body that could affect the sutures and
lead them to break. Besides, as per Willy et al. (2017), application of low quality sutures used
for tight sutures could also create pressure in the incision site due to which, the sutures of the
patient was found broken. Further, in the incision site of Mrs. Bacci, a dehiscence was
observed which could be one of the primary reasons for her risk of infection. As per Mesa et
al. (2015), dehiscence could also be a result of mechanical errors, surgical errors (loose or
tight sutures) and hence, contributed in the post surgical wound of the patient. During
proliferation, as per Hay and Morris‐Jones (2016), presence of serous exudates is normal as it
is one of the primary mechanisms of the body to prevent bacterial and fungal infection.
However, the wound of Mrs. Bacci was smeared with serous exudates and increased
accumulation of pollutants and foreign particles, hence, contributed in the wound infection
risk factor for the patient (Gordon, Plüddemann & Martinez Estrada, 2014). Further, it was
seen that the patient was unable to maintain hygiene of the wound and hence hygiene and
wound cleanliness could be one of the primary aspects which lacked in the wound
management for the forefoot amputated wound of Mrs. Bacci. Hence, as per Broz et al.
(2014), it could also lead to the occurrence of the wound infection and nursing intervention
should be included for this aspect.

3CASE STUDY ANALYSIS
The nursing priorities identified Mrs. Gina Bacci
While determining the optimal nursing priorities for Mrs. Bacci, her critical
healthcare condition should be assessed and her risk of wound infection should be utilised for
the development of care plan and nursing priority. While analysing her current healthcare
condition and her risk of wound infection, her first nursing priority would be the
management of her surgical wound infection so that health and hygiene of her amputee health
condition could be achieved and rapid and effective wound condition could be obtained. As
per healthcare researchers Chen et al. (2015), for patients suffering from higher risk of wound
infection should be provided with wound management strategies and guidelines so that their
post surgical wound health could be reinforced (Hay & Morris‐Jones, 2016). Besides this, it
would help to decrease the chances of bacterial and fungal infection due to the leakage of
serous exudates from the wound (Willy et al., 2017). Further, in this case study, Mrs. Bacci is
in outpatient service and hence, it is importance for her to know about the strategies of wound
management and hygiene and cleanliness for effective recovery of her wound.
Another priority for Gina Bacci and her healthcare condition would be her increased
weight. As per the case study, she is suffering from diabetes type 2 and the condition is
prolonged since 6 years. American Diabetes Association (2015) mentions that for healthy
women of 50 years of age with her height 167 cm should have 60 Kg weight and hence, her
current weight 110 kg is a severe health condition. Researchers have mentioned that due to
excessive weight the wound can undergo mechanical pressure due to which the sutures and
the adjacent tissues are under high risk of damage (Chen et al., 2014). Further, due to excess
weight, her blood sugar would increase the blood would not be able to reach to the incision
site, due to which, the blood flow in the wound would decrease and she would develop the
risk of infection. In this aspect, her risk of weight management would be conducted (Willy et
al., 2017).