Complex Nursing Care: Case Study Analysis and Nursing Interventions

Running head: COMPLEX NURSING CARE
Complex nursing care
Name of the student:
Name of the University:
Author’s note

1COMPLEX NURSING CARE
Introduction:
Complex nursing care involves critical assessment of patient’s objective and subjective
data to identify major health issues in patient and use clinical judgment and nursing knowledge
to implement appropriate nursing interventions for patient. The main purpose of this report is to
review the case study of Mr. Christopher Collins, a 54 year old male who is complaining of pain
at the incision site after left high tibia knee osteotomy and analyse the subjective and objective
data of patient to identify key problems in patient and the optimal patient outcomes needed to
resolved the issue. Based on the care plan developed, the report will focus on critical discussion
of two health problems for Mr. Collins and prioritize main nursing interventions that can be
undertaken by a newly graduate nurse to achieve desired health outcome for patient. The method
of evaluating the effectiveness of the intervention will also be explored.
Assessment data:
Mr. Christopher Collin is a patient who has been diagnosed with early stage osteoarthritis
in the left knee causing pain and affecting mobility. In response to this knee, a left high tibia
knee osteotomy was undertaken 5 days ago with an uneventful post-operative period. However,
Christopher represented at the ED with pain and others symptoms. The brief assessment data of
patient are as follows:
Airway: Objective data suggest patent airway indicating no airway obstruction
Breathing: Objective data RR 27 (normal respiratory rate is 12 to 20 breaths per minute) and
verbal report related to breathlessness suggest this as one of the problem for patient

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Circulation: HR 125 and BP 98/57 indicate risk of breathing related problem and tachycardia in
patient. He is also found to be hypotensive
Disability: The assessment of consciousness level using GCS revealed a score of 15. This is
indicative of the fact that there is no problem in terms of eye, verbal and motor response. As pain
may also contribute to disability and mobility related issues, the assessment of pain revealed a
score of 15 which means patient is suffering from moderate pain.
Exposure: Skin assessment is vital to identify any signs of infections. It revealed the
characteristics of the surgical site. The symptoms include sutures in skin, areas of dehiscence
with pus and shiny red swollen areas.
Fluids: Patient was on IV cannula
Glucose: Glucose 5.1 Nil
Two problems identified for the patient:
Based on the review of the assessment data and the links between each vital signs, the
key problems that has been identified for Mr. Collins includes pain, infection, breathlessness and
low blood pressure. Out of these health problems, the two major health problems that has been
identified for Mr. Collins include risk of infection and pain. The main rationale behind arriving
at these two health problem is that the characteristics of patient’s wound is indication of infection
at the surgical site. The symptom of redness, swelling, skin tightness, skin suture and dehiscence
with pus is a sign of bacterial infection at the wound site. As these symptoms have emerged in
patient after going through a surgical procedure (left high tibia knee osteotomy), it is indicative
of postoperative wound infections. Pus in the wound is indicative of necrosis. Symptoms like

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hematoma, wound dehiscence, necrosis and wound infection occurs because of penetration of
pathogen infection in the wound. The local proliferation of the infection along with
immunological response of the host organism to the pathogen results in inflammation and
presence of symptoms like redness, swelling and pus (Milne, Reeves and Blazeby 2016). Hence,
this pathophysiological explanation regarding the cause of redness, swelling and dehiscence has
helped to arrive at the conclusion that wound infection is one of the major health problems for
Mr. Collins.
Another major health issue that has been identified for patient includes pain due to
impaired skin integrity and infection. During representation to the ED, Mr. Collins had reported
about pain at incision site along with nausea and shaky feeling. As infection may further increase
the severity of pain, pain has been identified as the second health problem for patient. This issue
has been identified because both subjective and objective symptom of pain been experienced by
patient because of wound infection. Powers et al. (2016) defines that pain is a common
experience for patients with wounds and this mainly occurs because of tissue damage. The pain
is linked to inflammatory response and wound infection becomes painful because they occur
because of detrimental interaction between the host and the pathogen thus delaying wound
healing and amplifying wound pain. The key link between the health problem of pain and wound
infection is understood from the pathophysiological process associated with wound relate pain.
The penetration of infective microorganisms results in initiation of inflammatory response and
release of enzymes and free radicals which contribute to tissue damage. In addition, such patient
experience pain due to direct stimulation of peripheral pain receptors by the mediators and the
swelling of the wound area (Dumville et al. 2016). Hence, inflammation and tissue damage is the
main cause behind pain and identifying pain as a health problem for Mr. Collins.