Critical Analyses for a Patient with Post-Operative Wound

This paper analyzes and discusses the underlying pathophysiology of a patient’s post-operative wound status. It also provides nursing priorities of care and management strategies for quick recovery.

Running Head: CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 1
CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND
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CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 2
Across all the spectrums of health setting, wounds are very common. Wounds have a
range of presentation including surgical or traumatic wounds to chronic wounds like leg wounds
and diabetic foot ulcers. The less common wounds include pyoderma, vasculitis ulcers,
calciphylaxis, and necrotizing fasciitis. With any kind of wound, understanding the aetiology is
very important because it not only enables the victim to come up with an appropriate wound
management plan but also to manage all the comorbidities associated with wound development
or limiting the healing potential of the wound (Scott, et al., 2015). There are many clues which
are used to determine the healing stage of a wound or whether a wound is healing or has been
infected. Therefore, wound assessment must be done in a holistic way incorporating the key
aspects of patient health status and that of the wound for the best possible outcome. This paper
analyzes and discusses the underlying pathophysiology of a patient’s post-operative wound
status.
From the examination, there are some clues related to the patients wound to be used in
determining the status of the wound. The first clue is the island film dressing along with the
incision and which is wet from a serious exudate output. Also, the wound has some dehiscence
along the suture line. Finally, the skin surrounding the wound is dark pink, warm and painful
(Qiao, Feng, Zhao, Yan, Zhang & Zhao, 2015).
Although it’s normal for the skin which surrounds a wound to feel somehow warm, the
skin around Mrs. Gina Bacci’s incision has been presented to go beyond the normal warmth of a
healing wound. This is because it felt very warm to touch and did not show signs of cooling
despite the fact that the patient had some days after her operation. From a medical point of view,
that was an indication that her body had mounted campaigns against an infection which had
attacked the wound. The common infections which affect wounds are as a result of bacteria,

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 3
fungi, and virus (Scott & Miller, 2015). Mainly, the heat around the incision had been caused by
the release of vasoactive chemicals to increase blood flow to the incision area. In addition to that,
the victim’s immune system had generated a lot of heat by sending lymphocytes to generate
antibodies to destroy the pathogens and phagocytes and ingest the dead bacteria (Bester & Van
Deventer, 2015).
According to the examination report, the wound had some dehiscence. Wound
dehiscence is a surgical complication characterized by wound rupture along the surgical incision.
Primarily, wound dehiscence is caused by sub-acute infections resulting from imperfect or
inadequate aseptic techniques. The patient’s coated sutures such as vicryl had broken down at a
rate corresponding with the tissue healing of the wound but hastened by pathogens such as
bacteria and fungi (Bittner, Shank, Woodson & Martyn, 2015).
The examination has also pointed out that Mrs. Gina Bacci was experiencing increasing
and continual pain from the wound. Generally, a patient is said to be healing well if the pain on
the surgery or an injury wound is subsiding. Although medication to reduce pain is required in
the first few days, the patient continues to reduce the usage of the painkiller drugs and finally
discontinue them over time. However, the continual and increasing pain experienced by Mrs.
Gina Bacci is a sign of wound infection (Van Waes, et al., 2016). Mainly, the pain was caused by
skin damage, blood vessel injuries, ischemia and other pathogen related to infections. These
factors had led to hypoxia which impaired the healing process of the wound and increased
infection rates. For instance, the skin damage decreased tissue oxygen which in turn reduced the
rate of leucocyte production giving bacteria and other pathogens an opportunity to colonize the
wound.

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 4
The skin surrounding the wound being dark pink also indicated that the healing process
of the wound was not proceeding in the right way. The color implied that the wound tissue
known as Eschar was present (Bharucha, et al., 2015). Commonly, Eschar tissue is dry or moist
and appears as a thick and leathery necrotic tissue which is cast off from the wound surface.
Eschar prevents proliferation and maturity phase of a healing wound by inhibiting the formation
of healthy granulation tissue, epithelialization, and wound contraction. Because most eschar
tissues support the growth of bacteria, this increased the risk of Mrs. Gina Bacci’s wound being
infected.
From the discussion above, it is clear that Mrs. Gina Bacci’s wound condition is
worsening because it has been infected. Also, a large number of the signs which come out clearly
in the assessment are those of an already infected wound. Therefore, my first priority will be
treating the wound to deter the condition from worsening and spreading further to affect the
patient’s general health. Under this priority, the wound will be washed and cleaned thoroughly
using detergents like soap and warm water. This will make it both moist and open to absorb any
medication to be applied to it for treatment purposes (Ortega-Loubon, Fernández-Molina,
Carrascal-Hinojal & Fulquet-Carreras, 2016). Antibiotic medicine will be applied on the wound.
An antibiotic ointment such as Neosporin will help the wound heal faster by keeping it safe from
some of the common agents of wound infection like bacteria and Fungi. They will also keep the
wound clean and moist. After applying the antibiotic ointment, the wound will be covered with a
gauze dressing or a bandage which will be changed on a daily basis.
My second priority will be ensuring the wound is kept in a hygienic manner. This will
entail regular cleaning of the wound and re-dressing on a daily basis. Also, the patients
surrounding will be kept clean always. This will mitigate the risks of further infections after the

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 5
first treatment. This will be a favorable environment where the patient will not encounter with
contaminants. To redress the wound, clean medical gloves will be used to grab the old dressing
and pull it off. In a case where the dressing sticks on the wound, it will be moistened first before
it can be pulled off (Bryant & Nix, 2015).
When dealing with patients with Postoperative wounds or incisions, appropriate
management is imperative because it prevents further complications like wound dehiscence and
surgical site infections. Modern wound management tenets are only applicable for closed
incisions, subacute and chronic wounds. For instance, prevention of incision infections by
cleansing the wound regularly, maintaining skin care and managing wound moisture are requisite
in post-operative plan care. Also, cursory knowledge on the phases of wound healing will help
understand the rationale and importance of post-operative incision and surgical wound
management (Redmond, Davies, Cornally, Fegan & O'Toole, 2016).
To manage the condition of Mrs. Gina Bacci’s wound which is a surgical wound, It will
be ensured that the wound is always moist to support easy healing. Also, the wound would be
dressed regularly to ensure that the wound remains clean (Agra, et al., 2016). However, in cases
where dressing is required urgently before the previous one completes a whole day, aseptic
technique will be followed strictly. The aseptic technique entails the use of practices and
procedures which prevent a wound from pathogen contamination. It will entail the application of
very strict rules and measures to minimize the risks of infections.
Surgical incisions will be done regularly in order to remove pathogens, debris, and
exudate. This will be done with appropriate pressure which will involve utilizing the safest agent
to avoid cases of cytotoxicity or mechanical trauma. Typically, surgical dressing will be done
for the wound after every 24 to 36 hours (Phillips, et al., 2016). With time, the superficial

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 6
epidermis will be expected to primarily close the incision line and appear as a sealed. Because
it’s a closed surgical incision, the wound will be dressed in a way that the it will be protected
from trauma, contaminants and manage exudate and prevent excessive pressure on the incision
line.
Timeframe will be set for suture or staple removal to be three to four days depending on a
multitude of factors such as the progress of the healing process and the evident side effects on
the skin surrounding the wound. Also, because the patient is expected to undergo pain from the
wound, opioid narcotics will be administered to him. This is in consideration of the fact that
opioid narcotics are the mainstays of post-operative pain management. Opioid narcotics will be
combined with other non-steroidal anti-inflammatory drugs to significantly reduce opioid dosage
and achieve adequate pain relief (Peterson, Jung, Hoffman & Rice, 2016). This will also reduce
the deleterious side effects of opioids like altered mental status, respiratory depression,
constipation, and urinary retention. There will be comprehensive and complete initial
postoperative pain assessments which will table all the contradictions which may arise due to
different pain relief methods used (NSAID allergy, allergy to specific dressings and cleansers).
Considering the fact that pain related to anxiety, post-operative armament, and other daily
activities may limit the patients recovery time and also increase the perceived pain, also the
interventions will be tailored to meet patient’s -specific needs like allowing the patient to assist
in the process where possible, warming the wound cleansing solution, utilizing non-adherent
dressing and positioning the patient for comfort when dressing her to reduce incision-related
pains. (Cullum, et al., 2016)
The patient’s suggestion will be considered in regard to her preferred or desired
intervention and utilize them when feasible in order to make her happy and a sense of respected.

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 7
The distractive measures will not be discounted in the management because they can help
the patient recover faster: for instance, music therapy will be incorporated in the management to
help reduce the patient’s anxiety, reported pain, and opioid use. Frequent reassessment to pain
management plan will also be conducted frequently based on the type of pain, care setting and
other patient’s comorbid conditions (Chetter, Oswald, Fletcher, Dumville & Cullum, 2017).
Other key consideration in my post-operative wound management will include the
following factors: understanding the phases of wound healing; understanding the approach being
used by the surgical wound to heal (primary, secondary, or tertiary); Post-Operative management
of incisional pain and topical wound management. Attention to these and other ways of wound
care will help me optimize the clinical outcome for my post-surgical patient (Varga & Holloway,
2016).
In summary, this paper has critically analyzed and discussed the underlying
pathophysiology and causes of the patient post-operative wound status based on a given case
study. Moving forward, it has also given a nursing priority of care for the patient with
justification and rationale for each. Finally, nursing management has been drafted which will
enable quick recovery of the patient.
References

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 8
Agra, G., dos Santos, J. P., de Sousa, A. T. O., Gouveia, B. D. L. A., de Brito, D. T. F., de Lima
Macêdo, E., ... & do Nascimento Oliveira, D. M. (2016). Malignant neoplastic wounds:
clinical management performed by nurses. International Archives of Medicine, 9.
Bester, P., & Van Deventer, Y. (2015). Holistic care for patients living with chronic wounds:
nursing. Wound Healing Southern Africa, 8(2), 78-81.
Bharucha, A. E., Dunivan, G., Goode, P. S., Lukacz, E. S., Markland, A. D., Matthews, C. A., ...
& Rao, S. S. (2015). Epidemiology, pathophysiology, and classification of fecal
incontinence: state of the science summary for the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) workshop. The American journal of
gastroenterology, 110(1), 127.
Bittner, E. A., Shank, E., Woodson, L., & Martyn, J. J. (2015). Acute and perioperative care of
the burn-injured patient. Anesthesiology: The Journal of the American Society of
Anesthesiologists, 122(2), 448-464.
Bryant, R., & Nix, D. (2015). Acute and chronic wounds: current management concepts.
Elsevier Health Sciences.
Chetter, I. C., Oswald, A. V., Fletcher, M., Dumville, J. C., & Cullum, N. A. (2017). A survey of
patients with surgical wounds healing by secondary intention; an assessment of
prevalence, aetiology, duration and management. Journal of tissue viability, 26(2), 103-
107.

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND 9
Cullum, N., Buckley, H. L., Dumville, J., Hall, J., Lamb, K., Madden, M. T., ... & Stubbs, N.
(2016). Wounds Research for Patient Benefit:: a 5 year programme of research. Health
technology assessment, 1-334.
Ortega-Loubon, C., Fernández-Molina, M., Carrascal-Hinojal, Y., & Fulquet-Carreras, E.
(2016). Cardiac surgery-associated acute kidney injury. Annals of cardiac
anaesthesia, 19(4), 687.
Peterson, J., Jung, J., Hoffman, L., & Rice, D. (2016). Nursing management of maggot
debridement therapy (MDT) for wound debridement in patients with chronic graft versus
host disease wounds. Biology of Blood and Marrow Transplantation, 22(3), S456.
Phillips, C. J., Humphreys, I., Fletcher, J., Harding, K., Chamberlain, G., & Macey, S. (2016).
Estimating the costs associated with the management of patients with chronic wounds
using linked routine data. International wound journal, 13(6), 1193-1197.
Qiao, Y., Feng, H., Zhao, T., Yan, H., Zhang, H., & Zhao, X. (2015). Postoperative cognitive
dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the
influence of anesthetic technique, cerebral injury and systemic inflammation. BMC
anesthesiology, 15(1), 154.
Redmond, C., Davies, C., Cornally, D., Fegan, M., & O'Toole, M. (2016). Teaching and learning
in the Biosciences: the development of an educational programme to assist student nurses
in their assessment and management of patients with wounds. Journal of clinical
nursing, 25(17-18), 2706-2712.

CRITICAL ANALYSES FOR A PATIENT WITH POST-OPERATIVE WOUND
10
Scott, M. J., & Miller, T. E. (2015). Pathophysiology of major surgery and the role of enhanced
recovery pathways and the anesthesiologist to improve outcomes. Anesthesiology
clinics, 33(1), 79-91.
Scott, M. J., Baldini, G., Fearon, K. C. H., Feldheiser, A., Feldman, L. S., Gan, T. J., ... & Carli,
F. (2015). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1:
pathophysiological considerations. Acta Anaesthesiologica Scandinavica, 59(10), 1212-
1231.
Van Waes, J. A., Grobben, R. B., Nathoe, H. M., Kemperman, H., de Borst, G. J., Peelen, L. M.,
& van Klei, W. A. (2016). One-year mortality, causes of death, and cardiac interventions
in patients with postoperative myocardial injury. Anesthesia & Analgesia, 123(1), 29-37.
Varga, M. A., & Holloway, S. L. (2016). The lived experience of the wound care nurse in caring
for patients with pressure ulcers. International wound journal, 13(2), 243-251.