Critical Analysis of Case Study

Running head: CRITICAL ANALYSIS OF CASE STUDY
Critical Analysis of Case Study
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1CRITICALLY ANALYSIS OF CASE STUDY
The paper outline the case study of Mrs Gina Bacci who is of 46-year-old, has undergone
surgery of right foot ulcer. She had been suffering from type II diabetes, peripheral vascular disease
and obesity. The essay highlights the two priority of care that is to be given to the patient on the
basis of clinical reasoning cycle (Hunter & Arthur, 2016). The important care given to Mrs Bacci is
to manage her wound and control her diabetes level.
The collection of clues regarding the patient situation Mrs Bacci is 49-year-old
Italian lady suffering from right foot ulcer and has undergone surgery for partial amputation. Vital
signs were noted. She had blood pressure of 120/70 mm Hg which is in normal range. Recording
Pulse rate of 88 bpm, Respiratory Rate 18bpm and SpO2 97%, temperature 37.8 C. Therefore, her
blood pressure, pulse rate, respiratory rate, temperature and oxygen level is normal. On recording
her BGL she had 12.6 mmol/L which is high as compared to normal value of 5.6mmol/L. On
examination of her wound, it was noted that she had island film dressing with incisional wound. The
wound is wet from serous exudate output and have dehiscence with sloughy tissue. On touching she
also complains of pain. The information collected was processed to the concerned physician for
further evaluation.
To identify the problem, critical evaluation of the case study of Mrs Bacci, revealed that
the blood glucose level of Mrs Bacci is high, ranging to 12.6mmol/L as compared with the normal
value of 5.6mmol/ml. Reviewing the pathophysiology of High Blood Glucose Level, it is used to
record proper functioning of Pancreas that whether it is able to secrete insulin in order to limit the
glucose level in blood outside the cell. In normal individual, insulin is used to move the glucose out
of the blood into the cell (Tao, Shi & Zhao, 2015). In person who are diabetic are not able to secrete
insulin therefore level of glucose increases in the blood and person become hyperglycaemic
(Ogurtsova et al., 2017).

2CRITICALLY ANALYSIS OF CASE STUDY
The dysfunction of nerve emerges from glycosylation of protein of nerve cell that
may lead to ischemia. The cellular changes visible in foot ulcer component which are motor,
autonomic and sensory (Noor, Zubair & Ahmad, 2015). Any kind of damage in autonomic nervous
system, affects the sweat gland of person and unable to secrete excessive sweat due to which foot is
not able to get moisturized (American Diabetes Association, 2016). The outcome of this is
epidermal cracks and breakdown of skin. As seen in the case of Mrs Bacci, after operation of foot
ulcer, she develops sloughy tissue with some dehiscence in the wound.
Hyperglycaemia also leads to slow circulation of blood and red blood cell is not able to
reach the wound and provide required nutrient for faster healing. Therefore, the blood vessel
become hard and causes slow healing of wound. Additionally, high glucose level, affected the
functioning of white blood cells, resulting in failure to fight with the bacterial infection. This also
result in slow healing of wound (Kautzky-Willer, Harreiter & Pacini, 2016).
Considering the status of wound of Mrs Bacci post-operation of foot ulcer has resulted in
slow healing. The wound has dehiscence along the suture line with some sloughy tissue. In relation
from the vital sign of hyperglycaemia in Mrs Bacci it can be inferred that she is having wound
infection due to high blood glucose level.
Furthermore, Mrs Bacci is also obese with weight of 110 kg. The pressure of whole body
is on her feet, which can be the other reason for such slow healing resulting in infection and pain.
High pressure in wound delays its healing process and moreover, can damage the wound more
excessively and causes huge pain (Zaccardi et al., 2016). The high weight is also a sign of poor
control of blood glucose level, which is indirectly the reason for wound infection.
Looking into the pathophysiology of foot ulcer, the major cause of such wound is because
of peripheral neuropathy and vascular disease. It is seen from the history, she is having vascular