Nursing Assignment: Case Study Analysis (Mrs. Bacci)

This case study analysis focuses on the post-operative wound status of Mrs. Bacci and discusses the underlying pathophysiology, causes, and nursing priorities for wound management. It also provides appropriate nursing care management strategies for Mrs. Bacci's wound infection and elevated blood glucose level.

Running head: NURISNG ASSIGNMENT
CASE STUDY ANALYSIS (MRS. BACCI)
Name of the student
Name of the university
Author note

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Introduction
While caring for patients in their post-operative phase, the primary focus of caregivers
are the observation, evaluation, and application of effective intervention to ensure accurate
management of the incision site and resultant surgical wound. In this given case study, Mrs. Gina
Bacci has undergone a surgery and is in her post-operative phase. Therefore, the primary center
of the discussion would be discussion of her wound and related pathophysiological status.
Further, it would also discuss the two nursing priorities for the wound management if Mrs.
Bacci, after identifying the relative causes of her current wound status. In the final section, the
nursing management and handling strategies wound be discussed to manage the adverse wound
condition of the patient.
Underlying pathophysiology and causes of her current post-operative wound status
This case study discusses about Mrs. Bacci (49) who is an Italian women who has
undergone surgery two weeks ago for her diabetic foot ulcer and to treat her this health
condition, the surgeons amputee her forefoot. She visited the outpatient service of the healthcare
facility after 2 weeks and the primary thing which was noticed in her wound was presence of
wound infection. Upon observational examination, the wound appeared inflamed, swollen, dark
pink in color and was painful to touch. As per researchers Olczyk, Mencner and Komosinska-
Vassev (2014), the phases of wound healing such as inflammation, proliferation, and maturation
are crucial phases as while undergoing these phases wound appears inflamed and red in color.
While undergoing healing, the general immune response around the wound makes it appear red
in color and swollen in appearance as majority of the immunological reactions occur in the
incision site to prevent the risk of wound infection (Darby et al., 2014). As per Caley, Martins

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and O'Toole (2015), macrophages, red blood cells and white blood cells and fibrin proteins are
transferred to the wound site to fasten the healing process. Despite these, the wound site of Mrs.
Bacci observed with broken sutures and proper dehiscence that appeared from the incision site.
Further, a sloughy tissue was also appeared in the incision site of the patient due to which it was
observed that the sutures appeared tight and under tension of kin around the wound. As per
Olczyk, Mencner and Komosinska-Vassev (2014), while surgery, if the healthcare professionals
use improper type of suture instead of catgut sutures, or applies tight sutures for the surgery of
the patient, then it could increase the tension of the skin and lead to breakage of sutures upon
normal human reflexes such as hiccups, sneezes and coughs. Therefore, appearance of
dehiscence could be the result of manual error during surgery (Caley, Martins & O'Toole, 2015).
Further, there are several physical causes for the appearance of dehiscence and broken
sutures in the surgical wound incision site. In the case study of Mrs. Bacci she was observed with
serous exudates leaking from her incision site and was completely smeared on the incision site.
As per Wang et al. (2015), serous exudates are human body mechanism using which the body
provides immunological compounds, inflammatory agents, blood and wound healing using
which it could fasten the pace of wound healing. Despite this, wound exudates in large amount
around the wound provide favorable condition to the bacterial and fungal colonies to grow and
infect the wound (Grauhan et al., 2014). Further, due to malnutrition, trauma and severe
healthcare intervention processes the body is under shock after the surgery and in such situation,
such conditions could increase the chance of infection. Moreover, the immunological reaction of
wound increases the inflammation around the wound and hence, majority of the blood cells and
immunological cells are transported to the incision site. Further, with these, the body increases
the release of several enzymes and free radicals in the site of surgery and hence, the tissue of the

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surgical wound becomes damaged (Jockenhöfer et al., 2016). Therefore, patients suffering from
such conditions develop painful wounds, similar to which is observed in the case of Mrs. Bacci.
Finally, the proliferation immunological condition that determines the three phases of
immunological responses of wound management of human body includes vascular endothelial
cells, fibroblasts, epithelial cells that eventually enhance the level of cellularity (Olczyk,
Mencner & Komosinska-Vassev, 2014). This phase indicates that the wound is progressing
towards its maturation and the healing process is normal. However, in such situation, if the
patient do not maintain the hygiene and do not cleans the wound properly, the chances that the
normal flora of the skin contaminating and infecting the wound increases. Further Jockenhöfer et
al. (2016) mentioned that gram negative aerobes are the bacteria which is seen to colonize wound
in such maturation phase. Therefore, these are the pathophysiological explanation which could
be collected from the recent literatures, and comparing the case study provided with them.
Identification of two nursing priorities for Mrs. Gina Bacci
Development of care plan for Gina Bacci, suffering from post-operative risk of infection
and severe healthcare complications related to her existing healthcare conditions, requires
optimization of the interventions so that nursing priorities could be used for development of
effective nursing interventions (Mwebaza et al., 2014). The first healthcare priority that would be
chosen for Mrs. Bacci would be management of her wound by maintaining the aseptic condition
of her forefoot amputee wound. This would help to reinforce health and hygiene in her wound
condition and assures quick and rapid healing of wound (Jockenhöfer et al., 2016). As per Wu et
al. (2014), patients suffering from post-surgical wound should be provided with wound
management interventions as it would decrease the risk of spreading of infection through

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exudates or presence of dehiscence. Besides this Oliver, Foot and Humphries (2014), also
mentioned that managing and assisting patients for their hygiene and cleanliness should be a
healthcare priority as it could help to maintain their quality of life and decreases the risk of
associated wound infection (Mwebaza et al., 2014).
The second priority for the patient would be her increased obesity as she is suffering from
diabetes type 2 since 6 years and as per her height she is extremely overweight (Winfield et al.,
2016). As per Sebastian et al. (2016), overweight body could increase the risk of physical and
infection related harm to body as it exerts extra pressure on the incision site and if not controlled,
it leads to damage the tissues and sutures by exerting physical pressure. Hence, depending on
these research findings, her overweight and blood sugar level should be targeted by providing
her proper diet and nutrition and inclusion of physical activity so that her calories could be
controlled (Winfield et al., 2016. As Schaper et al. (2016) mentioned that patients with high
blood sugar are unable to heal their wound properly, Mrs. Bacci would be provided with low
carbohydrate diet to maintain a regulated level of blood sugar. Further, Sebastian et al. (2016)
mentioned that due to excess blood sugar, blood is unable to reach to the surgical wound and
relieve the nerves around the wound to decrease pain related aspects, however the increase blood
glucose of Mrs. Bacci could affect the wound condition and healing. Therefore, this would be
chosen as the care priority for Mrs. Bacci and according to this care plan would be developed.
Appropriate and safe nursing care management for Mrs. Bacci
The first nursing priority of the patient is her risk of wound infection and to provide care
to the patient she would be provided with wound management and to comply that aseptic
dressing change and wound care would be provided (Grauhan et al., 2014). As Mrs. Bacci is in

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outpatient service, she should be provided with interventions and their management strategies so
that she could comply with them at her home. Therefore, patient education and wound
management literacy would be the goal, with Hand hygiene, wound hygiene and cleanliness
strategies (Lipsky et al., 2016). Through this the healthcare professional could expect that she
would be able to management her broken sutures and serous exudates so that hygiene of the
wound could be restored (Yazdanpanah, Nasiri & Adarvishi, 2015). Besides these, Mrs. Bacci
would be asked to complete her bed rest period diligently so that her risk of mechanical injury
due to her overweight body could be prevented and the wound heals properly. Patient education
would also help to make the patient aware about her medication and the drawback it could exert
on her condition if she does not consume them properly (Grauhan et al., 2014). Therefore,
through patient education, as per the NMBA guidelines Nursingmidwiferyboard.gov.au (2019),
the patient would be provided with management and preventive interventions to mitigate the risk
of wound infection.
The second priority for Mrs. Bacci’s healthcare would be managing her extreme blood
glucose level. As per Güemes, Rahman and Hussain (2016), the optimal blood glucose level for
an adult individual is around 5.5 mmol/L however as per the case study the concentration of
sugar in her blood was 12mmol/L. therefore as per American Diabetes Association (2015), her
elevated blood glucose level was one of the primary reason for her delayed wound healing and
present wound infection risk. Another research by Hering et al. (2016) indicated to the fact that
due to excessive blood sugar level, blood becomes unable to reach to the wound site and due to
this, immunological cells are not present at the wound site, increasing the chances of bacterial or
fungal infection. Therefore, to manage her elevated blood sugar, she would be asked to change
her diet regime and all the carbohydrate would be excluded from her diet so that protein and fat

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rich food could be provided to her to control her elevated blood sugar level (Salas-Salvadó et al.,
2014). Tilg and Moschen (2015) mentioned in their research that application of protein and fat
rich food in diet increases the immunological responses near the wound site and hence, rapid
recovery is noted. Besides this as per pharmacological intervention, the patient would be
provided with insulin intravenous so that through the insulin increase, her excess blood sugar
could be controlled. As per Asif (2014), application of insulin with nutritional changes helps the
patients to control their diabetes, their obese condition and hence, it is a helpful intervention to
apply in the care priority for Mrs. Bacci. Finally, inclusion of dressing change and suture care
and management techniques would be provided to her and she would be provided with education
regarding management of serous exudates, broken sutures to prevent bacterial and fungal
infection. In this process she would be provided with education related to wet patch dressing so
that her would could be protected from pollutants and others foreign objects (Ong, Chua & Ng,
2014). Therefore, through the application of these interventions, and patient education the
nursing professionals would assure that Mrs. Bacci and her wound infection risk could be
mitigated and she could improve her health condition by complying the interventions herself.
Conclusion
Finally to conclude the assignment it could be said that Mrs. Bacci was suffering from
severe risk of wound infection as her wound appeared red swollen, with broken sutures and
serous exudates leaking from the wound. Hence. As per the nursing priority, she was provided
with interventions to management wound and incision site, and to ensure that she could comply
to the process without any medical assistance she was provided with patient education for wound
management. Finally to control her blood sugar level, she was provided with modified diet and

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intravenous dose so that her type 2 diabetes could be controlled and rapid recovery of the wound
could be ensured.

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