Nursing Assignment: Case Study Analysis (Mrs. Bacci)

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