Nursing Assignment: Wound Infection and Pain Management

This nursing assignment discusses the case study of a patient with a knee osteotomy and focuses on developing a plan of care for wound infection and pain management. It explores the pathophysiology of wound infection and pain at the incision site. The assignment prioritizes nursing interventions and evaluates their effectiveness.

Running head: NURISNG ASSIGNMENT
NURSING ASSIGNMENT CASE TSUYD ANALYSIS
Name if the student
Name of the university
Author note

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Patient background
This paper would discuss the case study of Mr. Christopher Collins (54) suffering
from left knee osteoarthritis in its earlier stage that affected the mobility of the patient. He
was admitted to the healthcare facility 5 days ago and undergone a left knee Tibia Knee
Osteotomy and to stabilize the knee, he had a screw and plate inserted within the cavity. The
postoperative phase of the patient was uneventful due to which, he was discharged after 2
days of the surgery and was prescribed with anti-inflammatory non- steroidal medication.
The patient was provided with enough support with a knee braces so that his post-operative
strains could be managed. However, this evening it was seen that the incision site of the
wound appeared tight, red and swollen, and dehiscence was observed due to the tightening of
the sutures. His vitals indicated towards, severely elevated heart rate, low blood pressure
decreased oxygen saturation level, and reported breathlessness.
Therefore, the primary aim of this paper is to develop a plan of care for Mr. Collins
and then identifying two health problems from the sign and symptoms of the patients with
proper rationale and pathophysiology of the identified concerns. After this, two nursing care
interventions would be provided to the patient so that he could achieve his desired health
outcome within a specific time period. Finally, a detailed evaluation of the care plan would
be developed so that the achievement of the goal of care could be understood.
Pathophysiological assessment of two identified health complication
Two healthcare complications which could be identified from the case study of Mr.
Collins are his risk of wound infection as persisting wound infection could lead to the
development of ulcerations and his pain at the incision site of surgery. These two healthcare
causes would be targeted in the care process so that the patient could improve his healthcare
conditions. The pathophysiology of these two aspects is as follows:

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As per Adogwa et al. (2014), due to lack of proper care and unawareness of
preventive measures, patients with crucial surgical wounds and large incisions are affected
with the risk of severe wound infection. Researchers have indicated that Surgical wound area
generally appeared red, inflamed and tight as increased blood flow and hydration helps to
increase the inflammation around the wound so that it could heal properly (Ramneesh et al.
2014). However, it should be noted that a wound and its healing process is marked by an
increased presence of granulated tissues as (Hawkins et al. 2014) mentioned that granulated
tissues around the wound help to increase the rate of healing. However, the patient in the case
study was seen developing dehiscence that exposed the internal tissues of the wound and
makes it vulnerable to wound infection. Considering the wound assessment information
provided, it can be mentioned that the wound area is at high risk of sustaining infection (Amri
et al. 2014).
The second chosen healthcare concern for the patient would be his pain related
complaint due to which his distress is increasing. While describing the pathophysiology
of pain, it could be said that upon injury or incision, the nerve endings of special nerves
called nociceptors are activated and starts creating nerve impulses that travel from
nerve peripheries, spinal cord and to the synapse of all higher ordered neurons. This
creates a sensation of pain and hence, depending on the intensity of the injury, feeling of
pain increases or decreases. As the patient underwent major surgery, his pain level was
higher and the sensation increased his distress which required rapid and accurate
intervention. In this case of Mr. Collins, it was seen that he is suffering from swelling,
redness and dehiscence and pus around the surgical incision site due to which his
wound swelling has been elevated. As per Schmidt‐Bleek et al. (2014), inflammation
and redness around the wound are immunological response due to which the majority
of the patient’s complaints of increased inflammation and pain around the wound.

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Further, it was mentioned that the redness is known as the Haemostasis in which the
blood vessels dilates to allow the immunological cells such as macrophages, white blood
cells to the wound site so that by elevating the inflammation and swelling around the
wound the immunological responses could be increased (Scott et al. 2015). Hence, due to
increased inflammation and blood movement in the blood vessels near the wound,
patients developed the feeling of pain and due to this their postoperative distress
increases (Pogatzki-Zahn, Segelcke and Schug 2017). However, increase inflammation is
not beneficial for the wound as Fabre et al. (2015) mentioned that inflammation is the
delayed wound recovery due to which the recovery speed decreases and the chance of
mild pain throughout the healing and wound scar increases.
Healthcare outcome rationale as per evidence
In the care process of Mr. Collins, application of his wound management related and
pain management related interventions are very crucial. It is mentioned in the research article
by Hawkins et al. (2014), if the surgical wound of any patient appears red inflamed and
dehiscence with pus is observed, then an assessment of the wound health and risk of infection
should be assessed. Further, it was also mentioned that patients could develop risk factor of
bacterial and fungal infection as the body tissues are exposed in the environment and
formation of pus around it that provides a favorable condition for the growth of bacteria
(Ramneesh et al. 2014). Further, it was also mentioned that patients could develop risk factor
of adverse health condition due to infection and hence, application of interventions for wound
infection prevention should be provided to the patients (Amri et al. 2014). In another article,
the risk factors of incision site infection were mentioned as it could lead to severe
bloodstream bacterial infection related condition due to affected blood flow and increased
stress and infection on the body (Adogwa et al. 2014). As per Eming, Martin and Tomic-

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Canic(2014), it is also mentioned that increased inflammation in patients could lead to severe
wound infection condition because of its delayed recovery.
Further, as per Scott et al. (2015), delayed recovery of the wound makes the
patient suffer from scars and increased pain condition. While treating for patients with
postoperative injuries, nursing professionals should be aware of the adverse effects such
as increasing pain could lead to. This is important because the distress happened after
severe pain could lead to crucial health complications among patients and could affect
their psychological and mental condition Garimella and Cellini. (2013). Further, it
could increase the complication of the wound as Kong et al. (2014) mentioned that
increased inflammation and the severe wound could increase the risk factors for
tachycardia, hypertension, poor wound healing and increasing distress related to
alveolar ventilation. Therefore, with wound management to prevent wound infection
condition, the patient should be provided with pain management intervention and
education so that he could take care of his wound without any medical assistance as well
(Chou et al. 2016). Hence, these should be included in the care process of developed
care plan for the patient targeting his pain management.
Prioritize the main nursing interventions which can be undertaken by a new
graduate registered nurse to assist the patient to achieve the desired health outcome:
On assessing the objective as well as the subjective data of the patient, two care
priorities for the patient can be identified. The first priority can be identified as the increased
risk of wound infection. The objective data of the patient suggests the wound area appeared
red, inflamed and tight. It should be noted in this context, that a healing wound is marked by
an increased presence of granulated tissues. Considering the wound assessment information
provided, it can be mentioned that the wound area is at high risk of sustaining infection.

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Research studies suggest that persisting wound infection leads to the development of
ulcerations (Dumville et al. 2013). The patient reports feeling increased pain at the incision
site. The first care intervention strategy to manage wound infection would include, changing
the cleansing of the wound. This would be achieved by changing the wound dressings and
teaching the patient about the asepsis method of changing dressings. Studies suggest that
changing dressing according to the aseptic method decreases the potential of transmitting
contamination (Schweizer et al. 2015). The next intervention would include, encouraging the
patient to consume protein rich and calorie-rich meal. Studies suggest that consumption of
protein-rich food helps in boosting the immune system responses that accelerate the recovery
process (Van Zanten et al. 2014). Subsequent nursing intervention strategy would include
arranging a consultation with the physician for medication which could help in reducing
inflammation and bacterial action (Van Zanten et al. 2014).
The second priority would include, pain management of the post-surgical wound.
The wound assessment would help in identifying the recovery stage of the wound.
Further, the patient has already mentioned about pain at the surgical site and upon
assessment, it seems there is an infection. The assessment method which would be used
for wound management would be PQRST assessment method which would help to
identify the provocation, quality, radiating/referred pain, assessment of severity and the
total time from which the patient is suffering from pain (Genord, Frost and Eid 2017).
The nursing intervention strategy would include administering analgesics and the
dosage would start from mild to strong. Studies reveal that analgesics administration
should be commenced from milder dosage so that effectiveness could be maintained
(Kampman and Jarvis 2015). The next care intervention would include, diversional
therapy to avoid or divert the concentration of the patient from pain to other leisure or
spiritual activities (Hyland et al. 2015). For this, the patient would be provided with a

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choice of any leisure or recreational activity so that he could help him to forget about
his illness and he would make a decision, self-goals and manage his own healthcare
condition using a recreational program.
How would you measure (evaluate) the effectiveness of your chosen
interventions, what evidence would be required to demonstrate if the goals of care had
been achieved:
To determine the effectiveness of the applied intervention, the patient, his wound
status and his pain score would be observed for at least a week. As per Hoffmann et al.
(2014), while evaluating the applied intervention, it is important to observe the patient
for a shorter time period so that effectiveness of the patient’s intervention could be
observed through the healthcare improvement of the patient. To evaluate the first
intervention for wound infection management, the white blood cell count of the patient
would be monitored. This would help in keeping a track of the white blood cell level of
the patient and accordingly the applied interventions could be altered or changed based
on the goal outcome (Dumville et al. 2013). Studies suggest that an increased, WBC level
indicates infection recovery and the range would be expected to be in between 4500-
11000 and A lower WBC count would reveal increased infection (Van Zanten et al.
2014; Dumville et al. 2013). Further, the patient would be monitored for symptoms of
‘increased redness’ or ‘increased swelling’ as these symptoms have been identified as
the primary symptoms that confirm the presence of infection (Kampman and Jarvis
2015). On the other hand, the evaluation measures for the second nursing care
intervention, for the pain management of the patient would also comprise of a number
of goal outcomes. PQRST assessment would be conducted twice in a week, once prior to
application of intervention and second after three days of applied intervention (Genord,
Frost and Eid 2017). This would help the healthcare professionals to observe the

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difference of patient’s perception of pain and he would be able to understand the
effectiveness of diversion therapy and a lower dose of analgesia in decreasing his
distress associated to pain (Radnovich et al. 2014). The second would include the
presence of a higher amount of granulation tissue at the impaired tissue site which
would reveal that the wound is recovering. Further, evaluation outcome would also be
determined by reduction of the wound size, reduction in inflammation as well as
redness. In addition to this, after the implementation of the nursing wound care
strategies, the patient would be asked to determine the pain score which would help in
understanding the effectiveness of the pain relief intervention applied for the patient.

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References
Adogwa, O., Fatemi, P., Perez, E., Moreno, J., Gazcon, G.C., Gokaslan, Z.L., Cheng, J.,
Gottfried, O. and Bagley, C.A., 2014. Negative pressure wound therapy reduces incidence of
postoperative wound infection and dehiscence after long-segment thoracolumbar spinal
fusion: a single institutional experience. The Spine Journal, 14(12), pp.2911-2917.
Amri, R., Bordeianou, L.G., Sylla, P. and Berger, D.L., 2014. Obesity, outcomes and quality
of care: body mass index increases the risk of wound-related complications in colon cancer
surgery. The American Journal of Surgery, 207(1), pp.17-23.
Eming, S. A., Martin, P., & Tomic-Canic, M. (2014). Wound repair and regeneration:
mechanisms, signaling, and translation. Science translational medicine, 6(265), 265sr6-
265sr6.
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Andraus, R.A., Fuirini, N. and Fernandes, K.B., 2015. Anti-inflammatory and analgesic
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American College of Cardiology, 64(22), pp.e77-e137.
Garimella, V. and Cellini, C., 2013. Postoperative pain control. Clinics in colon and rectal
surgery, 26(03), pp.191-196.

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Genord, C., Frost, T. and Eid, D., 2017. Opioid exit plan: A pharmacist's role in managing
acute postoperative pain. Journal of the American Pharmacists Association, 57(2), pp.S92-
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mechanisms to treatment. Pain reports, 2(2).

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Powers, J. G., Higham, C., Broussard, K., and Phillips, T. J., 2016. Wound healing and
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Scott, M.J., Baldini, G., Fearon, K.C.H., Feldheiser, A., Feldman, L.S., Gan, T.J., Ljungqvist,
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Running head: NURISNG ASSIGNMENT
APPENDIX
PLAN OF CARE
PATIENT or NURSING ORIENTED
PROBLEM OR PATIENT NEED
PATIENT ASSESSMENT DATA OPTIMAL PATIENT OUTCOME or GOAL
1.
Patient problem/issues/need - increased
risk of wound infection
Patient problems/issues/needs can be
actual present and occurring now
The wound assessment of the patient
Or potential when the patient is considered
to be ‘at risk of’.
The patient is at a high risk of suffering from
sepsis
As evidenced by (or how do we know this
problem exists)
Objective patient dataredness and swelling
around the suture area
Subjective patient data: complains of pain and
inflammation
Lab and other test results: FBC – Hb 112,
WBC 18.4, Platelets 276
What do we (patient and nurse) want to
achieve:
Specific, measurable, attainable, realistic and
time orientated (SMART goals)
Reduce risk of wound infection
Reduce inflammation
Make the patient feel better

14NURISNG ASSIGNMENT
The symptoms include:
Low platelet
Chills due to temperature fall
Problems in breathing
Low platelet
2. Infection at wound site Skin appears tight, swollen, shiny and red. Skin
is warm to touch and several dehiscence areas observed
with pus filling
Reduce infection at the surgical site
Reduce inflammation and observe increased
presence of granular tissue
Reduce redness
Foster pain relief
3. Difficulty with mobilization Subjective data reported about walking with
the help of non-weight bearing crutches
Improve mobilization
Referral to an occupational therapist for
assistance with mobilization and activities of daily living
4.Improper intake of nutrition Reported subjective data indicated delay in
wound healing
Improve wound healing
Strengthen muscle repair
Referral to a dietician who would assist the
patient with the consumption of a healthy nutritious
meal.

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5. Persisting pain at the surgical site objective data reported pain score 5/0 Reduce pain
Administer increased dose of NSAID for pain
relief
6. Educate patient about post-operative
care
No information provided about patient
education
Educate the patient about healthy nutrition
and hygiene to reduce infection and accelerate tissue
repair.

Running head: NURISNG ASSIGNMENT

Running head: NURISNG ASSIGNMENT