Nursing Assignment: Wound Infection and Pain Management

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-