Nursing Assignment: Case Study of Gina Bacci

This nursing assignment discusses the case study of Gina Bacci, a patient who underwent forefoot amputation surgery and is at risk of wound infection. It explores the pathophysiology of her wound condition and identifies two nursing priorities for her care. The paper also discusses the application of safe nursing care management strategies to address these priorities.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT (CASE STUDY OF GINA BACCI)
Name of the student
Name of the university
Author note

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Introduction
Post-operative healthcare conditions are considered as crucial healthcare conditions in
which, proper healthcare assistance and guidance is required (Baratta, Schwenk & Viscusi,
2014). As per Rawal (2016) after going through critical surgeries, the resultant wounds or
incisions are under the risk of bacterial and viral infections. Further, due to increases
inflammation and swelling of the wound mechanical injuries such as broken sutures, dehiscence
and other crucial condition arise (Son & Harijan, 2014). Therefore, the primary aim of the post-
surgical treatment is to provide patients with accurate assistance regarding their wound
management and mitigating their risk of infection. This paper would also discuss one such
patient Gina Bacci (49) who has undergone surgery for her forefoot amputation and is suffering
from the severe risk of wound infection. The primary aim of this paper is to describe the
pathophysiology of Mrs. Bacci's current wound status and then identify two nursing priorities so
that through the application of nursing interventions, nursing management could be achieved.
Pathophysiology and causes of her current post-operative wound condition
Mrs. Gina Bacci (49) is an Italian origin woman who was suffering from diabetic foot
ulcer due to which healthcare physicians amputated her forefoot and this surgery took place two
weeks ago. After she was discharged from the healthcare facility, she started developing redness
and swelling around her wound and she visited the outpatient unit of the healthcare facility.
Upon primary observation of her wound condition, sever risk of wound infection was notices as
her wound sutures were broken and soft tissue was visible in the form of dehiscence. Further, the
primary observation indicated that the wound is swollen, pink and dark in color, with sluggish
appearance and painful to touch. As per Chow and Barbul (2014), if the wound appears dark and
painful to touch, and reddish and swollen in appearance, then it is the immunological response

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that helps in the recovery of the wound and the immunological response helps in the wound
healing through inflammation, proliferation and maturation process. The inflammation phase of
wound healing is the stage when the immunological cells such as macrophages, white blood
cells, and leukocytes with fibrin proteins starts moving in the wound area so that through higher
inflammation, the wound could be protected from bacterial and fungal infections and hence, the
incision site is filled with immunological cells (Convente et al., 2015). However, in the case of
Mrs. Bacci, it was noted that her wound has broken sutures and dehiscence has appeared that
determine that the wound is exposed to environmental contaminations and pollutants. Further, it
was also noted that the sutures were tight due to which the mechanical pressure of sutures
increased the risk of infection (Yang et al., 2016). Besides this, the physiological reflexes such as
hiccups, sneeze, the cough could increase the chances of suture breakage and lead to infection.
Therefore, as per Goyal and Chowdhury (2014), dehiscence could be another reason for the
wound infection-related causes for Mrs. Bacci.
Further, it was also noted that patient is overweight and as per Watts et al. (2015), due to
her excess weight, there was excess pressure on her wound due to which she was suffering from
the severe risk of wound infection. The second step of immunological response that is
proliferation phase was the reason due to which the complication of the patients’ wound
increases. In this phase as per Widgerow et al. (2015), serous exudates are visible which helps to
accelerate the wound healing process. As per Jackson‐Jones et al. (2016), serous exudates helps
to drive immunological cells, white blood cells and other inflammation agents in the incision site
so that with elevated inflammation and immunological reactions, the risk of wound infection
could be eliminated. However, Mrs. Bacci’s wound was filled with exudates and she was unable
to maintain hygiene of her wound condition, therefore, it could provide a favorable condition to

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the bacteria and fungus for their growth and development. Hence, due to her poor hygiene and
wound management conditions, she developed a higher risk of wound infection.
The proliferation and maturation phase of wound management is the stage in which the
fibrin proteins, the vascular endothelial cells, and other immunological cells increase the
cellularity of the process so that maturation of the wound could be achieved and the healing
process could be accelerated. However, in the research of Percival et al. (2014), it was mentioned
that poor management of wound and favorable conditions for bacterial growth increased the risk
of wound infection through normal microflora of the body. Therefore, the poor hygiene,
immunological responses, patient’s overweight, and related mechanical pressure and patient lack
of proper wound management knowledge were associated with the pathophysiology of the
assorted wound infection of Gina Bacci.
Identification of two nursing priorities for Mrs. Gina Bacci
While caring for forefoot amputation related wound of Mrs. Gina Bacci, her care plan
should be optimized with accurate and appropriate healthcare interventions so that with her
wound infection risk, she could be provided with healthcare intervention for other healthcare
concerns related to her overweight, her prolonged diabetes condition could be treated. Therefore,
in this aspect, the first nursing priority that would be selected is her severe risk of wound
infection. And this would be mitigated by application of aseptic healthcare conditions. As per
Yazdanpanah, L., Nasiri, and Adarvishi (2015), application of proper wound management
strategies and hygiene measures for the risk of wound infection of patients could decrease the
chances of bacterial and environmental wound infection and increases rapid recovery of the
wound. On the other hand, Lipsky et al. (2015) also mentioned in their research that application
of wound management strategies would help the patient to understand the strategies and

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interventions of wound management and she would be able to overcome the risk of wound
infection through exudates and other wound secretions (Son & Harijan, 2014).
The second nursing and healthcare priority that would be selected for Mrs. Gina Bacci
would be her prolonged diabetes, especially her increased weight due to which she suffers from
extreme healthcare conditions. As per Edsberg et al. (2014), excess weight is a crucial reason for
exerting mechanical injury in the wound state of the patient, as well as due to her prolonged
diabetes condition, overweight body could lead to developing cardiac or airway related
complication in the patient (Edsberg et al., 2014). Further, it was seen that as per the American
Diabetes Association (2015), for healthy 49-year-old women the ideal weight should fall
between the range of 60 to 70 kg. However, she weighed 110 kg, due to which, her incision site
had severe pressure and the chances of the sutures to break due to this pressure was higher (Alavi
et al., 2014). Therefore, depending upon the weight, increased blood sugar level, excess physical
pressure, and management of her overweight condition would be chosen as the second priority of
healthcare. The primary aim of this priority would be providing the patient with interventions so
that her weight could be managed and her wound could get favorable condition to recover
rapidly.
Application of safe nursing care management process
To provide the patient with care intervention relayed to the first nursing priority, wound
management strategies would be implemented in the care process (Byrne et al., 2016. The
primary interventions and strategies that would be implemented in the process is the dressing
change and wound hygiene strategy provided by the Australian healthcare department and
complete compliance to these strategies would be maintained (Nursingmidwiferyboard.gov.au,
2019). In this aspect, it should be mentioned that Gina Bacci is in the outpatient service and has

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been discharged 2 weeks ago. Therefore, besides maintaining wound management strategies. She
would be provided with wound management and hygiene education so that she could conduct
these strategies at her home, with or without the assistance of healthcare professionals (Webster
et al., 2014). Hence, with wound management strategies, the interventions would include,
healthcare literacy, hand hygiene education, and wound hygiene and cleanliness strategies. The
outcome that the healthcare professionals would expect from these strategies would be patient’s
enhanced ability to maintain her wound hygiene, take care of her sutures and proper cleaning of
serous exudates that increases her risk of bacterial and fungal infections (Byrne et al., 2016). Her
patient education strategies would last for 4 weeks and in these weeks she would be provided
with each and every strategy, with its implementation skills and finally, an evaluation would be
conducted to determine the increased knowledge of the patient regarding the process. Further,
she would also become aware of the physical activities she should refrain from, so that effective
and proper result for the wound recovery could be achieved (Hingorani et al., 2016).
The second priority of her health is crucial as in this her prolonged diabetes, her habits,
her overweight condition would be targeted. The patient is suffering from prolonged diabetes and
is overweight, and hence as per Mitanchez et al. (2015), it indicated towards her poor diet and
the nutritional regime, lack of understanding the food products that she could consume to
decrease her blood sugar level and the adverse effects of inactive lifestyle. Therefore, these
aspects would be targeted for the second [priority of care of Gina Bacci. To target the first
condition, that is her prolonged diabetes, the patient would be asked to resume her insulin
therapy so that her blood sugar level could decrease and her wound recovery could be
accelerated. Further, from the case study, it was identified that the blood glucose level of the
patient was more than 12mmo/L however, the normal range determined by American Diabetes

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Association (2015) is around 5mmol/L, and hence, it was selected as one of the primary
priorities for Gina Bacci. Further, as per Merovci et al. (2014), with increased blood sugar level,
blood is unable to reach to the wound site and exert immunological responses due to which the
patient starts developing the risk of wound infection. Therefore, insulin dosage would help her to
maintain the blood sugar level. The second strategy that would be applied, is providing the
patient a diet and nutritional regime with less carbohydrate and excessive protein and fat so that
the total amount of calorie consumed by the patient could be decreased and with less amount of
carbohydrate, the amount of glucose in the body could decrease (Kushner, 2014). As per
Johnston et al. (2014), providing any patient with diet and national regime and continuous
dosage of insulin could help to manage extreme blood glucose and obesity. Further, application
of fat and protein in the diet could increase the movement of immunological cells around the
wound and achieve high inflammation level, therefore, helps to maintain the patient condition
(Bray et al., 2016). As the patient is suffering from post-surgical wounds, she would be asked to
restrict her activity level and in the aspect, she would ask to maintain bed rest for 3 weeks so that
the wound could reach to its maturation phase and fast healing and recovery could be observed.
Besides all these, she would be educated about wound dressing, patch dressing technique so that
she could utilize this knowledge at her home and could maintain the health and hygiene of her
wound.
Conclusion
This paper discussed Gina Bacci, who is suffering from the post-surgical risk of wound
infection and other physiological and lifestyle disorders included prolonged diabetes, severe
obesity, and increased blood sugar level. Hence, through the process of clinical reasoning, her

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healthcare priorities were determined and she was provided with nursing management
intervention so that faster recovery of her wound could be achieved.

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