Nursing Care for Mrs. Gina Bacci's Post-Operative Wound Infection

Nursing;
Institutional;

Mrs. Gina Bacci’s case study
Introduction.
Mrs. Gina Bacci is a 49-year-old female patient. She is an Italian lady with poor English.
She presented to the outpatient department for further wound management and checkup with a
history of hospital admission two weeks ago for surgery following complications from her right
foot ulcer. She underwent surgery under general anesthetics for partial amputation of the forefoot
and the great and first toes. Upon examination of the wound, an island film dressing along the
incisional wound which is wet from serous exudate output is noted. The wound has some
dehiscence along the suture line and there is some sloughy tissue. The skin surrounding the
incision line is warm, and dark pink and painful to touch. Her systolic and diastolic blood
pressure are 120/70 mm Hg, a regular pulse rate of 88 beats per minute, respiratory rate of 18
respirations per minute, and SpO2 of 97%. A temperature of 37.8 degrees Celsius though her feet
and toes on her right leg are cool to touch with a capillary refill of 2-3 seconds. She states that
she normally has cold feet and wears bed socks. She has a medical history of type II diabetes
mellitus which was diagnosed 6 years ago, peripheral vascular disease, and obesity with a BMI
of 40.4 m2. She commenced on insulin on her admission due to her worsening diabetes. She is
currently under some medications to manage her medical conditions though she admitted that
sometimes she forgets and doesn’t think she needs to take all her medications.
Pathophysiology of post-operative wound infection.
When surgery is performed it leads to an acute dermal wound which requires some time for
healing. Sometimes the dermal wound formed is colonized by aerobic or anaerobic bacteria.
Fungal strains can also cause post-surgical wound infection (Bertesteanu et al, 2014). The

bacteria causing the infections can originate from the skin that surrounds the incision site, or
from the external environment. They, therefore, form microbial communities called biofilms.
This mostly occurs in the failure of observing aseptic techniques during wound care and
management. Some of the aseptic techniques including thorough hand washing, wearing gloves
and maintaining a clean working area (Megeus et al. 2015) When we talking of pathophysiology
of the wound infection, we therefore simply mean the role of the polymicrobial film in delaying
repair processes and the outcome of it. Wound infection normally occurs when the virulence
microorganisms including the bacteria and the fungi overwhelm the body natural body defense
mechanism (Weiss & Schaible 2015). The infection will now, therefore, trigger the body's
immune system to respond which will lead to inflammation and tissue damage and slowing the
healing process. A response of the immune system results mainly into phagocytosis and
correlation. Phagocytosis is a process by which particulate matter is ingested into specialized
cells, degraded and the harmless debris or the products are expelled into the stroma. The
principles cells involved in the processes are the neutrophils and the macrophages. The immune
system is composed of the complement system that eradicates the microbes when activated
(Parham, 2014). There are three end results of the complement system, however, the major one is
the inflammation to attract additional phagocytes to kill the foreign particles including the
microbes. The end result of the system is also changing in the anatomy of the incision site thus
the pathophysiology.
Virulence microorganisms invade the body through the incision site and injure the viable
tissues surrounding the incision site. The damaged injured cells, therefore, produce chemicals in
response including histamine, bradykinin, and prostaglandins (Widgerow & Kalaria, 2012). The
released chemicals lead to inflammation by causing blood vessels to leak blood fluids into the