Nursing Care for Christopher Collins Case Study

This article discusses the nursing care for Christopher Collins, a patient with impaired tissue integrity and decreased cardiac output. It includes assessment data, identification of health problems, and interventions to address these issues. The article emphasizes the importance of monitoring and providing appropriate care to promote healing and improve cardiac function.

Nursing
Institutional:
Student name:

Christopher Collins case study
Introduction
The essay assignment will use Christopher Collins' case study. Christopher Collins is a 54-year-
old male who has presented at the ED following signs of infection at the site of incision.
Christopher Collins complains of pain at the incision site, is nauseated and shivers. From the
observations, the wound site at the left knee was sutured. The skin appears “tight”, red and shiny.
Dehiscence is also evident in some areas with pus. These presented 5 days after Christopher
Collins was admitted for a left high tibia knee osteotomy following a prior early-stage diagnosis
of osteoarthritis in the left knee which caused pain and altered mobility. When Christopher
Collins was admitted for the left high tibia knee osteotomy, a plate and screw were used to
stabilize the tibia. Antibiotics were also administered. He had an uneventful period of post-
operative and was discharged after two days with non-steroidal anti-inflammatory medication for
relieve of pain. Christopher Collins has a past medical history of osteoarthritis and asthma since
childhood. Christopher is a non-smoker and a regular swimmer, swimming 3 to 4 times a week.
Assessment data including objective data and subjective data can be used to bring out the actual
or potential health problems which will lead to the development of a plan of care.
Assessment data
This may include both the objective data and subjective data. Objective data can be verified by
an external source while subjective data is the information coming from the patient (Gibbs,
2018). For the case study, therefore, objective data that is abnormal which can be used to derive
the actual or potential health problems may include; temperature of 38.3 degrees Celsius, heart
rate of 125 beats per minute, and blood pressure of 98/57. Subjective data that can be used to

derive the actual or the potential health problems include; Christopher complaining of pain at the
incision site rating it 5/10. Swelling and redness at the incision site. Christopher also complains
of cool peripheries.
Health problems
The health problems can be actual or potential. An actual health problem is the one that is
currently present and it requires intervention to either end or reverse its effects (Bower et.al
2016, p.399) whereas a potential health problem is a health problem that has not yet occurred,
however, there is a risk that the patient may develop the problem based on the assessment data.
The health problems with Christopher Collins include the following; Impaired tissue integrity
related to surgical site infection as evidenced by Christopher complaining of pain at the incision
site and the skin appearing “tight”, swollen, shiny and red, the incision site simply shows signs
of infection. The second health problem is the acute pain related to surgery evidenced by
Christopher Collins complaining of acute pain at the incision site which he is rating the pain as
5/10. The third health problem is Hyperthermia related to inflammatory response secondary to
incision site infection (Ejaz et.al, 2017, pp 153-159) and is evidenced by welling at the incision
site, redness at the incision site and a temperature of 38.3 degrees Celsius which is higher than
the normal temperature ranges of 36.5-37.5 degrees Celsius (Faizi et.al 2014, pp 1942-1945).
The fourth health problem is decreased cardiac output related to alteration in heart rate evidenced
by tachycardia, an increased heart rate of 125 beats per minute higher than the normal heart rate
range of 60-100 beats per minute (Rao et al 2016), hypotension which is a decreased blood
pressure of 98/57mm Hg and cool peripheries. The fifth health problem is impaired physical
mobility related to the surgery of the left knee and is evidenced by Christopher’s discomfort and

a moderate pain of 5/10. The last health problem is a potential health problem, risk for activity
intolerance related to asthma a respiratory condition.
Nursing care
Of the six health problems identified, the essay will describe nursing care for two selected health
problems in their order of priority. Using the ABCDEFG approach to identify nursing priorities.
We will have our two health care problems as lowered cardiac output related to alteration in
heart rate evidenced by tachycardia and hypotension, this is under circulation. The second
nursing priority will be Impaired tissue integrity related to surgical site infection as evidenced by
Christopher complaining of pain at the incision site and the skin appearing "tight", swollen, shiny
and red, the incision site. Simply the incision site is showing signs of infection.
Decreased cardiac output simply means the blood that is being pumped by the heart to meet the
metabolic requirements is inadequate (de Souza et.al. 2015 pp 2478-2487). Many heart disease
conditions are believed to be the case for decreased cardiac output. However, there are some
other things that could contribute to the same including some drugs effects. The aging process
also may reduce the ventricles’ compliance making the older people at risk of heart conditions
including the decreased cardiac output and hypotension. In this case alteration of the heart rate
whereby Christopher Collins is tachycardic with a heart rate of 125 beats per minute is related to
the decreased cardiac output. Christopher is also under Ventolin medication clinically indicated
for his asthmatic condition. Ventolin increases heart rate and the heart rhythm (Gardenhire, 2015,
p 97). If the body needs more blood and the heart has decreased cardiac output in a minute, then
it will compensate for the same by increasing its rate of pumping blood. Decreased cardiac

output can lead to hypotension. A diastolic pressure of less than 60 mm Hg, Christopher’s
diastolic pressure is 57 mm Hg. Low blood pressure if not treated can develop to severe which
will deprive oxygen and nutrients the brain and other important organs leading to shock
(Sherwood, 2015). Shock is a life-threatening condition and that’s why we should the nurse
should come up with nursing interventions that when implemented will meet the goals. The goals
may include; Christopher will achieve adequate cardiac output which will be evidenced by
normal blood pressure and pulse rate and rhythm. The second goal is that Christopher will
exhibit warm skin peripheries in the next 24 hours of hospital stay as compared to before when
he was exhibiting cool peripheries. The last goal is Christopher to remain free of side effects
(including tachycardia) from the Ventolin medication used to resolve his respiratory condition.
The interventions to be implemented by the nurse to resolve the decreased cardiac output health
problem may include the following; the nurse should monitor fluid intake and output including
IV fluids this is because patients with decreased cardiac output will have poorly functioning
ventricles which cannot tolerate increased fluid volumes (Pinsky 2014, p.288). The second
intervention is that the nurse will closely monitor the symptoms of decreased cardiac output and
heart failure including cold and calmly extremities, increased respiratory rate, increased heart
rate, and neck vein distension as well. This is because as these symptoms progress it indicates
that the cardiac output is also declining. The third nursing intervention is the nursing checking
the respiratory rate, rhythm and breath sound every two hours, continued rapid shallow
respirations is a characteristic of decreased cardiac output (Alt, Medtronic Inc, 2014 pp.
7,777,851) and may indicate that the client is not progressing well. The fourth intervention is the
nurse to monitor laboratory tests such as complete blood count, serum creatinine and sodium
levels. The rationale of this is that routine blood check may provide insight into the aetiology of

the reduced cardiac output. In case of any medication prescribed by the physician, the nurse has
to administer as prescribed noting side effects and toxicity. Though it may depend on the
aetiological factors, some common medications including digoxin, diuretics, inotropic agents and
vasodilator therapy they resolve heart failure condition when administered (Chavey et.al, 2017).
The nurse has to review the chest X-ray since it may provide information on pulmonary edema.
Lastly, the nurse has to maintain adequate ventilation and perfusion by doing the following;
administering oxygen therapy as prescribed. This is because the failing heart is unable to respond
to the oxygen demand. Monitoring the vital signs including the blood pressure and pulse rate
before administering any cardiac medication prescribed. It is important for the nurse to check
how well the patient is coping with the current medications before he could be administered the
cardiac ones.
Impaired tissue integrity. This is damage to the mucous membrane, integumentary, corneal, or
the subcutaneous tissue (Doenges, Moorhouse &Murr, 2016). In this case, it is related to the
surgery done on Christopher's left knee. It is evidenced by the pain scaled rated as 5/10, the
swollen and red skin surrounding the incision site and some areas of dehiscence having pus.
Pathophysiologically may be due to the inflammatory response whereby the infection triggers the
body’s immune response causing inflammation and damage to the viable surrounding tissues.
The damaged cells released chemicals including histamine, bradykinin, and prostaglandins. The
released chemicals cause the surrounding blood vessels to leak fluid into the tissues resulting in
swelling (Story, 2014). The prostaglandins synthesize pain resulting in pain upon touching the
incision site. The expected outcomes for impaired tissue integrity are; Christopher will describe
measures to protect and heal the tissue including aseptic wound care. The second goal,
Christopher's wound will decrease in size and have increased granulation tissue.

The interventions to care for the impaired tissue. The nurse will monitor the site of the impaired
tissue integrity (the incision site) at least once a day for color changes, pain, redness swelling or
any other sign of infection. Daily inspection done systematically can lead to the identification of
impending problems early. The second intervention, the nurse will keep a sterile dressing
technique during wound cleaning. Applying aseptic techniques lowers the risk of infection in the
impaired tissue (Lynn, 2018). Third intervention, the nurse will wet the dressings thoroughly
with normal saline solution which is sterile before removal during wound care. This eases the
removal by loosening the adherents and decreases pain as well. The fourth intervention, the nurse
will administer the prescribed antibiotics as ordered by the physician. Topical antibiotic agents or
intravenous antibiotics can manage wound infections. The fifth intervention, the nurse will avoid
positioning Christopher on the incision site and he/she can therefore turn and position the patient
at least every two hours. This is to avoid the effects of external mechanical forces including
pressure which can exacerbate the pain. The sixth intervention, the nurse will teach Christopher
on the wound and skin assessment and the ways to note for the signs and symptoms of infection,
complication, and healing as well. Early assessment and early implementation of interventions
helps in preventing the development of serious problems. The seventh intervention, the nurse
will instruct Christopher in the proper care of a surgical wound. Proper care of the surgical
wound may include wound cleansing, hand washing, changing dressings and application of
topical medications (Cancio et.al 2017, pp.203-214). The eighth intervention, the nurse should
tell Christopher to avoid rubbing and scratching the site, he/she can, therefore, provide gloves or
clip the nails if there is the need to. Rubbing or scratching will automatically cause further injury
and delay healing. Lastly, the nurse has to educate Christopher the need to inform a physician or

nurse any abnormal changes to prevent further impaired tissue integrity complications (Menna,
Swanson, & de Abreu Almeida 2016, pp.104-110)
Routine check-ups will let the nurse know the wound progress and thus can measure her goals
and outcomes and evaluate whether they are met or not.
Conclusion
In conclusion, the essay has described Christopher Collins’ case study. A 54-year-old male
patient who represented to the hospital with signs of wound infection 5 days later after
undergoing left high tibia knee osteotomy to relieve the pain and help improve his joint function.
Christopher had been diagnosed with early-stage osteoarthritis in the left knee which was
causing pain and altering mobility. The essay also outlined his past medical history and
assessment data as well. From the assessment data, some health problems were identified. Using
the ABCDEFG criteria the health problems were prioritized and the first two problems are taken
care of by implementing the nursing interventions. Evaluation has to be done to check on the
prognosis of the health problems identified if whether the goals are met or there is a need to
come up with other nursing interventions.

References
Alt, E., Medtronic Inc, 2014. Congestive heart failure monitor and ventilation measuring
implant. U.S. Patent 8,777,851.
Bower, P., Brueton, V., Gamble, C., Treweek, S., Smith, C.T., Young, B. and Williamson, P.,
2014. Interventions to improve recruitment and retention in clinical trials: a survey and workshop
to assess current practice and future priorities. Trials, 15(1), p.399.
Cancio, L.C., Barillo, D.J., Kearns, R.D., Holmes IV, J.H., Conlon, K.M., Matherly, A.F.,
Cairns, B.A., Hickerson, W.L. and Palmieri, T., 2017. Guidelines for burn care under austere
conditions: surgical and nonsurgical wound management. Journal of Burn Care &
Research, 38(4), pp.203-214.
Chavey, W.E., Hogikyan, R.V., Van Harrison, R., Nicklas, J.M. and Hogikyan, R.V., 2017.
Heart failure due to reduced ejection fraction: medical management. American family
physician, 95(1).
de Souza, V., Salloum Zeitoun, S., Takao Lopes, C., Dias de Oliveira, A.P., de Lima Lopes, J.
and Bottura Leite de Barros, A.L., 2015. Clinical usefulness of the definitions for defining
characteristics of activity intolerance, excess fluid volume and decreased cardiac output in
decompensated heart failure: a descriptive exploratory study. Journal of clinical nursing, 24(17-
18), pp.2478-2487
Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2016. Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales. FA Davis.

Ejaz, A., Schmidt, C., Johnston, F.M., Frank, S.M. and Pawlik, T.M., 2017. Risk factors and
prediction model for inpatient surgical site infection after major abdominal surgery. Journal of
Surgical Research, 217, pp.153-159
Faizi, M., Farrier, A.J., Venkatesan, M., Thomas, C., Uzoigwe, C.E., Balasubramanian, S. and
Smith, R.P., 2014. Is body temperature an independent predictor of mortality in hip fracture
patients?. Injury, 45(12), pp.1942-1945
Gardenhire, D.S., 2015. Adrenergic (Sympathomimetic) Bronchodilators. Rau's Respiratory
Care Pharmacology-E-Book, p.97
Gibbs, G.R., 2018. Analyzing qualitative data (Vol. 6). Sage
Lynn, P., 2018. Taylor's clinical nursing skills: a nursing process approach. Lippincott Williams
& Wilkins.
Menna Barreto, L. N., Swanson, E. A., & de Abreu Almeida, M. (2016). Nursing outcomes for
the diagnosis impaired tissue integrity (00044) in adults with pressure ulcer. International
journal of nursing knowledge, 27(2), pp 104-110.
Pinsky, M.R., 2014. Functional hemodynamic monitoring: Current concepts in critical
care. Current opinion in critical care, 20(3), p.288.
Rao, P.T., Rao, S.K., Manikanta, G. and Kumar, S.R., 2016. Distinguishing normal and
abnormal ECG signal. Indian Journal of Science and Technology, 9(10).
Sherwood, L., 2015. Human physiology: from cells to systems. Cengage learning.
Story, L., 2014. Pathophysiology: A practical approach. Jones & Bartlett Publishers.