Nursing Priorities of Care for Post-Operative Wound Infection: A Case Study of Mrs. Gina Bacci

This essay describes a case study of Mrs. Gina Bacci, a 49-year-old Italian lady with diabetes type II and a history of obesity. The essay discusses the pathophysiology of postoperative surgical wound infection, nursing priorities of care, and appropriate and safe nursing management of the patient. Educational support is also provided to help Mrs. Bacci manage her condition effectively.

Nursing
Student’s name:
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Introduction
The essay will describe Mrs. Gina Bacci’s case study. Mrs. Gina Bacci is a 49 years old
Italian lady who has poor English, she has a history of diabetes type II. She is obese with a BMI
of 40.4 m2. The diabetes got worse and she is therefore commenced on insulin on her admission.
She underwent surgery following her complications from a right foot ulcer. Mrs. Bacci
underwent the surgery under general anesthetic two weeks ago and this time around she has
presented to the hospital mobilizing with an offloading boot and walking stick. Mrs. Bacci
underwent some examination where the vital signs were taken. The post-surgical wound was
examined and the findings was that the wound had an island film dressing along the incisional
line which is wet from the serous exudate output. Dehiscence was also noted on the wound.
There is also some sloughy tissue. The skin surrounding the wound is warm, dark pink and
painful to touch. Mrs. Bucci was put under medication when she was going home after the
surgery, she was given some medication including; Novorapid, Lantus, Pregabalin, and
Paracetamol.
Underlying pathophysiology and causes of the post-operative wound status.
The state of Mrs. Bacci wound showed signs of infection. Therefore, the essay will discuss
the pathophysiology of postoperative surgical wound infection. An infected wound is a localized
or excavation of the skin or the underlying soft tissue (Edmonds & Foster, 2014). For the surgical
site to be infected it requires contamination on the surgical site by microbes. The microbes may
include fungi or bacteria. Wound infection can occur when the number of virulence
microorganisms overwhelms the natural body defense mechanism (Weiss, & Schaible, 2015).
Mrs. Bacci’s body immune system is then triggered resulting in inflammation, tissue damage as

well as a delay in wound healing. The microorganism causing infection must have an origin.
Other microbes originate indigenously such as from the patient’s skin while others may originate
from exogenous sources such as microbes from the surgical cutting instruments, from the
healthcare team members and from the air as well. Therefore, virulence microbes normally injure
the intact skin that surrounds the incision site and which has viable tissues. The injured tissues
release chemicals including histamine, bradykinin, and prostaglandins (Harper, Young, &
McNaught, 2014). Some of the released chemicals cause the blood vessels to leak fluids into the
tissues causing the swelling and inflammation. The released prostaglandins lead to pain around
the incision site. When the inflammation has occurred white blood cells also produce chemicals
then release them to the infected tissue or the blood as a way of immune response, however, this
increases blood flow to the infected tissue resulting into the readiness and the increased warmth
(Sompayrac, 2019)
From the Mrs. Bacci case scenario, the following characteristics were observed from her
post-surgical wound; island film dressing along with the incisional line, wet dressing from the
serous exudate showing that the wound is oozing. The wound also has some dehiscence along
the suture line, it has a sloughing tissue, the skin surrounding the wound is warm and dark pink
in color. Exudate is an inflammatory liquid leaking between cells and which has been filtered
from the circulatory system into the areas of inflammation (Nash, Dalziel, & Fitzgerald, 2015).
Exudate plays an important role in wound healing. During wound healing, the exudate provides
moist wound bed. The exudate supplies the necessary nutrients required for quick wound
healing. Normal serous exudate can indicate the progressive wound healing whereas abnormal or
purulent effluent serous exudate normally yellow, grey or green in color shows invasion of an
infection in the surgical site.

The surgical wound ruptures along the incisional line as a result of operation done. If the
operation is done to a diabetic patient or to an obese patient, can lead to dehiscence along the
suture line of the surgical incision. The inflammatory phase during healing leads to the sloughing
of Mrs. Bacci's surgical wound. The slough is comprised of dead white blood cells, fibrin,
cellular debris, and liquified devitalized tissues. When the debris is forced out onto the wound
surface that's when it can be seen as a slough. Moist slough helps in shading dead or damaged
tissues. An increased amount of blood flowing to the incision site increases the warmth of the
area. Compared to the skin's temperature far from the incision site. When the scab forms the skin
surrounding the wound starts becoming pink in color (Han, 2016). This is the time when the
body’s immune system starts protecting the wound from the outside infection. Lastly, the
surgical incision site feels painful during and after touching. Some chemicals released stimulate
nerve endings making the area more sensitive.
Nursing priorities of care and their Justification
This part of the essay simply requires the identification of two nursing priorities of care for
Mrs. Bacci ending with justification and a rationale for each nursing priority. The nursing staff
should come up with nursing priorities which will help in giving out high-quality care effectively
and with the aim of satisfying the patients' needs fully at a particular time. The nursing
interventions for care can be derived from the data obtained during the assessment and from the
history obtained. The two main nursing care priorities are; management of overweight from the
nutrition domain and the second one is the Ineffective health management under the health
promotion domain.

The first nursing priority of care is Infective health management pattern which means
involves regulating and integrating into daily living a program of treating illness but failing to
meet specific desired health goals (Gordon, 2014). The defining characteristic from this case is
difficulty with the prescription regimen which makes Mrs. Bacci from forgetting the medication.
It is also defined by the failure of including the treatment regimen into the daily activities. Mrs.
Bacci admits that she is not seeing the need for taking all her medication. Lastly, Mrs. Bucci has
failed to take action in reducing the risk factor. The infective health management is related to the
following factors; decisional conflict (Gordon, 2014). Mrs. Bacci does not see the need to
complete her treatment. The infective health care management could also be related to
insufficient knowledge of therapeutic regimen. The rationale of this is that a client who is
allowed to participate in decision making while planning the treatment regime and is advised to
adhere to the medication will cooperate well and hence better results. Overweight is the
condition in which the client has accumulated abnormal fats or excessive fats for her age and
gender (Sharma, & Campbell‐Scherer, 2017). This one now becomes the second priority to be
managed. Overweight has the following defining characteristics; Mrs. Bacci has a Body Mass
Index of 40.4 which is more than 25 indicating that Mrs. Bacci is overweight. Overweight is
related to the average daily physical activity less than recommended for gender and age (Kahan,
& McKenzie, 2015). Mrs. Bacci Gina is mobilizing with an offloading boot and a walking stick
this makes her not to be stable enough to carry out the daily physical activities as required. For
effective health management. Rationale; the goal for managing the weight helps in general
wellbeing improvement. The client may become healthy due to the daily exercises and lastly
fitness as well.

Question 3
Appropriate and safe nursing management of the patient
. The aim of the management intervention is to stop her condition from worsening. During the
management, we will consider the drug regimen knowledge sufficiency and diabetes and obesity
will be managed as well. Then we will manage the minor conditions brought by the major
managed conditions and lastly management of the postoperative wound infection will come last
aiming at prevention of asepsis. ABC checkup comes first and in this, the following will be
considered; airway checkup, breathing pattern, and circulation (Rusoke-Dierich, 2018). The
client complains of cold feet sometimes and have a delayed capillary refill of more than 2
seconds. Tightening the offloading boot can lead to poor circulation at the feet, therefore the
offloading boot can be loosened up to allow free blood circulation to the feet. Sufficient blood
supply to the incision site aids in wound healing. Sufficient blood supply to the incision wound
supplies oxygen and fluid making the area moist (Han, & Ceilley, 2017). Strict fluid input and
output monitoring is required to maintain Mrs. Bacci fluid and electrolytes balance.
Overhydration or dehydration should be avoided, a sufficient amount of fluids moistens the
wound improving its healing rate whereas on the other side overhydration leads to edema. After
the nursing interventions are implemented for the infective therapeutic regimen management.
Mrs. Bacci who is the client will exhibit continuous adherence to treatment plan, the client
should verbalize the aim of following the prescribed regimen.

Educational support is given out by the nurse to Mrs. Bacci, by doing the following;
advising Mrs. Bacci on the importance of the drug adherence. when the patient understands the
importance of adherence of the prescribed regimen, the effectiveness of the suggested treatment
that it can reduce or promote her health, there is a likelihood that Mrs. Bacci will engage in it.
The nurse should also educate Mrs. Bacci on the aseptic techniques when handling her incision
site and surrounding her amputated part. Such knowledge includes; any other person visiting her
should perform hand washing to prevent wound infection (Ellingson et al 2014).
Overweight and obesity management. The nurse can educate Mrs. Bacci on dietary habits,
exercise, and lifestyle, change in behavior and administration of weight-loss medication. Mrs.
Bacci should be advised on taking fewer calories and practicing healthier eating habits such as
avoiding junk foods can help her overcome obesity. Mrs. Bacci should review her eating and
drinking habits with the nurse and make necessary adjustments. Increased physical activity such
as walking for 150 min a week can help reduce weight for an overweight patient (Swift,
Johannsen, Lavie, Earnest, & Church, 2014). The nurse can also help Mrs. Bacci with supportive
mobilization or requesting Mrs., Bacci’s family to help her perform her daily physical activities.
Another rationale for physical activity is increasing blood circulation to the lower extremities.
Lastly, the nurse should manage the side effects of the drugs that are administered. Some
drugs have same side effects while others have specific side effects that the nurse should be well
conversant with. Novorapid can lead to allergic reactions as side effects, including redness,
itching or swelling at the site of administration (Gough, & Narendran, 2016). Lantus can lead to
dizziness or drowsiness.
conclusion

A client who undergoes surgery needs proper aseptic management when caring for the
wound to prevent the wound from being infected by microbes. Microbes can lead to asepsis
changing the state of the wound to being worse. The wound has to be inspected regularly and
proper dressing be done since much exposure of the wound usually leads to it being invaded by
germs which eventually leads to further infections and complications. It is also best to ensure that
the patient-care is always individualized so that needs are addressed accordingly. Lastly, some
nursing interventions when implemented effectively reduce the rate of becoming obese and being
overweight.

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