Pathophysiology of Post-Operative Surgical Wound Infection

This article discusses the underlying pathophysiology of post-operative surgical wound infection and its impact on wound healing. It explains how the infection occurs, the role of microorganisms, and the body's immune response. The article also describes the symptoms of an infected wound and provides insights into nursing priorities and management strategies for infected wounds.

Nursing
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Question 1
The underlying pathophysiology of a post-operative surgical wound infection. A wound that
is infected is a localized or excavation of the skin or the underlying soft tissue. Surgical site
infection requires contamination of the surgical site by microbes. The wound infection can occur
when the number of virulence microorganisms such as the bacteria and fungi overwhelms the
natural body defense mechanism (Weiss & Schaible 2015). This triggers the body’s immune
response which results in inflammation, tissue damage as well as a delay in wound healing. The
microorganisms causing infection can either originate from endogenous sources such as the
patient's skin or exogenous sources such as from contaminated items on the sterile surgical field,
team members and microbes from the air. These virulence microorganisms injure the viable
tissues surrounding the incision site. The damaged cells of the injured tissues release chemicals
likes of histamine, bradykinin, and prostaglandins (Widgerow & Kalaria, 2012). The released
chemicals cause blood vessels to leak fluid into tissues causing the swelling called inflammation.
After the inflammation has occurred, the white blood cells produce chemicals as well which are
released into the infected tissues or the circulating blood as a way of immune response, however,
this increases blood flow to the infected area instead resulting into redness and warmth.
In the case scenario of Mrs. Gina Bacci, the following describes her post-operative wound
status; Island film dressing along the incisional wound and wet dressing from serous exudate
shows that the wound is oozing. The wound also has some dehiscence along the suture line, the
wound has a sloughing tissue, warm surrounding skin, dark pink surrounding skin and lastly the
wound surrounding is painful upon touching. The exudate is normally a liquid fluid produced by
the body and in this case, is due to the post-operative surgical infection. Its an inflammatory
liquid leaking between cells and has been filtered from the circulatory system into areas of

inflammation and plays an important role in wound healing by providing a moist wound bed and
supplying necessary nutrients required for quick wound healing. Normal serous exudates can
indicate progressive wound healing whereas abnormal or purulent effluent serous exudates
which are normally yellow, grey or green shows invasion of an infection in the surgical site. The
wound dehiscence along the incisional wound indicates a surgical complication whereby the
wound ruptures along the surgical incision (Arterburn & Courcoulas, 2014). and this can be as a
result of the operation being done to an increased age patient, a diabetic patient, client with
obesity or poor knotting of the stitches and trauma to the wound after the surgery. The slough of
the wound is a result of the inflammatory phase during wound healing. It is comprised of dead
white blood cells, fibrin, cellular debris, and liquefied devitalized tissues. This cellular debris
when forced out onto the wound surface that's when it can be seen as a slough. The wound bed
has dead or non-viable tissue, when the slough is moist it helps in shifting and shading the dead
tissue. When the slough dries it becomes sticky and requires a helping hand for the natural
debridement process. The warm surrounding is due to an increased amount of blood flowing to
the infected area more compared to the surrounding area. The skin surrounding the wound start
turning pink once the scab forms and the body’s immune system starts to protect the wound from
superficial infection. Blood vessels ended up opening in the infected area so that blood can bring
oxygen and nutrients to the healing wound. Oxygen is among the necessary requirements of
wound healing (Pierpont, et.al 2014). Lastly, the surgical site which is inflamed is likely to be
painful too especially during and after touching. some chemicals are released, these chemicals
stimulate nerve endings making the area more sensitive. Hence can be painful upon touching.

Question 2
Combining the history provided by Mrs. Gina Bucci, with the data gotten from assessment,
such as the vital signs, capillary refill, and her blood glucose level. The nursing staff can come
up with nursing priorities which will help in providing high-quality care effectively and
satisfying most of the patient’s needs at a particular time. The two main nursing priorities in this
case are; Ineffective health management under the health promotion domain and secondly is
overweight under the nutrition domain. The infective health management simply means a pattern
of regulating and integrating into daily living a program for treating illness and the condition of
the illness that is unsatisfactory for meeting specific desired health goals. The defining
characteristics of infective healthcare management as a nursing diagnosis in this case study is
difficulty with the prescribed regimen (Hinkle & Cheever, 2013). Client admits that she
sometimes forgets taking the medication. It is also defined by the failure of including the
treatment regimen in daily living. The client claims that she does not see the need to take all her
medications. And lastly, it is characterized by failure to take action to reduce risk factor. The
related factors for infective health management is due to decisional conflict; the client, not seeing
the need to complete her treatment. It could also be related to insufficient knowledge of the
therapeutic regimen. Rationale; when the client is allowed to participate in planning the
treatment program and adheres to medication have a greater chance of obtaining positive results.
The second nursing priority is overweight. Overweight means a condition in which the client
has accumulated abnormal fats or excessive fats for her age and gender (Sattar &Gill 2014). The
defining characteristics for the overweight nursing diagnosis are; the client having a Body Mass
Index (BMI) of more than 25. In the case study, the client has a BMI of 40.4 indicating that she
is overweight. Overweight is related to the average daily physical activity less than

recommended for gender and age, this is because the client is mobilizing with an offloading boot
and walking stick hence not stable enough to carry out physical activities as required for
effective health management. Rationale; goals of managing weight help to improve general
wellbeing, health and fitness as well.
Question 3
The above outlined nursing priorities can be used to justify the appropriate and safe nursing
management of the patient during this time. The management is basically to prevent worsening
of her condition. While managing in this case we will consider the drug regimen knowledge
sufficiency and management of diabetes and overweight as well lastly the minor complications
that could be coming hand in hand with the major conditions and the ones caused by the post-
operative wound infection as well. Starting with the ABC checkup the following measures can
be considered; check on her airway opening, her breathing pattern and finally her circulation.
Considering the circulation, the client is complaining of feeling cold at the feet sometimes, this is
also evidenced by the client having a capillary refill of 2-3 seconds which is more than the
normal which should be not more than 2 seconds. This indicates poor blood circulation to the
feet and can be due to tightening of the offloading boot hence checkup is required to be loosened
up to allow for free blood circulation without obstruction.
Efficient blood supply to the incision site aid in wound healing due to the oxygen supply, fluids
making the area moist and supply of nutrients required for wound healing.

Strict monitoring of fluids input and output is necessary for fluid balance maintenance. The
client should not be overhydrated or dehydrated, a sufficient amount of fluid moistens the
incision site aiding in healing. Overhydration leads to edema (Bracher, et.al 2012). For the
infective therapeutic regimen management, the following nursing management actions are
considered and they have the following goals. After the nursing interventions, it should be
evident that the patient will exhibit continuous adherence to the treatment plan, the patient will
verbalize aim to follow the prescribed regimen. The nurse will prove educational support by
giving out advice on the advantages of adhering to the prescribed regimen when the patient
understands the effectiveness of the suggested treatment that it can reduce risk or can promote
her health, there is a likelihood of engaging in it. The nurse will also educate the client in
observing aseptic techniques when handling her incision site. Any other person visiting a patient
should perform handwashing, such knowledge prevents the client with the risk of asepsis
(Cohen, Hyman, Rosenberg & Larson 2012). Knowledge on adherence to the medication such
antibiotics will reduce her chances of superficial infection which could rise up as she continues
with her treatment. Adherence also prevents or reduce resistance to the microbes. Nursing
management on the overweight and obesity is as follows; health education on dietary habits,
exercise, and lifestyle, change in behavior, and administration of weight-loss medications (Dietz
et.al 2015). The nurse should advise the client on reducing calories and practicing healthier
eating habits by avoiding junk foods, this is vital for overcoming obesity. The client should know
that dietary changes to treat obesity include cutting calories, this can be done by reviewing the
typical eating and drinking habits with the nurse. Another management is increased physical
activity or moderate physical exercise at least 150 minutes a week. The nurse can help Mrs. Gina
Bacci with supportive mobilization, or advising the client’s family relative to assist the client

when she needs to have some activities. Physical activities can also increase circulation to the
amputated feet. Another nursing management is the nurse monitoring the side effects of the
administered drugs. Drugs such as Novorapid can lead to redness, itching or swelling at the site
of administration (Jacquier, Chik, and Senior, 2013). These are allergic reactions. When the
allergic reactions become serious leading to swelling of the face or throat, difficulty in breathing,
wheezing or itchy skin should be reported and the drug administration stopped and further
medical interventions take place. Lantus can lead to dizziness or drowsiness, weakness and
tingling of the hands or feet.
When the above nursing managements can be prioritized according to the extent of attention they
require as outlined by the NANDA international knowledge base. NANDA outlines nursing
diagnoses (Gordon, 2014). which is used to determine the appropriate plan of care for the
patient. The nursing diagnoses drive out the actions to be performed by the nurse and patient
outcome enabling the nurse to develop a care plan which prioritize nursing management.

References
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connection. Burns, 38(7), 951-959. The wound dehiscence along the incisional wound
indicates a surgical complication whereby the wound ruptures along the surgical incision.