Case Study on Pathophysiology of The Problem

Running head: CASE STUDY
Case Study
Name of the Student
Name of the University
Author Note

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Introduction
The fixation of knee joints is done by an operative technique called an osteotomy. The
damaged joints are established by this particular surgery, especially to the patients who ache
from the severity of osteoarthritis (Bode et al. 2015). The patient with this condition of
arthritis experiences tears in the later period due to a condition of continuous draining of the
menisci or in the articular cartilage. This condition affects the physical activities of the body
and especially restricts mobility. The symptom of popping, catching, locking, and severe pain
occurs due to the degeneration of the tissues or bones are responsible for the easy and smooth
movement resulting in immobility (Firestein 2017). The patient in the case study named Mr.
Collins is an older person and underwent surgery of osteotomy in the left high tibia. The
patient’s tibia was settled with the help of screws, and he was discharged. The patient
revisited the hospital with a complaint of pain in the incision site of the surgery. The affected
area looked sutured, red, and he also had a fever along with nausea (Tande and Patel 2014).
He was also having a lower level of the blood pressure along with a higher respiratory rate.
The primary purpose of the below paper is to discuss the pathophysiology of the recognized
problems that the patient was anguishing from, along with its management plan and nursing
intervention that is needed to repair the condition.
Discussion
Pathophysiology of the problem
Surgical infection and sepsis
Mr. Collins is an older person who underwent surgery of osteotomy. The condition of
the surgical infection wound developed in the surgery area, which was recognized by the

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indications of the symptoms. The symptoms such as the development of pus, which are
draining from the surgical area, painful sensation with a score of 7/10, tightness, redness
occurred due to the occurrence of infections. The main reason for developing this condition is
the growth and spread of infectious bacteria that has occurred may be due to unhygienic
condition (Haque et al. 2018). The development of germs affects other organs of the body as
well. The immune system of older persons is usually very much prone to infections due to the
aging process, which in turn raises the chance of development of autoimmune disorder
because of severe damage or breakage of healthy cells of the body (Weyand and Goronzy
2016). The infectious bacteria spread the infections with the help of deeper layers of skin and
also spreading and affecting other organs with the help of blood transportation (Michael and
Shaukat 2019). The most related microorganisms that develop the condition of surgical
infection are enterococcus, Staphylococcus aureus, and coagulase-negative staphylococcus.
The redness in the affected area indicates the symptom of cellulitis, which results in the
dilation of the small blood vessels (Sullivan and de Barra 2018). The inflammatory chemical
mediators developed the symptom of fever in the body, which was 38’9 degrees centigrade in
this case. The swelling condition results in edema state of the body, which occurs due to the
accumulation of fluid in the blood vessels (Sleigh and Manna 2019).
The patient developed this state due to the accumulation of fluid in the incision site.
The pain symptom is due to the distortion of soft tissues, which is, in turn, results in an
exudation of chemical mediators such as prostaglandins, bradykinin, and serotonin. The pain
sensation is caused due to the particular threshold level, which is generally lower for the older
patient. The pathway has three neurons, such as a pseudounipolar neuron, second-order
neuron, and third-order neuron. The second-order neuron consists of cell bodies that are
present in the cranial nerves and the third-order neuron present in the stimulus-response area
of the brain (Kendroud and Hanna 2019). The condition of pus has developed due to the

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accumulation of fluid, which are basically rich in protein along with dead cells, leukocytes,
neutrophils, macrophages. The pus develops due to the body's immune response that is trying
to combat the infection (Brown and Watson 2019). The condition indicates the patient has
established septic arthritis.
Sepsis is a life-threatening condition that occurs due to infectious triggering. It is an
inflammatory reaction that results in symptoms such as hypothermia, tachypnea, tachycardia,
leucocytosis, and leukopenia. These are called response syndrome (Gyawali, Ramakrishna
and Dhamoon 2019). The condition developed due to impairment of the function of any
major organ and also due to the reason of metabolic acidosis (Burger and Schaller 2019). The
condition is mediated by the release of tumor necrosis factor, cytokines. The cytokines, in
turn, activates the cascade, especially the extrinsic pathway and inhibits the fibrinolysis. The
condition may also give rise to microvascular thrombosis with an accumulation of protein c.
The patient Cris, in this case, had a symptom of tachycardia, which was about 125beats per
minute, respiratory rate of 27 beats per minute, a higher level of WBC that was 18.4. The
lower blood pressure was due to vasodilation that has developed increased permeability,
which results in lower blood flow towards the organs resulting in organ damage and failure.
The respiratory rate was high and with spo2 is compressed due to lower passage of oxygen
into the organs, especially into the lungs leading to breathing difficulty (Chourpiliadis and
Bhardwaj 2019). The patient also had a higher level of lactate in the body, which is
5.3mmol/L, which indicates hyperlactatemia. It develops due to tissue perfusion and oxygen.
It can also result in acidosis.
Deep Vein Thrombosis
Three factors develop the condition of deep vein thrombosis. These are vascular
injury, hypercoagulability, and venous stasis. Out of these three venous stasis forms, this