Healthcare Case Study: Analysis of Mrs. Bacci's Post-Op Wound Issues

This case study focuses on Mrs. Gina Bacci, an Italian lady who underwent surgery for a right foot ulcer complicated by type II diabetes, PVD, and obesity. The assignment analyzes the pathophysiology of her post-operative wound status, emphasizing dehiscence due to improper wound closure and the impact of her medical conditions. It identifies two main nursing priorities: wound care and managing immediate threats, with justifications for each. The study details appropriate and safe nursing management strategies, including proper wound cleaning, sterile closure techniques, and appropriate dressing changes like the Island film dressing, to prevent complications. The conclusion highlights the importance of adhering to safe nursing management to prevent issues such as dehiscence and infection, emphasizing the need for meticulous post-operative care for patients with similar health profiles.

CASE STUDY

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Analyse and discuss underlying pathophysiology and causes of patient's post-operative wound
status............................................................................................................................................3
Two main nursing priorities of care for the patient with justification........................................4
Appropriate and safe nursing management of the patient for this case study.............................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Pathophysiology can be defined as disordered psychological process that is mainly
associated with any kind of wound, disease or injury which can further cause any kind of
infection or further problems. It is important to perform complete psychological process in better
way so that further complications can be decreased (Wang, & Bellomo, 2017). This case study is
about an Italian lady Mrs. Gina Bacci who underwent a surgery because of some complications
from a fight foot ulcer. However, even after surgery she had not recovered perfectly. So in this
case study Pathophysiology and patients post operative wound status will be analysed. This case
study will also lay emphasis on nursing priorities and safe nursing management of the patient in
details.
MAIN BODY
Analyse and discuss underlying pathophysiology and causes of patient's post-operative wound
status
Mrs Gina Bacci had a cold feed with pain and painful wounded area because her wounds
were not stitched or closed properly she had dehiscence while dressing was done on the wounds
and due to her type two diabetes her wounds were not able to heal properly and on the upper
hand she was asked to weal offloading boots which kept her foot closed (Bloomer, & et.al.,
2015). All these reasons together made her feet wounds area wet, painful with pinkish skin.
Here her complete details are explained and discussed in details.
In this case study, Mrs. Gina Bacci was admitted to the hospital for surgery due to the
complications in right foot ulcer. And underwent surgery for the same. However, before the
surgery her medical conditions and history was seen and research and accordingly she was
admitted and given the treatment before and at the time of surgery. She was a type II diabetes
patient which was diagnosed six years ago, she suffered from PVD i.e. peripheral vascular
disease, she also suffered from obesity with BMI 40.4 mm (calculated with the help of her height
which was 165 cm and weight which was 110 Kg), which was way too much. Due to all such
reasons but mostly one of them was the main area of concern which was her diabetes and as a
result she was admitted to the hospital with the commencement of insulins (Verma, Patil, &
Bhardwaj, 2018). After her surgery she was not supposed to see her surgeon for at least 2 weeks
and was given certain medicines which were: Novorapid TDS 12 Units, Lantus 30 unites nocte,
pregabalin 75 mg mane, Paracetamol 1 g QID. Also after her surgery she was asked to wear

offloading boots and walking sticks (Czerwonko, & et.al., 2018). After two weeks when she was
examined and medical records were updated she had good blood pressure which was 120/70 mg
(normal blood pressure 120/80 mg), Pulse rate was also normal which was 88 bpm (normal 60 to
100 bpm), RR was also normal which was 18 bpm (normal 12 to 20), normal SpO, which was
97% ( normal 95% to 100%) and normal body temperature which was 37.8>C. However, her feet
were cold to touch with capillary refill of 2 to 3 seconds. After examining her wounds it was
observed that one her wounds island film dressing was done in such a way that her skin suffered
serous exudate output which is some kind of tissue damage and as a result her wounds were still
wet. As a result her skin around her wounds was warm, light pink in colour and painful to touch.
Because of this reason her feet were always cold and painful to touch (Sturm, R. & et.al., 2017).
After examining and analysing the post surgery wounds it was observed that the main
cause of her present wound condition was that her dressing was not done in a proper manner
because her wounds were closed in such a way that her wounds had some dehiscence as a result
her internal skin tissues of her wound area were damaged which caused the wound to remain wet
. Due to this factor her wounds were painful and she had a cold foot.
Wound healing is a complex process which consist of three stages which are:
inflammatory reaction, tissue restoration and tissue remodelling (Hochman, & Asch, S. M.,
2017). If this wound healing is needed to be done properly then there is a need to stitch the
wounds in a clean way without any dehiscence and proper dressing. This will help in faster
healing of wounds. Similarly, if the wounds are not stitched properly as well as not dressed
properly then it can cause sever problems in fact can damage the tissues near the wounded part.
Two main nursing priorities of care for the patient with justification
There are various kinds of nursing priorities of care that can be used for this patient
which will help in eliminating all the issues that can occur post medical or operational treatment.
Sometimes small mistakes in nursing can become life threatening problem for patients can be a
challenge to be cured. Nursing priorities according to the case study taken for this patient is
wound care and managing the immediate threats.
Wound Care: According to this mostly varies from the type of dressing that has been chosen. In
this method also type of wound is examined i.e. if the wound is of burned patient then it will be
needing semi-open method. If the wound is of operation then open method will be chosen where
pain loss of heat, fluid and electrolytes is considered (Jakimowicz, & Perry, 2015). In this case of

Mrs Bacci open method of nursing care should be chosen as she is suffering from heat loss,
painful to touch and is completely wet. So by using open method of wound care her post
operation can be solved.
Manage immediate threats: First and the foremost nursing priority of care for the patient is to
manage immediate threats. There are various kinds of assessments or treatment that are needed
to be priorities in a significant way so that any kind of further risk, injury, infection can be
eliminated or removed. Complete wounded area should be inspected and should be seen that
whether any other kid of wound is not present nearby the wounded, injured or operational area or
somewhere else. After this type of wound or injury should be identified and accordingly it should
be handled orc dressing should be done (Qiao, Y.& et.al., 2015). In this case Mrs. Bacci's
wounds were dressed with Island film dressing which is mostly applied post operation but it
should be changed more often. But in case of Mrs. Bacci she didn't change the dressing for two
weeks which damaged the kind and made the wounds wet. So, first priority is to identify the type
of wound and accordingly dressing should be done so that further threats can be minimised.
Appropriate and safe nursing management of the patient for this case study
Nursing management of this type of patients need surgical wound nursing management.
It is done in few stages and at each stage proper procedure is followed such that wounds of the
patients are healed properly (Khoury, & et.al., 2018). Safe nursing management is very important
especially in case of surgical wound nursing management as in this if the wounds are not closed
properly or if dressing is not done properly then it might care some serious issues afterwords or
can damage any tissue. So it is important to know proper and safe nursing management for the
patients. Life in the above case study if the wounds were closed properly then no such problem
would have occurred.
Safe and appropriate nursing management for such patients can be done by: firstly post
operative wounds should be taken care of properly i.e. before closing any wound it should be
cleaned properly. After cleaning proper healing method should be chosen i.e. it should be closed
in a proper manner (Lavin, Harper, & Barr, 2015). It should be done in such a way that there is
no place for any kind of bacterial invasion. It should be done in such a way not part of the wound
is open or is in contact with the outer part. After cleaning dressing of surgical wounds is done. In
this type of dressing is chosen according to the wound and is based on the cost of the surgery and
personal preferences. The main primary function of wound dressing is to provide a moist

environment in order to protect wound from harmful agents or any kind of further injury.
According to the chosen dressing it should be changed in a fixed time interval such as Island film
dressing, the dressing should be changed in a fixed interval of time so that any kind of infection
can be avoided (Lekas, & et.al., 2016).
After this surgical wound complications should be checked in a fixed interval of time. It
is of two types first is dehiscence where a part of wounded skin is remained open due to which
tissue damage or internal layer damage can be done. This mainly happens in case of diabetes,
obesity, smoking etc. In such case wound should be cleaned again and closed properly. Another
complication is infection in which due to some problems' redness, pain swelling problem occurs.
All these steps should be followed properly so that proper nursing management of surgical
wounds can be done (Meeker & et.al., 2016).
In this case Post operative wounds were not treated properly and dressing was also not
done properly. Due to which surgical wound complication arised (dehiscence). It got worsen
because of type II diabetes and obesity and as a result her wounds were wet, skin area became
sensitive and pink in colour caused pain when touched. This would not have occurred if proper
and appropriate nursing management of the patient's surgical wounds was done.
CONCLUSION
From the above assignment it has been concluded that Mrs. Bacci's had to undergo a
surgery due to the complications in right foot ulcer. Before undergoing the surgery her medical
history was checked and she was suffering from type II diabetes patient, PVD, obesity with BMI
40.4 mm. As a result she was given her insulin while she was admitted in the hospital. Post her
surgery her wounds were closed but some complications arised as it was not closed properly she
had dehiscence. Due to this her wounds were wet, wounded skin area was sensitive, pink in
colour and painful at touch ever after 2 weeks of the surgery. In this case study patients post
operation wound status are discussed, main nursing priorities for Mrs Bacci are discussed and
lastly for this safe nursing management of the patient is also discussed.

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