NRSG 258: Principles of Nursing Surgical Care Report - Mrs. Bacci

This report presents a detailed analysis of Mrs. Bacci's case, a 49-year-old Italian woman with diabetes, PVD, and obesity, who underwent a partial foot amputation and is experiencing post-operative complications including wound dehiscence and potential infection. The report examines the pathophysiology of her condition, highlighting the impact of her health issues on wound healing, medication adherence, and peripheral circulation. It addresses key nursing priorities, emphasizing the importance of wound care, patient education, and health literacy to manage her diabetes and PVD effectively. The report further explores nursing interventions such as wound cleaning, dietary recommendations, and the significance of patient understanding and adherence to medication protocols. It also underscores the significance of health education concerning the patient's conditions and the need for a well-balanced diet to improve wound healing, while highlighting the importance of proper wound management to prevent infection and promote tissue repair, including the need for wound swabs to determine the presence of pathogens. The report aims to provide a comprehensive understanding of the nursing care required for Mrs. Bacci, considering her complex medical history and the challenges associated with her recovery.

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Nursing Care
Student’s Name
Professors Name
Institution of affiliation
Date

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Question one
The pathophysiology of Mrs. Bacci’s condition involves the formation of an Island film
covering along the incisional wound which is wet from serous exudate output. Also, the wound
bears some dehiscence along the suture line, and there is some sloughy tissue. The surrounding
skin is warm, and dark and painful to touch (Bullock, & Hales, 2019). The cause bad condition
after surgery may be as a result of low immunity of Mrs. Bacci’s body who type II diabetes,
making her immunocompromised (Su, Chang, Peng, & Chen, 2018). Type two diabetes is known
to cause a delay in healing of any wound of the body and patient with it are advised to avoid
injuries at any cost.
Mrs. Bacci reveals that sometimes she forgets to take her medication while at times she thinks
that she is not supposed to take all the medication. Her failure to adhere to doctor’s prescription
is one of the causes of the worsening state of the wound. Among the medications, she received
during discharge is paracetamol 1g QID, a drug used to relieve or kill pain in the body. In case
one of the medications she has not been taking is paracetamol, then that is why the wound is so
painful to touch (Rwegerera et al, 2018).
Mrs. Bacci has poor English which affects the understanding of the label or rather instructions
written in the drug’s packet for medication. Her forgetting and failure to take all the medication
is due to lack of understanding as well as ignorance of the consequences of failing to adhere to
doctor’s medication protocols.
The tests show that her feet and toes on her right foot are cool to touch with a capillary refill of
2-3 seconds and she states that she normally has cold feet. The coldness is due to her previous
peripheral vascular disease and obesity which interferes with blood circulation. Blood circulation

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matters are the most common causes of cold feet. The warm blood gets difficulties in reaching
extremities whereby the high cholesterol in the body of obese person forms plaques inside the
blood arteries that decreases the amount of blood reaching the feet or legs, resulting to cold.
The dehiscence of the wound leads to the production of a large amount of serous fluid which
makes the healing process of the wound more complicated. Generally, a healing wound is
supposed to have a medium amount of wetness, but an excess of it interferes with healing (Craft,
& Gordon, 2019). The cause of dehiscence is systemic because Mrs. Bacci has several health
complications apart from the surgery state.
Question two
Keeping wound clean
Ensuring that the wound is clean to prevent emergence infections is the best nursing
priority of care to Mrs. Bacci “nurses are unique kind. They have this insatiable need to care for
others, which is both their greatest strength and fatal flaw” by Dr. Jean Watson. Intermittently,
wound cleansing is needed to assist in eliminating wound debris like excess exudate, that mostly
delays healing of the wound. Mrs. Bacci has Island of film from serous exudate output, and this
is causing complication in wound healing (Brown, Edwards, Seaton, & Buckley, 2015).
Patient health literacy
The patient has wound dehiscence which is painful to touch. Her wound dehiscence is due to a
weakened immune system because she has diabetes and her skin integrity compromised. The
nurse should educate her properly concerning eating a healthy diet that helps to prevent wound

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dehiscence. Also, health education on the importance of taking medication as per doctor’s
prescription, so that wound can heal as expected with less pain (Levett-Jones, 2018).
Question three
Wound dehiscence and infection are the most common surgical wound complications.
Thus, nursing priorities of care target on dealing the two main areas. The wound cleaning assists
sterilizing the wound to prevent pathogen infections that cause diseases at the wound site. Mrs.
Bacci’s wound is dark pink and warm which may indicate the presence of infection. Wound
swabs can be taken for culture to determine the pathogen so that antibiotic therapy can be
commenced immediately (Sveen et al, 2018).
Health studies reveal that patient with peripheral vascular disease, oxygen distribution to the
tissue meet halfway — the tissues failure to acquire enough oxygen result in slower healing of
the wound. Mrs. Bacci suffers PVD disease; this explains the importance of health literacy to her
form the nurse (Lin, Xie, Yao, Dai, & Wu, 2018). She needs to be aware of the root cause of
complication so that she can be able to take it easy “Just like there’s always time for pain, there’s
always time for healing”-Jennifer Brown. Health literacy the best safe wound management
principles (Thorp, 2019).
Dietary health literacy this patient is vital to expose her on the best diet to follow to enhance
wound healing (Chakravartty et al, 2018). Research reveals that poor nutrition makes metabolic
process slow thus minimizing collagen synthesis. Low collagen synthesis leads to delayed
wound healing, resulting in complications (Forbes, & Watt, 2016). Additionally, a special diet
needed for a diabetic patient, and she requires guidance on how to feed because diabetes leads to
weak immunity thus poor wound healing. Patient health literacy is the best wound management

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care because Mrs. Bacci have many immunosuppressive disorders and if she is not aware of her
health condition well, the process will not be easy to her.

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