NRSG258 Principles of Nursing: Case Study of Mrs. Gina Bacci's Wound

This case study analyzes the post-operative wound condition of Mrs. Gina Bacci, a 49-year-old Italian woman with diabetes and a history of a foot ulcer. The analysis begins by identifying the underlying pathophysiology of the wound, which includes signs of infection like redness, swelling, and dehiscence. Two primary nursing priorities are established: effective wound management and addressing the patient's diabetes and obesity. The case study then details appropriate and safe nursing management strategies, including patient education on wound care, hygiene, and medication adherence, along with interventions for diet, nutritional regime and blood glucose control. The ultimate goal is to improve the patient's wound condition and overall quality of life by accelerating recovery and preventing further complications. The study emphasizes the importance of a holistic approach to patient care, integrating both medical and lifestyle interventions.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS (GINA BACCI)
Name of the student
Name of the university
Author note

1CASE STUDY ANALYSIS
Introduction
While providing care to the patients suffering from post operative healthcare
complications, the primary focus of the healthcare process should be on the observation,
evaluation, diagnosis and application of effective healthcare interventions so that effective care
could be provided (American Diabetes Association, 2015). Through this case study analysis, the
post- operative condition of Mrs. Gina Bacci’s wound would be described as she is suffering
from the risk factor related to wound infection. The paper would commence with identification
of underlying pathophysiology of the patients wound and then two nursing management
priorities would be selected so that wound management could be addressed. Finally, nursing
management and handling strategies would be provided to improve the patients wound condition
improvement.
Associated pathophysiology of the wound status observed in Gina Bacci
The case study provides a detail of an Italian woman Mrs. Gina Bacci (49) who suffered
from diabetic foot ulcer and as an intervention, she was provided with partial amputation of
forefoot 2 weeks ago. However, after she discharged from the healthcare facility, the
complication regarding her wound condition worsened. She visited the outpatient service of the
healthcare facility, where after detailed vigilance and observation, observed with severe risk of
wound infection. The wound of the patient appeared dark pink in color, with swollen and tight
incision area and the wound appeared warm and painful to touch. As per Alavi et al. (2014),
these are the sign sof immunological reactions that occurs in the wound incision site.
Immunological reactions progresses in three steps such as inflammation, proliferation and
maturation. The phase of inflammation is associated with redness and swelling and this indicated

2CASE STUDY ANALYSIS
that the human immune system is associated with human immune system and in this phase the
immunological cells such as macrophages, white and red blood cells starts moving towards the
incision site. Further, fibrin protein also starts accumulating towards the wound due to which the
redness, swelling and other general signs occur. Therefore, depending on the immunological
reactions, if the wound appears red and warm, the wound is undergoing healing and recovery
that would help the wound to overcome the condition (Baltzis, Eleftheriadou & Veves, 2014).
However, in the case study of Mr. Bacci, it was observed that her sutures are broken and
dehiscence has appeared due to which the wound appears exposed and the sloughy tissue
appeared. Therefore, this was the risk of severe wound infection as the wound was open and
exposed to the environmental conditions (Bertesteanu et al., 2014). As per Noor, Zubair and
Ahmad (2015), there are several reasons due to which the wound suture may appear broken or
disrupted and the mechanical error during surgery could the primary reason for this. As the
patient showed tight appearance, and the dehiscence appeared, it shows that the suture of her
wound has extremely tight that broke due to the mechanical pressure exerted by the patient
during physiological activities such as sneezing, coughing, bowel activities and others.
Moreover, besides the physiological reasons, the appearance of dehiscence could also
occur due to the bacterial or viral infection as researchers mentioned that patients who are
nutritionally lacking or are unable to fulfill the cleanliness or hygiene of the wound, suffer from
bacterial infection in their post- operative wound status and hence, indicated towards the high
risk factor that the patient was suffering from (Baltzis, Eleftheriadou & Veves, 2014). The
patient’s wound was filled with serous exudates due to which the incision line was completely
damp. As per Noor, Zubair and Ahmad (2015) serous exudates are effective in making patient’s
wound recover effectively by increasing the amount of immunological cell movement around the

3CASE STUDY ANALYSIS
wound as this the immunological reaction of the human body to overcome harmful wound
condition. However, in the case study of Mrs. Bacci, it was observed that she is unable to
maintain hygiene and cleanliness of the wound area and hence, excess amount of exudates filled
with bacterial and environmental pollutants could increase the bacterial and chemical
contamination of the wound, thereby affecting the health status of the wound (Alavi et al., 2014).
Further, the patient developed pain around her wound, because the wound area raises the
inflammation severely upon facing the risk of wound infection due to which the surrounding
tissues started releasing wound management enzymes and free radicals. This increased the
feeling related to pain around the wound as the body started the mechanism of prote3cting the
wound from external and internal infections (Yazdanpanah, Nasiri & Adarvishi, 2015).
These two phases indicated towards the inflammation and proliferation of the wound.
However, in maturation phase as well, wound becomes prone to infection as the cellularity of the
wound increases if the wound is kept clean and hygienic however, in case of Gina Bacci, she
was unable to maintain these two critical aspects of her wound and hence, the chances of her
wound being infected with her normal micro flora increases (Noor, Zubair & Ahmad, 2015).
Therefore, these are the possible associated pathophysiology of the wound condition described in
case study of Mrs. Gina Bacci.
Identification of two nursing priorities and justification
As the patient was suffering from increased risk factor associated with Wound infection
and appearance of dehiscence, her care plan would include wound management and it would be
the primary priority of her physiological condition. As per this priority, she would be provided
with proper wound management and handling technique so that the wound of the patient could

4CASE STUDY ANALYSIS
be accelerated for quick healing and recovery technique (Yazdanpanah, Nasiri & Adarvishi,
2015). This is an important aspect for management of wound infection as aseptic techniques of
the wound management process decreases the spreading of infection and pathogens in the wound
or around the surgical site. Further, the patient would be provided with hygiene and cleanliness
techniques so that while complying with the wound management techniques, she could
effectively maintain the hygiene condition of her post- operative wound (Guffanti, 2014).
As per the case study, the patient is suffering from prolonged diabetes and her weight is
extremely high, as per her height and age. This could be another reason due to which the
recovery of her wound delayed. Further, it was also provided in the researches that people with
excessive weight exert high pressure on their wound or incision site due to which the sutures
break and the wound becomes exposed to chemical and bacterial infection from the environment
(Phillips et al., 2016). Hence, depending on these facts and signs, the second nursing priority for
the management of Mrs. Bacci’s health condition would be reducing her weight and excessive
blood glucose level. This would help to accelerate the recovery of her post- operative wound and
she would be able to maintain health and hygiene of her wound site as her quality of life would
be improved (Avishai, Yeghiazaryan & Golubnitschaja, 2017). Further she would also be
provided with diet and nutritional management intervention so that her calorie consumption and
caloric output could be controlled (Yazdanpanah, Nasiri & Adarvishi, 2015). As per Guffanti
(2014), patients with diabetes and excessive blood glucose level are unable to heal their wounds
effectively as the excess blood glucose level inhibits or hinders the rapid recovery of the wound.
Hence, it should be included in the nursing intervention so that the care priority of the Mrs. Bacci
could be developed and the care plan for healthcare development could be developed.
Appropriate and safe nursing management

5CASE STUDY ANALYSIS
As per the first care priority of Mrs. Gina Bacci, she would be provided with intervention
of healthcare literacy and training. As the patient came in the outpatient service and has already
been discharged from the healthcare facility, she would be provided with education related to
asepsis dressing change and wound care processes (Phillips et al., 2016). This would help her to
conduct the wound management and dressing change techniques at her home with or without the
support of medical healthcare professionals and she would be able to understand the importance
of proper management and dressing change of her wound so that bacterial and environmental
infection could be eliminated. As per Serra et al. (2015), health literacy and patient education are
important and crucial healthcare processes due to which patients develop ideas and
understanding about the healthcare interventions they goes through and provided complete
support to the healthcare professionals to overcome their healthcare condition. Therefore, the
efficiency of the interventions in increasing the wound healing process increases. Further, as per
the NMBA guidelines, including patients in the care intervention increases their and the care
professionals interpersonal communication and they would be able to overcome the healthcare
condition effectively. Hence, as per Powers et al. (2017), Mrs. Gina Bacci would be provided
with healthcare education related to her wound management, dressing change, cleaning of
sutures and serous exudates so that patients could be provided with healthcare education and she
could also practice these actions at her home to overcome the risk related to wound infection.
The second nursing priority of Gina Bacci is her prolonged diabetes and associated high
blood glucose level and resultant obesity. The case study mentioned that the patient has blood
glucose level 12mmol/L and her weight was 110 kg. Whereas as per American Diabetes
Association (2015), the ideal weight of a 49 year old fit woman should range between 55 to 65
kg with 5mmol/L. Therefore, this was one of the primary reasons for the healthcare complication

6CASE STUDY ANALYSIS
of the wound infection. As per Kushner (2014), the excessive sugar level or diabetes could
hinder the wound healing process as it blocks the nerve endings due to which the blood and other
immunological cells are able to understand the surgical site require inflammation and other
preventive reactions (Mitanchez et al., 2015). Hence, it makes the recovery delayed and hence,
the diabetes management should be managed in case of diabetes and blood glucose levels. To
manage the healthcare conditions, it should be mentioned that diet and nutritional regime could
be one of the critical intervention that could effectively reduce the blood glucose level of the
patient (Bray et al., 2016). From the diet of the patient, all the carbohydrate containing food
products would be eliminated and would be replaced with fat and proteins that would accelerate
the immunological reactions and effectively decrease the blood glucose levels further, the
immune system wound also become responsive after decreasing the rate of carbohydrate.
Besides this, the patient would be educated for her diet and nutritional regime and would be
asked to drink plenty of water so that all the accumulated toxins in her body could be eliminated
(Kushner, 2014). Therefore, through the wound management, dressing change, suture education,
hygiene measures, weight management, diet change, and blood glucose reducing interventions,
healthcare professionals would target to achieve improved wound condition and accelerated
recovery of the wound (Bray et al., 2016).
Conclusion
This case study discussed about the wound condition of Mrs. Bacci and discussed the
pathophysiology that makes the patient suffer from the risk of wound infection, after she
undergoes the amputation of her front foot. Therefore a detailed pathophysiology, mentioning the
reason due to which her wound condition affected was mentioned. After this, two nursing
management priorities were determined so that the wound condition of the patient could be

7CASE STUDY ANALYSIS
improved and her quality of life could be improved. To achieve this, the interventions related to
patient education, for her wound management and weight management with diet and nutritional
shift was included in the case study analysis.

8CASE STUDY ANALYSIS
References
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R. S. (2014). Diabetic foot ulcers: Part I. Pathophysiology and prevention. Journal of the
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Avishai, E., Yeghiazaryan, K., & Golubnitschaja, O. (2017). Impaired wound healing: facts and
hypotheses for multi-professional considerations in predictive, preventive and personalised
medicine. EPMA Journal, 8(1), 23-33.DOI: https://doi.org/10.1007/s13167-017-0081-y
Baltzis, D., Eleftheriadou, I., & Veves, A. (2014). Pathogenesis and treatment of impaired wound
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Guffanti, A. (2014). Negative pressure wound therapy in the treatment of diabetic foot ulcers: a
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