Case Scenario Mrs Gina Bacci is a 49year old Italian lady (with poor English) who was admitted to hospital 2 weeks ago for surgery following complications from a right foot ulcer. She underwent surgery under general anaesthetic, for partial amputation of forefoot and the great and first toes. She has a history of; Type II diabetes (diagnosed 6years ago); Peripheral vascular Disease (PVD); and Obesity (BMI 40.4m2; Height 165cm weight 110kgs). Due to her worsening diabetes she has been commenced on insulin during her admission to hospital. Gina was discharged from hospital 7days ago and has presented to the outpatient department for further wound assessment and management. She is not due to see the surgeon for her follow up post-operative appointment for another 2 weeks. Current Medications on discharge one week ago are as follows: • Novorapid TDS 12units • Lantus 30units nocte. • Pregabalin 75mg mane • Paracetamol 1g QID Mrs Bacci admits she sometimes forgets and doesn’t think she needs to take all her medications. She is mobilising with an offloading boot and walking stick. On examination her blood pressure is 120/70mmHg; Pulse 88 bpm regular; RR 18 bpm and SpO2 at 97% on RA, temp 37.8ºC Her feet and toes on her right foot are cool to touch with a capillary refill of 2-3 seconds. Mrs Bacci states that she normally has cold feet and wears bed socks. Her BGL is 12.6mmol/L. When you examine her wound you note that there is an Island film dressing along the incisional wound which is wet from serous exudate output. The wound has some dehiscence along the suture line and there is some sloughy tissue. The surrounding skin is warm, and dark pink and painful to touch. Assessment 1: Essay (1800 words) +/- 10% Considering the case study above and using the clinical reason cycle write an essay that addresses the following 3 questions. Question 1: Based on the case study, critically analyse and discuss the underlying pathophysiology and causes of the patient’s post-operative wound status. (650 words) Question 2: Identify 2 main nursing priorities of care for this patient and provide a justification and rationale for each. (350 words) Question 3: From your identified priorities, outline and justify the appropriate and safe nursing management of the patient during this time. (600 Words) [Hints:] The word limits for each question are a guide and gives you an idea of the weighting of discussion required, plus allows for approximately 100words for an introduction and 100words for a conclusion. In order to justify and rationalise your nursing priorities and nursing management strategies, you need to link your discussion specifically to both the case study, and academic literature in answering each question. Specific Guidance for the Case Study Please review the marking rubric before you commence your essay. Your assignment is to follow an essay format. Please use either Times New Roman size 12 font or Arial size 11 font. Your assignment must be double spaced to enable the marker to provide in text comments and feedback for you. Answer the three (3) questions included in your case study, using the following Stages from the Clinical Reasoning Cycle as a frame work to guide your discussion and analysis. Question 1: Step 1 - 3 of CRC Question 2: Step 4 and 5 of CRC Question 3: Step 6 and 7 of CRC Provide an introduction to the case study – what are you going to discuss. Write the introduction last after you know what you have discussed. You will also need to included a conclusion as this forms a summary of the key points of what you have discussed. No new information should be included in the conclusion.

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