Post-Operative Inguinal Hernia Repair
The clinical reasoning cycle framework is used while treating patients through various stages. The stages include collecting the cues, process the information, understand the problem, develop interventions, evaluate the outcome and learn from it (Arita et al., 2015). In the case of Mr. Peter Ling, a 67-year-old he has various conditions that should be considered in the delivery of post-operative care. The patient previously had open mesh inguinal hernia repair but he now requires post-operative care. The purpose of the post-operative care is to ensure the condition does not deteriorate and that the inguinal hernia is treated successfully.
The Situation
Considering the condition of the patient is the first stage in the clinical reasoning cycle. In this case, the patient had been presented to ED with non-reducible tender and inguinal mass after commencing a weight lifting trend. The patient is retired from active service and lives with his wife. He is an ex-smoker who is currently taking medication for hypotension and hyperlipidemia. The two conditions are well controlled by taking medication. The patient is also suffering from mild Congestive Heart Failure (CHF). He is obese and his body mass index (BMI) of 30. The high BMI shows that the patient is likely to suffer from other health problems (Cai, Foster, Kethman, Weiser & Forrester, 2018). He is a former weight lifter which complicates the situation about obesity and congestive heart failure.
The patient was recovering well after the operation to repair an inguinal hernia. However after 2 days he started experiencing some complications such as calf pain, agitation, and confusion. The vital signs indicate that there is need for post-operative care to prevent severe complications (Berger, 2016). The situation of the patient also shows he has a high temperature of 39.3oC and Respiratory Rate of 25. The pain score is 7/10 while the Glasgow Coma Score (GCS) is 14/15. The patient is also restless as well as confused about time and place. The post-operative is oozing a green purulent discharge. The left calf is larger compared to the right one and it is red and warm.
Collect, Process and Present
The related health information of the patient shows that he has been exposed to various situations such as weight lifting which can complicate his condition. Weight lifting could be one of the reasons why the patient develops complications after the surgery. The reason is when the muscles are stretched they are likely to develop some problems such as calf pain (Arita et al., 2015). The patient is also on medication for hypertension and hyperlipidemia. The two conditions can also interfere with the healing process after the operation. The patient post-operative treatment could also be negatively affected by congestive heart failure.
The patient has abnormal conditions such as the respiratory rate which is 25 per minute. A healthy adult should have a respiratory rate of 12-20 per minute. Therefore, the high respiratory rate shows there are internal problems that could undermine post-operative care (Bueno-Lledó et al., 2017). One of the causes is blood clots which could have formed during the surgery. Additionally, the patient is under severe pain which restricts him to carry out activities of daily living (ADLs) (Cai, Foster, Kethman, Weiser & Forrester, 2018). The pain score of 7/10 shows that it is disabling. Therefore, the patient requires immediate care to counter the complications which could affect the recovery after inguinal hernia repair.
Three Nursing Problems
The cleaning reasoning cycle involves identifying the problem by synthesizing the facts about a patient. Identification of a problem is important since it helps in making a definitive diagnosis of the problem (Frydenlund & Ramaswamy, 2019). In the current case study, identification of the three nursing problems is essential in clear diagnosis that will help the patient to recover successfully. The first nursing problem is that the patient has developed complications in the process recovering after inguinal hernia repair (Gause et al., 2017). The second nursing problem is calf pain which is accompanied by agitation, restlessness, and confusion. The patient does not know the place and time thus showing the severity of the condition.
The third nursing problem is high temperature and the high respiratory rate which are vital signs of an underlying problem. The temperature is 39.3oC while the respiratory rate is 25. For example, although fever is considered normal after an inguinal hernia repair surgery, it should not be experienced after 48 hours (Hunter & Arthur, 2016). Therefore, because the 48 hours have already elapsed, it is possible to conclude that there is an underlying problem. The respiratory rate is also high which could be due to hypertension although it is well-managed (Jacobsen & Reynolds, 2018). The nursing problems are essential in developing the right diagnosis for the patient for successful recovery.
Goals for Priority of Nursing Care
The nursing goals according to the clinical reasoning cycle helps a nurse to identify the interventions to be undertaken within a specified time period. When the goals are clear the treatment can be efficient in improving the health and well-being of a patient (Koivisto, Multisilta, Niemi, Katajisto & Eriksson, 2016). The nursing goals are essential in providing the best treatment based on accurate diagnosis. The first nursing problem is complications after the inguinal hernia repair. The goal is to assess the patient to find out the underlying problem that could be interfering with the smooth recovery (Kolachalam et al., 2018). The assessment will be done on the wound that has a discharge to identify the problem.
The patient is also experiencing restlessness, agitation, and confusion which are the signs and symptoms of an underlying problem. The goal is to provide the patient with medication that would stabilize them despite the pain and complications (Koning et al., 2017). High temperature could also because of restlessness. Therefore, it is important to administer drugs that will lower the body temperature of the patient. Another set of drugs should be administered to lower the respiratory rate. The interventions should be accomplished with a few minutes or hours upon admission of the patient (Melkemichel, Bringman & Widhe, 2019). The patient should be put under watch for a period of time to assess the changes that occur.
Nursing care
The nursing care of the patient will also involve taking care of them based on medical history. For example, the patient has hypertension and hyperlipidemia which should be managed to avoid interfering with the treatment of other conditions (Olsson et al., 2017). The medical history also shows that the patient is an ex-smoker who could have been exposed to various risks such as blood clots or constricted blood vessels (Patterson, Beck, Currie, Spence & Spence, 2019). For example, it is important to assess the blood vessels of the patient to ensure they are functioning normally. The treatment process will take care of the problems the patient could be experiencing as a result of their history.
The nursing care is also considerate that the patient is obese. The condition should be monitored through interventions meant to reduce weight. For example, nursing care can recommend a diet that will be helpful to the patient to reduce weight (Pochhammer, Lang, Scuffi, Schäffer & Smaxwil, 2017). Another nursing care intervention involves preventing congestive heart failure from becoming worse. The nurse should also administer drugs that will enhance the performance of the heart (Ramshaw & Chiu, 2018). The patient is also an ex-weight lifter who might have strained the muscles and nerves by lifting heavyweights. Nursing care interventions should ensure the patient is taken care of based on their current and past medical history.
Nursing Care Strategies
Nursing care strategies will involve interventions that cab justifies nursing care. One of the strategies is to administer diuretics to relieve dyspnea. The purpose is to eliminate fluid congestion in the lower limbs (Vad, Frost, Rosenberg, Andersen & Svendsen, 2017). Another nursing care strategy is to involve the family in the treatment process especially in managing hypertension. The family and the patient should be educated about the lifestyle changes they should adopt to live a healthy life (Gupta, Mazari, Samuel & Balchandra, 2017). On the issue of hyperlipidemia, it is important to provide a healthy diet for the patient to reduce the amount of cholesterol in the body (Wakasugi et al., 2019). For example, the patient should be advised to limit intake of saturated fat.
Nursing care strategies will also focus on the wound that has a discharge. It is important for the patient to take sponge births in the first few days until the wound is dry (Yazdani, Hosseinzadeh & Hosseini, 2017). The patient should also take specific food which will not strength the hernia. For example, it is not advisable to take food with high fiber content. It is also crucial to avoid exercises that stretch the muscles since it may lead to the rapture of the surgical site. All the nursing care strategies will be aimed at improving the quality of care and the health of the patient.
Outcome
The clinical reasoning cycle involves reflecting on, assessing the treatment procedures and identifying the lessons learned in the course of handling the patient. The outcome of the nursing care administered to the patient produces better results such as stabilizing the patient. Medication provided was essential in reducing the high temperature and thus reducing restlessness and agitation. However, the severe pain that had a 7/10 score was reduced significantly, but after a period of time. The reason is that the pain was caused by various factors such as complications after the inguinal hernia surgery.
The lessons learned are important in improving the quality of care in subsequent treatment procedures. For example, the patient should have been advised about the specific lifestyle to adopt after the surgery to prevent complications. It was also advisable to keep the patient in the hospital for further checkups (Arita et al., 2015). The nurses could also have administered medication to treat the specific medical history such as hypertension. It is also important to take precautions while operating on a patient who is an ex-smoker, ex-weight lifter and obese (Vad, Frost, Rosenberg, Andersen & Svendsen, 2017). The reason is that the complications that can emerge in such a patient are worse compared to normal patients with normal weight and no smoking history.
Conclusion
Mr. Peter Ling has requires nursing care strategies that will enhance the condition and reduce the complications. It is important to follow the clinical reasoning cycle since it provides the best step-by-step analysis of a patient’s condition. The analysis has demonstrated that various medical procedures need to be carried out and drugs administered to improve the well-being of the patient. The lessons learned during the analysis is that more precaution could have been taken while operating on an ex-smoker, ex-weight lifter, and obese person. The postoperative inguinal hernia repair treatment should be carried out to improve the condition of the patient.
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