Clinical Reasoning Cycle

This paper uses the clinical reasoning cycle to address the case of Mr. Peter Ling provided. It considers Mr. Peter Ling situation, collects and processes the health data provided in the case then determines and three main issues presented in his health assessment data. The paper establishes goals for the priority of nursing care, which is linked to the identified issues. Furthermore, the paper discusses the nursing care of the patient and evaluates some of the nursing care strategies that can be used for quality outcome of Mr. Peter Ling.

Running head: CLINICAL REASONING CYCLE 1
Clinical Reasoning Cycle
Name of Author
Institution of Affiliation
Date of Submission

CLINICAL REASONING CYCLE 2
Clinical Reasoning Cycle
1. Introduction
The paper uses the clinical reasoning cycle to address the case of Mr. Peter Ling
provided. Clinical reasoning cycle involves the approach by which health care specialists collect
important data, process in order to determine the issue of the patient, and come up with the
solution or plan (Forsberg, et al., 2014). The paper considers Mr. Peter Ling situation, collects
and processes the health data provided in the case then determines and three main issues
presented in his health assessment data. Besides, the paper establishes goals for the priority of
nursing care, which is linked to the identified issues (Hunter & Arthur, 2016). Furthermore, the
paper discusses the nursing care of the patient and evaluates some of the nursing care strategies
that can be used for quality outcome of Mr. Peter Ling.
a) Consideration of facts from Mr Peter’s health condition
The paper considered the case of Mr. Peter Ling, a 67-year-old man who is admitted to
the surgical ward. The admission comes after his mesh inguinal hernia repair. Mr. Peter is
admitted with a 6-hour history of inguinal mass and reducible tender. As per Mr. Peter’s
condition, a nurse needs to collect and his past medical history, assess the patient’s temperature
and pressure. Besides, the physical assessments of the client will be critical as it will provide
directions of nursing goals and interventions.
b) Collection of information
The types of information collected from the patient include his medical history, his
current presenting health issues, and his physical examination. The patient is currently
complaining of significant left calf pain, having feelings of agitation and confused after two days
of open mesh inguinal hernia repair. The health conditions started after commencing a weight

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lifting regime. According to the patient’s medical history, Mr. Ling is retired, lives with his
family, and is an ex-smoker with a BMI of 30. The patient is currently on taking drugs for the
management of heart related disorders such as hypertension and hyperlipidemia, the conditions
that are well controlled.
The results from the assessments of the patient indicate that the patient has a temperature
of 39.3, RR: 25, HR:100 regular, SpO2 95% on room air (R/A), BP: 170/90, Pain score 7/10
(wound site and left calf), GCS 14/15. The physical assessment of Mr. Ling indicates that he is
restless and confused to time and place. Besides, the physical examination indicates that Mr.
Ling’s chest is clear, dry skin; post-op surgical wound dressing is oozing green purulent
discharge and tender to touch. His left calf appears larger than the right, and it is red, and warm
to touch. Furthermore, the patients' hemoglobin is 16.5 gm/dl, and the blood cell count indicates
that the patient has white blood cell count, neutrophils, and CRP all elevated. All this
information will be important in determining the health issues that Mr. Peter Ling is facing.
Besides, the information will be important for the nurse to determine effective interventions for a
quality outcome.
c) Processing gathered information
The patient’s present signs are left calf pain, feelings of agitation, and confused. This is
after two days of open mesh inguinal hernia repair. The signs can be as a result of complications
of inguinal hernia repair, which can take one month for a patient to recover. Sometimes recovery
can take a one year depending on the patient’s condition. The other current presenting issue that
has been noted is inguinal mass and R non-reducible tender. A bulge in the inguinal canal can
confirm the hernia. A hernia can be identified as a non- reducible. The acute incarceration can

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present with some pain which can commonly be felt in the overlying skin (Francis & Fitzpatrick,
2013).
The other important information is the body mass index which is used as a screening tool
to determine overweight or obesity of a patient. In this case, Mr. Peter’s BMI is 30, which
indicate that his BMI is abnormal as it falls within the range of overweight. The normal body
mass index falls within the range of 18.5 to 25 (Meissner et al., 2015).
The abnormal BMI of Peter is 30, which fall within the obese range. This indicates that
Mr. Peter has health issues of obesity which falls within class one. As per the case, Mr. Peter is
currently on medication for hypertension, hyperlipidemia besides having mild congestive heart
failure. The medications for these health conditions means that Mr. Peter is also having
hypertension, hyperlipidemia, and is experiencing congestive heart failure, which both are
considered to be the risk factors for cardiovascular complications. Hypertension is linked to high
blood pressure and high cholesterol content in the blood (Fung et al., 2011).
The physical examination of the patient indicates that he has a temperature of 39.3. The
temperature reading of 39.3 is high, thus abnormal. The high or elevated temperature might be as
a result of a virus or bacterial infection (Foronda et al., 2014). The normal body temperature
should range from 37 degrees Celsius.
The number of hearts per unit time also referred to as pulse of the client indicates that is
within the range of 100 regular, which is normal as the normal rate ranges from 60 to 100. The
physical assessment of the client also indicates that his SpO2 is 95 percent, which in this case is
normal as the normal ranges from 95 percent to 100 percent. The blood pressure results of
170/90 indicate the patient has high pressure. The client’s pain score of 7/10 indicates his pain is
severe, thus needs more attention. Furthermore, the Glasgow Coma Scale (GCS), which

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describes the level of consciousness for the client is 14/15, which indicates that the client has a
mild injury (Glowacki, 2015).
The blood test results of the patient show hemoglobin are 16.5 gm/dl, which in this case
is within the normal range. The results of white blood cell count, neutrophil, and CRP is
elevated. Elevated white blood cells may indicate that the body’s immune system is trying to
fight or destroy an infection (Sanders & Waydia, 2014). Also, the elevated neutrophils indicate a
sign of body infection and increased levels of CRP indicate there’s inflammation in the arteries
of the heart, thus a high risk of a heart attack. Furthermore, the red and warm appearing on the
left calf to touch of the client may be as a result of swelling, which may result due to deep
venous thrombosis. The respiratory rate (RR) of the client is 25, which is within the range of
abnormal. The normal respiratory rate of a person should range from 12 to 20 and under 12 or
over 25/m is considered abnormal as in this case of Mr. Peter Ling (Tolver, Rosenberg &
Bisgaard, 2012).
d) Identify the problem
1) Pain due to Post-operative inguinal hernia repair
2). Risks of cardiovascular or heart disease due to high cholesterol content (Ouaïssi, et al., 2012)
3) Obesity due to lack of good diet and exercise
e) Establish goals
 One of the goals is to stop or lower the pain, which is as a result of his post-operative
inguinal hernia repair that was done two days before his hospital admission.
 The other goal is to reduce the risks of his cardiovascular disease
 The third goal will be to reduce his obesity.

CLINICAL REASONING CYCLE 6
f) Take action A
In order to lower or stop the pain that the patient is experiencing as a result
of postoperative inguinal hernia repair, I will be required to act and undertake measures
accordingly. One of the nursing interventions that I will undertake is to him analgesics as
required. Analgesics medications will be important in managing Mr. Peter’s postoperative pain.
Injectable analgesics drug such as non-steroidal anti-inflammatory drugs like diclofenac will
play a key role in relieving the pain (Tolver, Rosenberg & Bisgaard, 2012). Besides, I will
provide the client with postoperative care by encouraging him to do some exercise and advising
him to avoid stress and feel comfortable as the condition will be cured for the time being.
A cardiovascular disorder refers to the health condition that constitutes the heart and the
blood vessels as a result of atherosclerosis. To reduce the risk of cardiovascular disorders of the
patient, the interventions that I will undertake will include encouraging the client to do physical
activity and exercise as required, providing him with an effective diet plan that will help reduce
the risk and advising him not to move back to smoking as smoking. Besides, maintain his blood
pressure to the acceptable range and encourage him to participate in tasks that can lower the
blood pressure (Elliott & Coventry, 2012).
Overweight and obesity contribute a lot to one’s health by increasing the chances of
disorders such as coronary heart illnesses, diabetes, and stroke. Mr. Peter’s obesity should be
looked at and intervened. As a nurse, interventions that I will undertake in order to reduce the
obesity level of the patient provided in the case will be to carry out and review the patient’s daily
food intake and formulate an eating plan with the client. The formulation of the diet plan will be
based on the client’s age and BMI. Besides, I will educate the patient by emphasizing on the

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significance of avoiding diets that are rich in fats. Furthermore, I will administer drugs appetite
suppressants drugs such as diethylpropion and Sibutramine that can help in lowering his obesity
to normal range.
g) Evaluation and Reflection
The nurse could have provided postoperative care to the patient by encouraging him to
rest when he feels tired; encouraged him to eat a good diet and to be active by either walking as
such activities can help the patient to recover quickly. Besides, such activities are important
when it comes to managing obesity which is a threat to Mr. Peter’s health condition.
Furthermore, the nurse should have made the patient be aware of the medications he is given and
the importance of each prescription (Osborne et al., 2015)
Conclusion
The medical history, the client’s current presentation, and the results of the patient’s
assessments provide an idea on what health issues Mr. Peter might be having. Some of the health
issues identified include Pain due to Post-operative inguinal hernia repair, Risks of
cardiovascular or heart disease due to high cholesterol content and Obesity due to lack of good
diet and exercise (Bruce, 2012). Intervention to reduce or prevent these health issues will play a
key role in the quality outcome of health care.

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