Writing in Nursing - Common Assignments

Running Head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author’s Note:

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Presentation of the health information
Considering patient situation
The patient in the case study is Mr. Peter Ling, 67-year old who had an operative inguinal
hernia repair. Based on his past medical history it is stated that he is obsess having a BMI of
30. He was under medication for hypertension and hyperlipidaemia but the levels were well
controlled. He has also suffered a mild congestive heart failure.
The patient underwent an open mesh surgery for inguinal hernia repair. Mr. Ling was
recovering well but on the second day post-surgery he complained of significant pain on his
left calf due to which he seemed agitated and confused.
Collection of cues
Based on the complaint by the patient the left calf was examined and stated to be swelled
up looking larger than the right leg and it was also red and warm to touch. The pain score test
also exhibited intense pain soring 7 out of 10. The wound dressing was oozing green purulent
discharge and that area was tender to touch. The white cell count especially the neutrophils
were elevated in number and he exhibited elevated levels of CRP. The patient also had
elevated body temperature of 39 degrees centigrade. The respiratory rate of the patient was
slightly elevated than the normal range. Elevated blood pressure of 170/90 mm of Hg was
also observed.
Processing information
The observations obtained states that there is a surgical site infection (SSI) that might have
occurred which has led to the chain of events to occur. The green colour purulent discharge is
due to the infection at the site. The pain score obtained is 7 put of 10. This indicates that the
pain in the left calf of the patient is considered to be very intense which dominates the senses

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impacting the thinking ability of the patient (Bates & Divino, 2015). It might be due to this
pain and expected infection that the patient is suffering from elevated body temperature. The
patient seems to be effectively disabled. Elevated level of CRP in the blood is a marker of
inflammation which is exhibited in the left calf of the patient indicating the sign of infection
(Carbonell et al., 2013). The patient was having high blood pressure previously but he was
administered medication which had aided in maintaining the blood pressure under controlled
range. But presently the blood pressure of the patient has also increased.
Identification and prioritisation of nursing problems
The infection needs to be treated immediately to treat and prevent several distresses in the
patient that might lead to further clinical deterioration of the patient. The green exudate that is
being discharged should be sent for a culture for determine the microbe that is causing the
infection if at all. The swelling in the left calf of the patient is also of concern that needs to be
reduced to reduce the CRP level in the blood. The elevated level of CRP is also a problem as
it increases the risk of heart attack (Cavazzola & Rosen, 2013). The pain is also identified as
a problem should be treated to reduce several complicacies like the fever, confusion that is
observed in the patient. The elevated blood pressure is another identified problem since the
patient had already been affected by a mild congestive heart failure.
Goals for delivering priority care
The major goal in delivering the care is the comfort of the patient with exuding wounds is
complex. The cause of the exudate and the potential complications related to it should be
addressed. It should be noted that the comfort and the dignity of the patient needs to remain
paramount in course of delivering the care. The first aim should be to reduce the pain of the
patient which is considered to be quite intense that is impacting the respiratory rate of the
patient as well. The incision site should be dressed properly in order to remove the exudate

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that might make the patent feel uncomfortable. The swelling of the left calf should be
reduced. The patient has had a mild congestive heart failure hence the hypertension of the
patient should be under control to avoid unnecessary pressure exerted to the walls of the
arteries.
Nursing Care of the patient
It is essential to keep the patient in the Trendelenburg’s position so as to reduce the
pressure that is exerted on the hernia site. A hernia truss can be recommended which is a
supportive undergarment for men that aids in relieving the discomfort (Campanelli et al.,
2013). But it should be worn only when the hernia has been reduced. Also, when the exudates
have reduced. The patient should be encouraged to breathe deeply and change their positions.
Ice bags can be applied to the calf region to reduce the swelling and relieving the pain.
Elevating the left calf on a rolled towel may also aid in alleviating the swelling (Bansal et al.,
2013). IV fluids as well as analgesics should be provided for pain relief and acetaminophen
can be administered in order to control the elevated temperature (Burcharth et al., 2013). Till
the culturing of the exudate is executed broad spectrum antibiotic can be used.
Evaluation of the nursing care strategies
The expected outcomes are considered to be the standards against which the nurse assesses
whether the goals have been met and to ensure that the delivered care was comparable to the
standard and effective. The health care to be delivered should be competent, challenging,
cost-effective, and timely as well as complex that should lead to favourable client outcomes
(Valvekens, Nijs & Miserez, 2015).
In the Trendelenburg’s position the body of the patient is laid in a supine position also
referred to as flat on the back or at 15 to 30-degree incline such that the feet are elevated
above the head. Supine position secures the upper extremities of the individual (Werner,

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2014). Ensuring the patient is at ease and also reducing the pressure on the operated area.
This position aids in improving the cardiac function by elevating the cardiac output as well as
the arterial and venous pressure. This position would also help in reducing the blood pressure
of the patient. Changing the position frequently will prevent the pressure sores and also
prevent exertion of pressure on the operated site (Cima et al., 2013).
The green colour of the exudate is because some of the white blood cells produce a green
antibacterial protein which is known as myeloperoxidase. But if the green colour exudate has
a foul smell the incision is considered to be infected with Pseudomonas aeruginosa (Smith et
al., 2013).
Ice is considered to be a tried-and-true tool that has been used for the reduction of the pain
and swelling. But the ice pack should be covered with a light, absorbent towel to help prevent
frostbites. Cold aids in numbing the pain and also helps in reduction of the inflammation
(Hammond, 2014). Cold therapy works by ensuring the reduction of the blood flow to the
affected area that promotes the significant reduction of the inflammation and swelling that
causes the pain. It also aids in temporary reduction of the nerve activity that also relieves
pain.
Elevating the calf in the even in the supine position has proven to not affect the heart rate,
blood pressure as well as the subjective comfort of the different areas of the body are not
impacted. This act of elevating the legs above the level of the heart aids in reducing the
swelling in the calf that the patient is complaining about.
The IV fluids are the intravenous route that is taken for the fastest delivery of the
medications and the fluid replacement throughout the body. This is because the fluids through
this method are directly introduced into the circulation. Acetaminophen is an analgesic that is
used extensively for the reduction of fever temporarily and it also aids in reduction of pain.

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There are antihistamines in the drug that would help the patient to get sleep thus ensuring
sufficient rest for the patient that would promote the recovery of the patient (Korol et al.,
2013). The use of broad-spectrum antibiotic ensures that the antibiotic can act on a wide
range of bacteria especially gram positive as well as gram negative bacteria.
Expected outcomes of the person receiving the care
Based on the nursing care plan proposed for Mr. Ling the expected outcome is that the
pain and the swelling of the calf should be reduced as an immediate impact and the infection
should also start healing with less amount of exudates getting discharged that should
gradually become translucent in colour provided the broad spectrum antibiotic should be
effective. Else specific antibiotic should be administered post receiving the culture reports.
Reducing the swelling and the pain and administering acetaminophen would also reduce the
fever of the patient. All these effects also impact the respiratory rate and the blood pressure.
The supine position will also promote reduction of the blood pressure.
Thus, this holistic approach would aid in reduction of the patient distress and prevent
further deterioration and this promote quality of life for the patient.
Reflection on the entire process
Initially the scenario had made me panic stricken. But I felt the holistic assessment of the
patient with the infection in surgical site is vital with regards to the identification of the risk
factors of the patient as well as the monitoring of the vital signs of the patient. Accurate
assessment of the scenario helped me in selection of the most appropriate management
therapies that aided in improvement of the quality of life of the patient and thus, in contrast
reduced the potentially life-threatening risks that are associated with the infection. I should
also consider the cost effectiveness of the selected therapies and the efficacy of the planned
care that was delivered was also considered. The entire situation taught me the idea of having

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complete knowledge about infection and the risk of the factors that can cause infection in the
patients. The assessment of the patients also made me realise the importance of the
management skills. The management of the patients who are suffering from critical illness
should be done on a prior basis that can help me in the critical situation.

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References
Bansal, V. K., Misra, M. C., Babu, D., Victor, J., Kumar, S., Sagar, R., ... & Rewari, V.
(2013). A prospective, randomized comparison of long-term outcomes: chronic groin pain
and quality of life following totally extraperitoneal (TEP) and transabdominal
preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surgical endoscopy, 27(7),
2373-2382.
Bates, A. T., & Divino, C. (2015). Laparoscopic surgery in the elderly: a review of the
literature. Aging and disease, 6(2), 149
Burcharth, J., Pedersen, M., Bisgaard, T., Pedersen, C., & Rosenberg, J. (2013). Nationwide
prevalence of groin hernia repair. PloS one, 8(1), e54367.
Campanelli, G., Bertocchi, V., Cavalli, M., Bombini, G., Biondi, A., Tentorio, T., ... &
Canziani, M. (2013). Surgical treatment of chronic pain after inguinal hernia
repair. Hernia, 17(3), 347-353.
Carbonell, A. M., Criss, C. N., Cobb, W. S., Novitsky, Y. W., & Rosen, M. J. (2013).
Outcomes of synthetic mesh in contaminated ventral hernia repairs. Journal of the
American College of Surgeons, 217(6), 991-998.
Cavazzola, L. T., & Rosen, M. J. (2013). Laparoscopic versus open inguinal hernia
repair. Surgical Clinics, 93(5), 1269-1279.
Cima, R., Dankbar, E., Lovely, J., Pendlimari, R., Aronhalt, K., Nehring, S., ... & Team, C. S.
S. I. R. (2013). Colorectal surgery surgical site infection reduction program: a national
surgical quality improvement program–driven multidisciplinary single-institution
experience. Journal of the American College of Surgeons, 216(1), 23-33.

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Hammond, C. B. (2014). Care of patients undergoing day case inguinal hernia
repair. Nursing standard, 28(31).
Korol, E., Johnston, K., Waser, N., Sifakis, F., Jafri, H. S., Lo, M., & Kyaw, M. H. (2013). A
systematic review of risk factors associated with surgical site infections among surgical
patients. PloS one, 8(12), e83743.
Smith, M. A., Dahlen, N. R., Bruemmer, A., Davis, S., & Heishman, C. (2013). Clinical
practice guideline surgical site infection prevention. Orthopaedic Nursing, 32(5), 242-248.
Valvekens, E., Nijs, Y., & Miserez, M. (2015). Long-term outcome of surgical treatment of
chronic postoperative groin pain: a word of caution. Hernia, 19(4), 587-594.
Werner, M. U. (2014). Management of persistent postsurgical inguinal pain. Langenbeck's
archives of surgery, 399(5), 559-569.