Clinical Reasoning Cycle for Open Mesh Inguinal Hernia Repair

Student’s name;
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INTRODUCTION.
Open mesh inguinal hernia surgical procedure is a procedure that includes any of the three
procedures; Herniotomy, hernioplasty or Herniorrhaphy. The assignment describes A case
scenario of a 67-year-old man Mr Peter Ling, currently admitted to the surgical ward following
an open mesh inguinal hernia repair. Despite having started with reasonable progress post-
surgical, he later developed signs of wound infection on his second day postoperatively. The
assignment will make use of clinical reasoning cycle where the following processes will follow
sequentially. The patient will be considered; the cues will be collected; followed by information
collection and processing. The patient's problem will then be understood, planning of the
interventions and implementation, outcome evaluation and finally, a reflection from the process.
The assignment will, therefore, help the reader understand the use of clinical reasoning cycle in
managing the same case scenarios.
CONTENT
Consideration of facts from the patient/situation.
Mr. peter Ling was brought to the surgical ward for post-operative nursing management; he
underwent an open mesh inguinal hernia. He has been showing excellent progress till day
postoperatively, he has started showing signs of post-surgical wound infection. He is restless and
confused about time and place. His post-operative surgical wound dressing is oozing green
purulent discharge, and the wound is tender to touch. He had visited the emergency department
with a 6-hour history of an R non-reducible tender, inguinal mass, and post commencing a new
gym regime. He is retired, besides, he currently lives with his wife. He is obese with a BMI of
30, an ex-smoker and an ex-weight lifter. He has hypertension and hyperlipidemia disorders;

however, he is currently on medication to control the conditions, and they are both controlled
well. Besides, he has mild congestive heart failure.
Collection of cues.
Information collected during the assessment includes objective and subjective data. The
objective data collected include BMI of 30, a temperature of 39.3 degrees Celsius, respiratory
rate of 25 breaths per minute. A heart rate of 100 beats per minute. Systolic blood pressure of
170/90 mmHg. Hemoglobin of 16.5gm/dl. He also has 95% SPo2 level and a Glasgow coma
scale of score 14/15. Surgical wound dressing oozing green purulent discharge and tender to
touch was also noted. Plus, an increase in white blood cell count. His left calf seems bigger than
the right one, has a clear chest and a dry skin. The information provided by the patient (Mr Peter)
includes a history of hypertension and hyperlipidemia, pain of score 7/10, history of being an Ex-
smoker and ex weight lifter.
Processing gathered information.
The BMI of 30 is an indication of Mr Peter being obese. He has hyperthermia with a temperature
of 39.3 (it is above 37.5 degrees Celsius). Mr Peter is tachypneic, his respiratory rate of 25
breaths per minute is above the normal range supposed to be 12 to 20 breaths in a minute. He is
hypertensive with a heart rate of 100 beats in a minute. The heart rate is alarming in as much as it
is within the normal range of 60-100 breaths in a minute. He has a high blood pressure with a
systolic pressure of 170 mmHg which is above the normal range of 100 to 120 mmHg. Besides,
he has a higher diastolic pressure of 90mmHg, which us more elevated than the normal range of
60-80 mmHg. He has normal but alarming SpO2 levels despite being within the normal ranges of
95-100%. Pain Rating Scale usually used by the nurses and other healthcare professionals to

understand certain aspects of patient's pain better gives Mr Peter's pain a score of 7/10. Such a
pain score is considered very severe that requires immediate management to make Mr Peter
comfortable. He has a Glasgow coma scale of 14/15 in which the Best verbal response is given a
score of 4/5 since he is confused to time and place during the assessment (Teasdale et al., 2014).
The post-operative surgical wound dressing oozing green purulent discharge is a sign of wound
infection (Harrington, 2014). Wound infection can also be confirmed by the increase in white
blood cell count — an indication of recruitment of Neutrophils to phagocytose the microbes
causing the surgical wound infection.
Performing surgery on someone leads typically to an acute dermal wound. Normally the
cutaneous wound should progress well and heals with time. But this may not be the case,
especially when infection kicks in. Aerobic or anaerobic bacteria and fungal strains colonize the
dermal wound forming microbial communities (Bertesteanu et al., 2014). The bacteria can
originate from the skin surrounding the incision site or from an external environment; including
unsterile surgical instruments used during the surgical procedure. And, failure in observing septic
techniques, including thorough handwashing before handling the incision site. Failure in
maintaining a clean working area during wound care cleaning (Megeus et al. 2015). During
wound infection, the polymicrobial film delays the process of wound healing. Overwhelmed
natural body defence mechanism by the virulence microorganisms, i.e. bacteria and fungi lead to
wound infection (Weiss & Schaible 2015). The body’s immune system will then respond by
inducing inflammatory process and damaging the infected tissues.
After the virulence microorganisms have invaded the tissue through the incision site, they injure
the viable tissues surrounding the incision site. The cells that have been damaged, therefore,
produces chemicals in response (Artis & Spits, 2015). Such chemicals include bradykinin,