Post-Operative Inguinal Hernia Repair

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Question:

Mr Peter Ling: Post-Operative Inguinal Hernia Repair

Mr Peter Ling a 67-year-old man who is admitted to the Surgical ward, following an open mesh inguinal hernia repair. He had presented to ED with a 6-hour history of a R non-reducible tender, inguinal mass, post commencing a new gym/weight lifting regime.

Past Medical History: Mr Ling is retired, lives with his wife, ex-smoker and is obese, with a body mass index (BMI) of 30. Incidentally, he is an ex weight lifter. He is on medication for hypertension and hyperlipidaemia, which are both well controlled, and he also has mild congestive heart failure (CHF).

Mr. Ling was recovering well, but on Day 2 post op, he has become a little agitated and confused, complaining of significant left calf pain.

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On your assessment:

  • Vital signs: Temp: 39.3oC, 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
  • Physical assessment: Mr. Ling is restless and confused to time and place. His chest is clear, skin is dry, 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.

Investigations:

  • Haemoglobin 16.5 gm/dl,
  • WCC, neutrophils and CRP – all elevated

Nursing notes:

  • Mr. Ling has an 18g Cannula in his Right arm
  • He has tolerated diet and is voiding well
  • Bowels opened yesterday
  • Agitated and confused to time and place on assessment this am.

You are the registered nurse looking after Mr. Ling.