Choose one (1) of the case studies available and answer the associated questions.
CASE STUDY ONE: Susan Jones - Cushing's Syndrome - Adrenalectomy
Susan Jones, aged 30 years, is unmarried with 3 children under the age of 10 years. Susan currently works in casual employment, stacking shelves in the local supermarket. Her mother helps out with the children while she is at work. Susan drinks a bottle of wine every night to help her "cope with stress". She is obese with a BMI of 36.
Over the last few months Susan has been experiencing some changes in her body. Her face has become very round and she has noticed the development of stretch marks on her abdomen. Her GP suspects an endocrine disorder and refers her to an endocrinologist. The endocrinologist diagnoses Susan with Cushing's Syndrome due to a benign tumour of her right adrenal cortex. The endocrinologist refers her to surgery for a laparoscopic right adrenalectomy.
Susan signs a consent form for the surgery and is admitted to hospital for surgery the following week.
She is admitted to the operating theatre and undergoes a retroperitoneal Laparoscopic Right Adrenalectomy. Following the surgery, which was uneventful, Susan is transferred to the post-anaesthetic recovery room (PARU).
On admission to PARU, as Susan begins waking up, she experiences emergence delirium and becomes aggressive and is crying uncontrollably. She is given 2mg IV diazepam and her agitation settles and she is drowsy but rousable. Her vital signs are as follows: temperature 36.3oC; pulse 110, blood pressure 90/55; respirations 32; O2 saturations 98%. Susan has an indwelling urinary catheter (IDC) is on hourly measures with 20mls for the last hour; IV fluids 1L Hartmann's solution over 6hrs. She has 4 puncture wounds on her abdomen and a Redivac drain which contains 300mls of blood.
After 2hrs in PARU, Susan is ready for transfer back to the ward. She remained in hospital post-surgery to stabilise her blood cortisol levels and to ensure her wounds had healed. Susan was discharged from hospital with take-home medications of prednisone, fludrocortisone and tramadol. She states that she does not know how she will cope when she gets back home & is worried about her finances, being overweight and her physical appearance. She acknowledges that she drinks too much alcohol.
Q1. In relation to your chosen patient, discuss the pathophysiology of their presenting condition, and using evidence based literature explore current surgical treatment options for your patient.
Q2. Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient's discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.
Q3. Develop a discharge plan to support your chosen patient on discharge home. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.
CASE STUDY TWO: Ajay Mahajan - Appendicitis - Appendectomy
Ajay Mahajan is 18 years old and lives on campus at a university. He is in his first year of study and works part-time at a fast food restaurant on the weekend. He has a past medical history of asthma. Ajay drinks alcohol and uses party drugs at social events. He has been partying a lot since he broke up with his girlfriend. He smokes 20 cigarettes a day. His parents live in nearby but are currently on a 6 month holiday overseas.
Ajay was at work when he complained of abdominal pain and feeling nauseous. He went home and put himself to bed. The pain continued overnight and he vomited many times. At 4am he called an ambulance to take him to the Emergency Department at the local hospital. He was diagnosed with acute appendicitis and it was recommended that Ajay undergo a laparoscopic appendectomy/open appendectomy as soon as possible. Ajay signed the consent form for both procedures and was scheduled for surgery later that day.
On admission to the Operating Room, Ajay was febrile and his abdomen was swollen. The surgeon began the procedure using a laparoscopic approach but it was discovered that Ajay's appendix had ruptured. The surgeon changed his approach and an open appendectomy with peritoneal lavage was undertaken.
Following the surgery, Ajay was transferred to the post-anaesthetic recovery room (PARU). On admission to PARU Ajay was drowsy and was in a supine position. The nurse observed a snoring sound during respiration. When roused, Ajay said he felt cold and that his mouth felt dry. Ajay's vital signs were as follows: temperature 35.0oC; pulse 80, blood pressure 90/50; respirations 10; O2 saturations 94%. A Bair Hugger warmer was applied and 1L Normal Saline over 6 hours continued to be administered. A short time later Ajay began to cry in bed and complained of severe pain in his abdomen. Morphine, 2mg IV, was prescribed and administered. After 2 hours in PARU, Ajay was transferred to the ward.
The next day Ajay was able to ambulate with assistance and tolerated clear fluids. He stated his stomach was very painful. IV analgesia, IV anti-emetics and IV antibiotics were administered regularly and a nicotine patch was prescribed. Ajay told the nurse he has no other family and Australia and he has not told his parents that he has had surgery as he does 'not want to worry them'. He told the nurse that he feels like his life is "out of control" and that he has been drinking too much alcohol and taking too many drugs on the weekends. He said he is worried about his study as it is exam period at university and he doesn't know how he can cope.
Five days later Ajay was reviewed and told he could be discharged home. He was provided with a prescription for oral Tramadol and Metronidazole.
Q1. In relation to your chosen patient, critically discuss the pathophysiology of their presenting condition, and using evidence based literature, explore current surgical treatment options for your patient.
Q2. Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient's discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.
Q3. Develop a discharge plan to support your chosen patient on discharge home. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.
CASE STUDY THREE: Gianna Rossi - Osteoporosis - Hip Arthroplasty
Gianna Rossi is 79 years old with 5 adult children. Gianna was married to Antonio, who died 4 months ago. Gianna is retired, and is currently living with her oldest son Luca and his family. She has her own self-contained area in Luca's house and has been generally independent with her activities of daily living (ADL). She has needed some assistance with shopping, some housekeeping tasks and managing her medications (currently uses a Dosette box). She is 158cm in height and weighs 89kgs with a BMI of 35. Her medical history includes osteoporosis and hypertension. Blood tests revealed low vitamin D levels.
Over the last few months Gianna has been experiencing increasing pain in her left hip which has significantly impacted her mobility and capacity to self-care. Her son found her lying on the floor.
Gianna said 'I just collapsed because the pain in my hip was so bad'. Luca called an ambulance which transported Gianna to the Emergency Department. An X-Ray revealed a fracture of her left hip due to osteoporosis. Gianna signed a consent form for a left total hip replacement (THR)/arthroplasty the following day.
Following a left THA, Gianna was transferred to the post anaesthetic recovery room (PARU). Her blood loss during surgery was estimated at 1500mls. On admission, Gianna was asleep and difficult to rouse. A Redivac drain, with 200mls blood in it, and an indwelling urinary catheter (IDC) were insitu. The IDC had drained 30mls of concentrated urine for the hour. One unit of packed cells was being administered over 2hrs and she had oxygen at 6L/min via a Hudson mask. Her vital signs were as follows: temperature 36oC, pulse 110, blood pressure 95/50, respirations 10, O2 saturations 93%. A foam abduction pillow was between her legs. Upon wakening, Gianna complained of pain and was administered 5mg of Morphine with good effect.
Gianna was transferred to the orthopaedic ward where she has been for the past 4 days. She is eating and drinking well. but requiring some assistance with ADLs. She is teary and is expressing concerns about her ability to maintain her independence after discharge. Gianna is currently mobilising under supervision using a four-wheeled walker. Her pain is being managed with paracetamol 1gm q6h, and tramadol 100mg B.D. Her son Luca is worried about his mother's safety at home as both he and his wife work long hours during the day.
Q1. In relation to your chosen patient, discuss the pathophysiology of their presenting condition, and using evidence based literature explore current surgical treatment options for your patient.
Q2. Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient's discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.
Q3. Develop a discharge plan to support your chosen patient on discharge home. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.
I need required 1600 words and the references should be at least 12 with all less than 5 years old references.