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 : 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. 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.
Q2. 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.
Question 2 (15%)
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.
(Suggested length for your answer approximately 740 words).
? Note this says �critically discuss�. You need to support your discussion with evidence. An example of critical discussion might be: whereas Jones (2010) suggested capillary refill should be <2 secs, others (Brown 2012, Green 2013) suggested OR a number of studies (Jones, 2010, Brown 2012, Green 2013) found that capillary refill varies depending on age and sex.
? The markers want to know you understand the effects of anaesthetics/opioids/surgery on consciousness, ventilation, circulation, body temperature; potential changes in fluid volume/blood loss. Your discussion will demonstrate that you can provide safe patient care after surgery. NB: As this is a case study � all your discussion should be linked and specific to your chosen patient. Do not discuss the Aldrete Scale.
? The effects of anaesthetics and opioid analgesia is covered in your lectures and in pharmacology books e.g. Bryant & Knights 2015
Ch14 (anaesthetics); Ch15 (opioids); Brown et al 2014 Ch15 &
research. Up-To-Date is an online site, which reviews the current literature on various topics (search for this resource online) has information about general anaesthesia). Search Google Scholar. You may need to go older than 5-10yrs for effects of anaesthetics etc. on consciousness, circulation & ventilation. Look for review articles as these will give you an overview of the effects.
? An example for ventilation:
You need to discuss the effects of anaesthetics opioids and
surgery on the respiratory system. Link your patient�s vital signs in
PARU to the effects of anaesthetics, opioids and surgery
E.g. Patient�s respiratory rate is 10 and is below normal 12-16. This is due to�.
? Do the same for circulation & consciousness (NOT the GCS).