In relation to your patient , discuss the pathophysiology of their condition and using evidence based practice current treatment options for your patient’s condition , include any pharmacological and non-pharmacological considerations. There 3 questions
NRSG258 Acute Care Nursing 1, Semester 2 2015
Case Study 3: Arthur Jones (Osteoarthritis – Total Hip Replacement)
Arthur Jones is an 83 year old male who moved from England to Australia when he was in his late 30s. Arthur’s medical history includes osteoarthritis, hypertension, depression and vitamin D deficiency. He is a long term smoker and continues to smoke between 5-
10 cigarettes per day. Arthur has lived alone since his wife died last year. He has no children and no family in Australia.
Arthur went to visit his General Practitioner (GP) after noticing he had increasing pain in his left hip. He told his GP that he had noticed he was having difficulty walking and getting out of bed. Arthur’s GP referred him to an orthopaedic team and he was diagnosed with severe left hip joint degeneration related to osteoarthritis. The orthopaedic team suggested that he undergo an elective total hip replacement.
When Arthur attended his pre-admission appointment the nurse noted that he had a large laceration and bruise on his left arm. Arthur reported that he fell on his way to the toilet the week before.
Arthur’s surgery was uneventful during the intra-operative stage. On arrival to the post anaesthesia recovery unit, Arthur was placed in a semi-Fowler’s position with an abduction pillow between his legs. He was drowsy and oxygenated through a facemask on 02 at 5l/min. A wheeze and non-productive cough was noted. Arthur had a Redivac drain at the surgical site and IDC insitu. He was noted to be shivering and have a capillary refill time >3seconds. His observations were: T 36 oC, HR 90, RR 25, BP
110/70 and SpO2 93%.
Arthur was transferred to the surgical ward after a 60 minute stay in PARU. Arthur remained drowsy but easily roused. He was oxygenated via intra-nasal cannulae at
2l/min and scored his pain as 3/10. He had an 0.9% sodium chloride infusion running at
125ml/hr. Post-operative orders included intravenous fluids and analgesia. Arthur was ordered IV Paracetamol 1g 8/24, Oral Oxycodone 5mg 6hourly PRN. It was noted that there was 100mls of frank blood in the drain.
Two hours after Arthur’s return to the ward he was observed to be in pain, reported his pain score as 5/10 and was distressed and restless. At this time his vital signs were noted to be: T 36.2 oC, HR 91, RR 28, BP 135/91 & SPO2 96%. Arthur was reviewed by the surgical team and was ordered Oral OxyContin 10mg BD.
The following day Arthur was visited by the physiotherapist and transferred to sit out of bed. He was noted to be pale. Arthur stated his pain was “much improved” and that all he wants “is to go back to my own house where I do not get pestered all the time”.
NRSG258 Acute Care Nursing 1, Semester 2 2015
Please refer to the rubric on page 14 on the Unit Outline for full marking criteria
1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice explore current treatment options for your patient’s condition, include any pharmacological and non- pharmacological considerations.
2. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case study.
3. Develop a discharge plan to support your patient on discharge. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.
Although I am recommending current textbooks on where to find the basic information, the assignment does require you to find current literature/research to use to support your discussion, throughout the case study. Better Health Channel, WedMed, dictionaries, encyclopaedias etc. are not suitable academic sources. Do not use these, you will lose marks.This essay should have between 10-20 relevant sources. Textbooks should be a range of medical-surgical, pathophysiology + A and P and pharmacology for specific information e.g. organ function or drugs.
1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice (i.e. relevant research/review articles from medical and nursing websites e.g. Cinahl, Medline etc. you can also try Google Scholar) explore current treatment options for your patient’s condition, include any pharmacological and non-pharmacological considerations. (NB: approx. 700 words for this but this is not exact and the markers are not counting). This is worth 15% of the marks.
• First give a very brief overview of the anatomy and physiology – uterus, gall bladder, hip joint i.e. what and where is it and how does it function. (see A and P books – full texts not Essentials)
• Then give a brief definition of the presenting condition i.e.; what is osteoarthritis; (pathophysiology textbooks and research)
• Then discuss the pathophysiology of the condition i.e. how do you get, osteoarthritis, (pathophysiology books/research)
• What pharmacological methods can be used e.g. NSAIDs for pain, joint injections etc. (see pathophysiology text, surgical nursing text, pharmacology text/research)
• Then what non-pharmacological methods can be used, e.g. rest, exercise, diet etc. or surgery e.g. joint replacement, cholecystectomy, myomectomy (pathophysiology books/research)
2. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case study. (approx. 600 words for this). This is worth 10% of the marks.
• Note this says ‘critically discuss’. Do not just say ‘if the patient has a score of 1 he stays in PARU if he has a 2 he can go’. This is not critical discussion and the Aldrete Scale gives this information in any case. You will lose marks if you do this. You need to support your discussion with evidence.
• Briefly introduce this section with some reasons why do we use the Aldrete Scale (think about safety of the patient & the effects of anaesthesia, other drugs, operation, theatre environment, exposure). The marker wants to know you understand why you do things, not just because it’s what everyone does.
• Next chose 4 (of the 5 Aldrete scores) to discuss critically
• You need to think about why these are measured e.g. what is the effect of anaesthetics & opioids e.g. morphine, blood or fluid loss during surgery on the chosen criterion e.g. anaesthetic agents affect the function of the hypothalamus and the result is? Morphine acts on the brain stem and the result is? This is covered in your lecture on anaesthetic agents and the lecture on analgesics.
• Finally link each one of your chosen criteria to your chosen patient e.g. Arthur is shivering this could be due to …
• An example if you chose Respiration:
? When a patient has an anaesthetic (describe the effect of the anaesthetic on breathing).They may also have morphine which acts on (state correct part of brain which controls breathing) and this causes (state effect of morphine on respiration). The patient can become (what is the term for low blood oxygen?). Jin’s rate was…X breaths/min. Normal is Y breaths/min so Jin is……This might be due to this or that reason (state reason for abnormal breathing if it is given in the case study for the patient. NB not all cases have abnormal breathing).
3. Develop a discharge plan to support your patient on discharge. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale. (approx. 400 words). This is worth 10% of the marks. This section should be supported by literature/research also. In order to understand the discharge needs of the patient you must understand their condition e.g. Arthur with is hip replacement will have specific requirements for this type of surgery
• The discharge plan must be linked & specific to your patient e.g. think about the patient’s condition, surgery and situation and decide what referrals are appropriate to your chosen case and their surgery. Inappropriate referrals show you do not understand the patient’s condition and therefore cannot give safe care and you will lose marks.
• You can discuss the general patient discharge needs e.g. letters, specific education e.g. what would Arthur need to know about preventing dislocation of his hip; follow-ups; contacts.
? Please give a title to your essay e.g. Case Study – Jin Wong. Although you do not need a conclusion or introduction, and are answering each question, you must write in sentences not point form as this does not show critical thinking.
? Do not use abbreviations e.g. i.e. etc. in your essay. Write for example if you need to explain something further.
? You must explain any terms you use not just copy them out of a book/article/research. The markers need to know that you understand your chosen patient’s condition and management for safe care.