Case Study 3: Arthur Jones (Osteoarthritis – Total Hip Replacement) 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”. QUESTIONS Question 1 (15%) 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 nonpharmacological considerations. Question 2 (10%) Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilise the scale provided on LEO as a resource in your case study. Question 3 (10%) 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. REFERENCES: 10-15 References. APA format. From 2010-2015. Research + statistics (Australian statistics) must be from 2010-2015,
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