Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient’s discharge from PARU.
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 36o
C, 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.
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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
anesthesia 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.