66years paul returned to the Post Anaesthesia Recovery Unit (PARU) having undergone a right total knee arthroplasty. He received a general anaesthetic and it was reported his estimated blood loss during surgery was 1200mls. A blood transfusion was given in the operating theatre. An occlusive compression dressing covered the surgical site and bloody ooze was noted at the distal end. Raoul had a Redivac drain in situ with 200mls of bright blood in it. Initially on arrival, Raoul was unconscious and oxygenated via a laryngeal mask at 10 litres per minute. Raoul had one litre of Hartmann’s IV over 6hrs running. Raoul was noted to be shivering and have a capillary refill time >3seconds. He was drowsy but easily roused when the nurse spoke to him. His vital signs were as follows: BP 99/50, HR 99bpm, T 35.5 oC, RR 14 and SpO2 88%.
Paul was transferred to the ward after a 2hr stay in PARU. He remained drowsy and was oxygenated via intra-nasal cannulae at 4L/min. Raoul had an intravenous infusion of 1000mls of Hartmann’s solution continuing over 6hrs. He arrived on the ward where the staff commenced Paul’s patient controlled analgesia (PCA). After a physiotherapist mobilized Paul, his pain reduced from 8/10 to 2/10. He was advised to remain in the hospital until he could fully weight bear with the aid of walking stick. Now Paul requested to go to his saying he is okay
QUESTIONS
1. Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient’s discharge from POST ANAESTHESIA RECOVERY UNIT (PARU). Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.( 650 words)
2. 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. (450 words)
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