Jin Wong is a 25 year old woman who was born in Australia to Chinese parents. Jin has been experiencing severe menorrhagia, debilitating backaches and constipation for the past few months. Jin went to visit her General Practitioner (GP) and was diagnosed with uterine fibroids and anaemia. Jin’s GP put her on the waiting list for a hysteroscopic myomectomy as a day patient.
The nurse conducting the pre-admission visit noted that Jin was not currently taking any hormonal contraceptives and did not have any surgical history. Jin told the nurse that she recently lost her job, is estranged from her family and drinks 4 glasses of wine “most nights of the week”. Jin stated she often takes “other things” on the weekend, including cannabis, and that she was very nervous about having the surgery. She stated she did not smoke cigarettes. The nurse commented that Jin was shaky and pale. After consultation with the GP, it was recommended that Jin be admitted as an inpatient and have 2 units of Packed Red Blood Cells (PRBCs) transfused prior to the procedure.
Jin’s surgery was uneventful during the intra-operative stage. Following cervical dilatation, the surgeon removed a number of fibroids. On Jin’s arrival to Post Anaesthesia Recovery Unit (PARU) she was drowsy and was oxygenated through a face mask on 02 at 5L/min.
Shortly after her arrival in PARU Jin developed emergence delirium and became quite distressed and agitated, throwing her arms around and crying. She complained of pain and her breathing became rapid and laboured. Her observations were: T36.5 oC, HR 90, RR 25, BP 130/70 and SpO2 98%. IV diazepam 2mg was administered by the PARU nurse.
After a 40 minute stay in PACU Jin returned to the ward. She was oxygenated via intranasal cannulae at 2L/min. She had a sodium chloride 0.9% infusion running for hydration at 125mls/hr and was prescribed 4-6hrly oral Paracetamol 1g, and oral Endone 5mg 6/24 PRN. Her vital signs were HR 70 (sinus rhythm), BP 110/65, T 36.9oC, RR 16/min and shallow, Sp02 99%.
One hour after transfer to the ward the nurse noted that Jin was restless and anxious. Jin was complaining of pain in her abdomen which she scored at 8/10. When the nurse-in-charge spoke to Jin, Jin stated “I just want to go home and have a cigarette and a drink. I can’t cope with this hospital business. You aren’t allowed to keep me here”.
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