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Case Study:Rheumatoid Arthritis – Total Knee Arthroplasty

NRSG258 : Acute Care Nursing :Raoul Arbessier Case Study -Nursing Assignment

Case Study 3: Raoul Arbessier (Rheumatoid Arthritis  Total Knee Arthroplasty)

Raoul Arbessier is a 65 year old man who is retired and receives an Age Pension. He lives alone and he has no family in Australia. His medical history includes hypertension, chronic obstructive pulmonary disease and depression. He has been smoking 40 cigarettes a day for at least 40 years. Raoul visited his doctor to complain that he had been experiencing high levels of pain and discomfort in the joints of his fingers and feet. He said he found walking increasingly difficult with increased pain in his right knee. He was referred to a rheumatologist who diagnosed Raoul with rheumatoid arthritis. Raoul was then referred to an orthopaedic surgeon who suggested a right total knee arthroplasty, to which Raoul consented. On admission to hospital Raoul told the ward nurse that he felt tired and that he was “not sure this surgery was really going to help”. He appeared gaunt and thin and his BMI was calculated at 18. After speaking again with his doctor, Raoul agreed to proceed with the surgery. Raoul 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%. Raoul 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 Raoul’s patient controlled analgesia (PCA).

Question 1 
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

Question 2 
Critically discuss the assessment of ventilation, circulation and consciousness prior to the patient’s discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions, and be directly related to your chosen patient.

Question 3 
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.

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