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,

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,