CASE STUDY TWO: Ajay Mahajan – Appendicitis – Appendectomy: Ajay Mahajan is 18 years old and lives on campus at a university. He is in his first year of study and works part-time at a fast food...

CASE STUDY TWO: Ajay Mahajan – Appendicitis – Appendectomy: Ajay Mahajan is 18 years old and lives on campus at a university. He is in his first year of study and works part-time at a fast food restaurant on the weekend. He has a past medical history of asthma. Ajay drinks alcohol and uses party drugs at social events. He has been partying a lot since he broke up with his girlfriend. He smokes 20 cigarettes a day. His parents live in nearby but are currently on a 6 month holiday overseas.
Ajay was at work when he complained of abdominal pain and feeling nauseous. He went home and put himself to bed. The pain continued overnight and he vomited many times. At 4am he called an ambulance to take him to the Emergency Department at the local hospital. He was diagnosed with acute appendicitis and it was recommended that Ajay undergo a laparoscopic appendectomy/open appendectomy as soon as possible. Ajay signed the consent form for both procedures and was scheduled for surgery later that day.
On admission to the Operating Room, Ajay was febrile and his abdomen was swollen. The surgeon began the procedure using a laparoscopic approach but it was discovered that Ajay’s appendix had ruptured. The surgeon changed his approach and an open appendectomy with peritoneal lavage was undertaken.
Following the surgery, Ajay was transferred to the post-anaesthetic recovery room (PARU). On admission to PARU Ajay was drowsy and was in a supine position. The nurse observed a snoring sound during respiration. When roused, Ajay said he felt cold and that his mouth felt dry. Ajay’s vital signs were as follows: temperature 35.0oC; pulse 80, blood pressure 90/50; respirations 10; O2 saturations 94%. A Bair Hugger warmer was applied and 1L Normal Saline over 6 hours continued to be administered. A short time later Ajay began to cry in bed and complained of severe pain in his abdomen. Morphine, 2mg IV, was prescribed and administered. After 2 hours in PARU, Ajay was transferred to the ward.
The next day Ajay was able to ambulate with assistance and tolerated clear fluids. He stated his stomach was very painful. IV analgesia, IV anti-emetics and IV antibiotics were administered regularly and a nicotine patch was prescribed. Ajay told the nurse he has no other family and Australia and he has not told his parents that he has had surgery as he does ‘not want to worry them‘. He told the nurse that he feels like his life is “out of control” and that he has been drinking too much alcohol and taking too many drugs on the weekends. He said he is worried about his study as it is exam period at university and he doesn’t know how he can cope.
Five days later Ajay was reviewed and told he could be discharged home. He was provided with a prescription for oral Tramadol and Metronidazole.
Q1. In relation to your chosen patient, critically 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 anaesthesia 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.