Susan Jones, aged 30 years, is unmarried with 3 children under the age of 10 years. Susan currently works in casual employment, stacking shelves in the local supermarket. Her mother helps out with the children while she is at work. Susan drinks a bottle of wine every night to help her “cope with stress”. She is obese with a BMI of 36.Over the last few months Susan has been experiencing some changes in her body. Her face has become very round and she has noticed the development of stretch marks on her abdomen. Her GP suspects an endocrine disorder and refers her to an endocrinologist. The endocrinologist diagnoses Susan with Cushing’s Syndrome due to a benign tumour of her right adrenal cortex. The endocrinologist refers her to surgery for a laparoscopic right adrenalectomy.Susan signs a consent form for the surgery and is admitted to hospital for surgery the following week.She is admitted to the operating theatre and undergoes a retroperitoneal Laparoscopic Right Adrenalectomy. Following the surgery, which was uneventful, Susan is transferred to the post-anaesthetic recovery room (PARU).On admission to PARU, as Susan begins waking up, she experiences emergence delirium and becomes aggressive and is crying uncontrollably. She is given 2mg IV diazepam and her agitation settles and she is drowsy but rousable. Her vital signs are as follows: temperature 36.3oC; pulse 110, blood pressure 90/55; respirations 32; O2 saturations 98%. Susan has an indwelling urinary catheter (IDC) is on hourly measures with 20mls for the last hour; IV fluids 1L Hartmann’s solution over 6hrs. She has 4 puncture wounds on her abdomen and a Redivac drain which contains 300mls of blood.After 2hrs in PARU, Susan is ready for transfer back to the ward. She remained in hospital post-surgery to stabilise her blood cortisol levels and to ensure her wounds had healed. Susan was discharged from hospital with take-home medications of prednisone, fludrocortisone and tramadol. She states that she does not know how she will cope when she gets back home & is worried about her finances, being overweight and her physical appearance. She acknowledges that she drinks too much alcohol.Q1. 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.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.

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