ANP-652W4D2

THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM.  REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH APPROPRIATE REFERENCE WITHIN 5 YEARS AND 7TH EDITION APA STYLE . MINIMUM OF 350 WORDS WITH AT LEAST 2 PEER REVIEW REFERENCE.  

 You are working in the critical care unit as an ACNP, in your first year, on nights, and you are the only one in the department. You have a critical care MD, pharmacist, and hospitalist on call and available to you by phone. Describe your assessment and appropriate interventions and referrals for the following patient.

1. He is a 90-year-old male with mild dementia who underwent a total right hip replacement and a right-sided thoracotomy/chest tube placement earlier in the day due to trauma: He fell down 13 stairs and remained on the floor for 13 hours prior to discovery and rescue.
2. His head CT noncontrast is negative, but closed head injury is highly suspect. He is confused, combative, yet understandably complaining of 10/10 pain in his hip and chest tube site.
3. The surgeon has ordered morphine 1 mg q. 4 hours prn pain and Tylenol 650 q. 4 hours prn. The patient's family is very concerned and wants the patient's pain addressed.
4. He is a full code blue; his VS are as follows: BP 160/75, HR 98 Afib RVR, RR 24 spontaneous, 02 sat 90% on 3 liters NC. This patient has COPD with 2 liters of 02 at home, hypertension, dementia-early, Afib on ASA and metoprolol, and takes oxycodone 10 mg q. 3 hours at home prn due to debilitating rheumatoid arthritis.