Instructions for Answer to 4 Question

1- After Each DQ (question), write down references

2- 300 minimum words for every DQ, you can go up to 800 words but answer should be complete.

3- 2-3 Peer Reviewed/ scholarly references for each question

4- References should be within 4 years

5- I am in acute care nurse practitioner program.

6- The response to the DQ is expected to be a minimum of 300 words. A minimum of two peer reviewed/ scholarly  resources are expected. These need to be appropriate for a clinical professional to guide decisions about patient care. If a textbook is used for one of these responses, the other needs to be journal or professional-level website. The references need to be correctly formatted, as do the citations for those references.  “ Question words” don’t count towards 300 minimum count”

Question 1

Discuss appropriate referrals and consultations for the adult-geriatric patient experiencing acute or chronic immobility.

Differentiate the requirements for acute rehabilitation, skilled care (transitional care), long-term care, and hospice patients who are preparing for discharge from the acute care setting and may require bridge therapy to increase strength, balance, and conditioning prior to transitioning to a safe independent living environment. Discuss general admission criteria, including number of modalities of therapy, number of hours of therapy per day in which the patient must participate, and any restrictions such as renal dialysis.

Identify at least one restorative level of care that an acute care adult-geriatric patient can be transferred to as a bridge to independent living and briefly describe the criteria for admission; e.g., number of hours of therapy and number of different modalities of therapy (speech, PT, OT, skilled nursing) within skilled or transitional care, home health, acute rehabilitation, long-term acute care, hospice, or other.

Question 2

Explain how you would utilize at least one laboratory finding (B12, albumin, vitamin D, and others) in diagnosing malnutrition and potential healing deficits in wound management for the complex acute, critical, and chronically ill adult-geriatric patient.

Name at least one nutritional replacement and supplement that promotes wound healing.

Discuss at least one treatment modality, intervention, or diversion that promotes wound healing or mobility by altering or improving bowel, bladder, and wound drainage for complex acute, critical, and chronically ill adult gerontology patients.

Question 3

You are a new AGACNP at an urban, tertiary referral center working in the emergency department. You are presented with the following case.

1. Patient is a 45-year-old, White male, acute care nurse practitioner (ACNP) who comes in with a chief complaint of back pain, acute on chronic. He describes severely compromising, debilitating lumbar spine pain due to a fall from a 20-foot scaffolding. There is MRI evidence of multilevel degenerative spine disease and bulging discs, with a dx of “failed back surgery.”

2. He is prescribed the following by a local pain clinic: OxyContin 20 mg BID, with oxycodone 5 mg q. 3 hours breakthrough pain, Lyrica 100 mg at HS, Lexapro 10 mg daily, and Xanax 0.5 mg BID prn anxiety.

3. He is receiving physical therapy as well as intermittent epidural blocks (last one was 2 weeks ago).

Summarize your actions for the following, in detail:

1. This patient received #60 OxyContin 20 mg and #60 oxycodone 5 mg 2 weeks ago, but is saying that he has been out of medication x 2 days. He would like another prescription. What is your response?

2. He is nauseated with emesis episodes that are too numerous to count this morning. He also has intractable diffuse abdominal pain, intermittent piloerection, and diaphoresis. What is your diagnosis for these symptoms?

3. He admits to using many more pills than prescribed due to increased pain following a fall at home. He wants help, admits to opioid addiction, and is accepting of inpatient admission. What are your initial orders and appropriate referrals? He is requesting methadone. Can you prescribe methadone for acute/chronic pain or addiction as an AGACNP?

4. Ethically and professionally, what are your concerns for this patient and his own ACNP practice? What resources are available to you as a prescriber to track this patient’s opioid use/abuse? What resources are available to a provider of medical care who suffers from addiction?

Question 4

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.