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Critical Care Unit: New Graduate ACNP

Critical Care Unit: New Graduate ACNP

 

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My first worry for this patient is his severe hip and chest tube discomfort. I would be concerned about a retroperitoneal hemorrhage if I had surgery and a total hip replacement there earlier in the day. Any surgical moving in that location can induce organ or vascular damage, which can result in a bleed, and in this situation, the patient is taking aspirin at home for his atrial fibrillation, which renders him anticoagulated and increases the probability of bleeding. A down-trending hemoglobin level is the single most important laboratory parameter for narrowing the differential diagnosis to retroperitoneal hemorrhage (Sahu et al., 2020).

While waiting for the blood test results, a physical examination of the location would indicate discomfort and the possibility of a hematoma in the posterior flank and abdominal region, as well as abdominal fullness. If there was a considerable reduction in hemoglobin, the patient would be quickly taken for further imaging to determine the cause of the bleeding. A CT scan with angiography (CTA) of the abdomen would be able to pinpoint the source of the bleeding (Areza-Fegyveres et a., 2018). Another source of worry is pain at the chest tube site; because the patient is becoming increasingly disoriented, the chest tube may have been dislodged and is no longer draining effectively, which may contribute to his higher oxygen need in comparison to his usual dose of O2. A chest x-ray would show the provider where the chest tube is now and whether it has moved since earlier imaging. I would also have an a

 Critical Care Unit New Graduate ACNP

rterial blood gas to rule out the potential of hypoxia-induced delirium. Organ function begins to decline when oxygen transport is significantly impeded. Ischemia can begin within five minutes of low oxygen levels because brain cells are very sensitive to oxygen deprivation. When hypoxia persists for an extended length of time, it can result in seizures and anoxic brain damage.

Continuous monitoring of serial labs like CBC, lactic acid, and ABG every 4 hours is recommended for this patient. It is critical to place a bed alarm and have the patient visible to the nursing staff to prevent repeated falls (Patel et al., 2020). Soft limb restraints may be necessary if the patient becomes belligerent. During the patient’s hospital stay, a referral to rheumatology and a nutritionist would allow him to further discuss his rheumatoid arthritis pain management, and a nutritionist would offer a food plan that would maximize the patient’s nutritional requirements for better recovery.

 

 

References

Areza-Fegyveres, R., Kairalla, R. A., Carvalho, C., & Nitrini, R. (2018). Cognition and chronic hypoxia in pulmonary diseases. Dementia & neuropsychologia, 4(1), 14–22. https://doi.org/10.1590/S1980-57642010DN40100003

Patel, I., Akoluk, A., Douedi, S., Upadhyaya, V., Mazahir, U., Costanzo, E., & Flynn, D. (2020). Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report. Journal of Clinical Medicine Research, 12(7), 458–461. https://doi.org/10.14740/jocmr4256

Sahu, K. K., Mishra, A. K., George, S. V., & Siddiqui, A. D. (2020). Managing retroperitoneal hematoma: Associated complexities and its challenges. The American Journal of Emergency Medicine, 38(9), 1957-1958.

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Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

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Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource