You are working in the critical care unit as a new graduate ACNP, on nights. You are the only provider on the unit that night, but you have a critical care MD, pharmacist, and hospitalist on call and available to you by phone.
Describe your assessment, interventions, recommendations, and referrals for the following patient. Support your answer with two or three peer-reviewed resources.
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 a massive hemothorax from multiple rib fractures.
He fell down 13 stairs and remained on the floor for 13 hours before being found by his neighbor. He does not recall what happened to him or why he fell.
His noncontrast head CT is negative for intracranial abnormalities, but closed head injury/concussion is highly suspected. He has gotten more confused and combative as the night has gone on yet understandably is complaining of 10/10 pain in his hip and chest tube site.
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.
He is a full code and his VS are as follows: BP 160/75, HR 118, he’s in A-fib w/ RVR, RR 24, 02 sat 90% on 3 liters NC. This patient has COPD wearing 2 liters of 02 at home, hypertension, early stages of dementia, A-fib on ASA and metoprolol, and takes oxycodone 10 mg q. 3 hours at home prn due to debilitating rheumatoid arthritis.
He has been without nutrition for over 24 hours and the bedside nurse says that he refuses to eat or drink anything or take his medications.
ainst one of the biggest currencies, the pound was “18% lower than the dollar” (Monaghan 2016). As you can see below, the graph shows how the value of pound dropped when the decision of the referendum was released. Since then, the value of the pound has stayed low as people are still unsure of what is going to happen when the article 50 is triggered and the UK has left the EU completely. These effects below are only the start of the consequences to the UK leaving. People stopped investing their money in the pound worried about what was going to happen. As there was a drastic drop in the investments in the pound; at the same time there are businesses at this point in time deciding to move their businesses to another country. A big example is Vodafone as they are looking to move their headquarters. The reason they wanted to move is because they liked the free movement of people within EU as it was easy to get capital and goods around and it benefited the company. (Palmer, 2016) (Trading, 2016) The value of the pound is depreciating as you can see from the chart above, the prices of houses within the UK is falling. This isn’t due to the high supply; however, it is due to the outcome of the referendum as people are not buying houses as no one knows what other drawbacks are going to be because of the UK leaving. Citizens of the UK are not buying houses at this current time because they are considering whether it would be the best decision to make an investment in a house and stay in the UK or move abroad depending on what other consequences we are going to have to face because of the vote to exit the EU. As the decision was made by the UK to leave, there has been a “0.4%” increase in the inflation rates as you can see in the graphs below (Statistics, 2016a). As the pound fell, the demand for goods and services increased because when the pound is converted into different currencies, the value of the pound worked out cheaper for other countries to purchase. Therefore, this was taken as an advantage as they would be able to buy more for the price they pay now in comparison to before. As mentioned, the demand has increased so the prices of goods and services have also increased too which has a similar effect on tourism. This has had a positive effect on our economy as the employment rate figures have gone down as the more tourism we get the more jobs there are to keep up with demand. (Ferreira, 2016)>GET ANSWER