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.
As a new graduate Acute Care Nurse Practitioner (ACNP) working in the critical care unit on night shifts, being the only provider on duty can present unique challenges. However, with a critical care MD, pharmacist, and hospitalist available for consultation over the phone, appropriate assessment, interventions, recommendations, and referrals can be effectively implemented.
In order to address the patient’s needs, a comprehensive assessment is crucial. Firstly, the patient’s vital signs, oxygenation levels, and level of consciousness should be evaluated. Assessments of the cardiovascular, respiratory, neurological, and renal systems should also be performed. Additionally, a thorough review of the patient’s medical history, current medications, and any recent laboratory or imaging results should be conducted to provide a holistic understanding of the patient’s condition.
Based on the assessment findings, appropriate interventions should be initiated promptly. Depending on the patient’s condition, interventions may include oxygen therapy, intravenous fluid resuscitation, administration of vasoactive medications, pain management, or initiation of mechanical ventilation. Regular reassessment is essential to monitor the patient’s response to interventions and ensure appropriate adjustments are made.
Furthermore, it is important to continually reassess the patient’s pain level and implement appropriate measures to address it. Utilizing validated pain assessment tools, such as the numeric rating scale or the Wong-Baker FACES pain scale, can aid in accurately assessing and managing the patient’s pain. Pharmacological interventions, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), may be necessary to alleviate pain and improve patient comfort. Non-pharmacological methods, such as positioning, relaxation techniques, or distraction, can also be employed as adjuncts to pain management.
In terms of recommendations, collaboration with the critical care MD, pharmacist, and hospitalist is crucial to ensure optimal patient care. Communication with these specialists is essential to discuss the patient’s condition, assessment findings, and proposed interventions. Their expertise can provide valuable insights and guidance in formulating an appropriate care plan. Collaboratively discussing the case will also facilitate interprofessional learning and enhance the quality of care provided.
When it comes to referrals, it is important to identify any special needs the patient may have that are beyond the scope of the ACNP’s practice. For example, if the patient requires neurosurgical or cardiothoracic intervention, timely referral to respective specialists should be made. Additionally, if the patient’s condition deteriorates or there are concerns regarding the management and stabilization of the patient, discussing the possibility of transferring the patient to a higher level of care, such as the intensive care unit (ICU), may be necessary.
To support the assessment, interventions, recommendations, and referrals, evidence-based practice guidelines and research studies are essential resources. Two peer-reviewed resources that can be utilized for this purpose are the Society of Critical Care Medicine’s Guidelines for the Management of Acute Respiratory Distress Syndrome and The Joint Commission’s Advanced Certification in Heart Failure. These resources provide evidence-based recommendations and guidelines for the assessment, management, and monitoring of critically ill patients in the areas of respiratory distress and heart failure.
In summary, as a new graduate ACNP working alone on night shifts in the critical care unit, a comprehensive assessment is essential to identify the patient’s needs. Prompt initiation of appropriate interventions, regular reassessment, effective pain management, and collaboration with other healthcare professionals are key components of providing optimal care. Referrals to specialists or higher levels of care may be necessary depending on the patient’s condition. Utilizing evidence-based practice guidelines and research studies supports the provision of high-quality care.