Answer last Morphine injection was 1 hour

Answer the following questions:1.

    Listat least two advantages to using morphine sulfate for pain control in thepostoperative critical care patient.Morphinecompared to lipid- soluble opioids (morphine is Water-soluble):·      "Slower onset of action andlonger duration" (Urden, Stacy, & Lough, 2018, p. 127)  When you ask Ms. Thomas if she is having pain, she indicatesthat she is having 9/10 pain. Her last Morphine injection was 1 hour ago (4mgIV).

She is alert but appears anxious, heart rate is 95 beats per minute, bloodpressure is 155/90 and her respiratory rate is 20. Her skin is warm and dry.2.    Determinethree interventions related to Ms. Thomas' pain (can be pharmacologic ornon-pharmacologic).

·      Give acetaminophen to helpreduce pain. (if prescribed) ·      Minimize stimulation topromote rest, and relaxation therapy. ·      Ice therapy or massagetherapy. (Urden, Stacy, & Lough, 2018, p. 133)3.    Whatother members of the team could you involve in the care of Ms.

Thomas to helpalleviate her pain?·      Physical therapist can helpprovide physical techniques such as ice therapy, and massage therapy.·      Behavior therapist to helpwith relaxation techniques. (Urden, Stacy, & Lough, 2018, p. 133)4.    Whatother pain medications could be used in this case? ·      Acetaminophen·      NSAIDS·      Codeine·      Lidocaine·      Ketamine(Urden, Stacy, & Lough, 2018, p. 127-130)Ms.

Thomas is becoming restless and is not responding well tocommands. She is looking around the room and not making eye contact. 5.    Wouldyou consider this delirium or agitation? Why?Delirium, she seems to have changed in mental statusand can't pay attention. (Urden, Stacy, & Lough,2018, p.

141)6.    UsingFigure 9.2 in your text, determine Ms. Thomas' RASS score. How is this scoreused (list the steps of the assessment)? What does it indicate?HerRass score is +1 and she is CAM-ICU positive Delirium present. 1st step sedationassessment- determine level of sedation- unarousable- combative.

( pt isrestless so score is +1)2nd step deliriumassessment1.    Isthere a change of mental status? Yes move on no- negative. (Pt has change instatus)2.    Inattention:tell patient to squeeze on letter A and spell SAVEAHAART (Pt is unresponsiveand will miss every A) more than 2 errors move on.

0-2- Negative. 3.    Alteredlevel of consciousness: if patients score from step one is above zero they arePositive ( our patient is +1 so they are positive) If not move on to step 44.     Ask them to hold up the same number of fingersas you. If they mess up more than once then they are positive, if not they arenegative. This indicates that she isPositive and Delirium is present.

(Urden,Stacy, & Lough, 2018, p. 142) 7.    Determineher ICDSC (figure 9.3) (Just for this time period-one time).

She is in soft wrist restrainsso that is a +1She can't followinstructions so that is a +1She is awake so she is a Dwhich is a 0 So she has a score of 2points, because she cant be assessed for orientation, hallucinations,inappropriate speech, sleep wake cycle or symptom fluctuation since she cantrespond or we don't have enough information. (Urden,Stacy, & Lough, 2018, p. 143)8.    Listat least two possible causes of delirium/agitation. "Pain,anxiety, delirium, hypoxia, ventilator dyssynchrony, neurologic injury,uncomfortable position, full bladder, sleep deprivation, alcohol withdrawal,sepsis, medication reaction, and organ failure."(Urden, Stacy, & Lough, 2018, p.

141)9.    Whatmedication(s) is commonly used to treat agitation/delirium?Haloperidol– Agitation and DeliriumBenzodiazepine-High SAS or RASS (extreme situation only)(Urden, Stacy, & Lough, 2018, p. 141)10.Discuss common adverse effects of this medication."Confusion, headache,hypertension, blurred vision, drowsiness, dry mouth, urinary retention," (Skidmore-Roth,2017, pp.

579-580) 11.What are some ways to reduce the incidence of delirium in ICU patients? (Listat least three). ·      Spontaneous awakening trials·      Daily delirium monitoring·      Early mobility(Urden, Stacy, & Lough, 2018, p. 143)  References:Urden, L. D., Stacy, K.

M., & Lough, M. E. (2018). Critical care nursing:diagnosis and management.

Maryland Heights, MO: Elsevier.Skidmore-Roth, L.(2017). Mosbys 2017 nursingdrug reference. St.Louis, MO: Elsevier.