| Course | NR 567 Advanced Pharmacology for the Adult Gerontology Acute Care Nurse Practitioner |
|---|---|
| Week | 5 |
| Paper type | Sedation and analgesia plan |
| Length | About 1,150 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Acute Care NP (AGACNP) |
| Updated | October 2026 |
Free sample paper for NR 567 Week 5
Sedation and Analgesia Plan: Fentanyl First for a Ventilated Patient in Septic Shock, a RASS Band of Minus One to Zero, Propofol Chosen on Offset and a Daily Lightening Paired With a Breathing Trial
Student Name
College of Nursing, Chamberlain University
NR 567: Advanced Pharmacology for the Adult Gerontology Acute Care Nurse Practitioner
Instructor Name
Month Day, Year
Sedation and Analgesia Plan: Fentanyl First for a Ventilated Patient in Septic Shock, a RASS Band of Minus One to Zero, Propofol Chosen on Offset and a Daily Lightening Paired With a Breathing Trial
The Patient Today
It is day 3 for the composite patient followed through this course: 66 years old, 92 kg, ventilated for severe pneumonia with septic shock, on norepinephrine and vasopressin, anuric on continuous hemodiafiltration. Overnight the patient was agitated, pulling at the endotracheal tube, with a heart rate of 118 and ventilator dyssynchrony. The night team had increased the propofol. This plan resets the approach.
Pain First, and Named
An agitated ventilated patient may be in pain, and sedating pain produces a quiet patient who still hurts. The sources here are identified by name: the endotracheal tube, the right internal jugular central line and the femoral dialysis catheter, pleuritic pain from the pneumonia, and positioning and turning. The Critical-Care Pain Observation Tool (CPOT) is scored at 5 on assessment, above the threshold of 2 that suggests significant pain. Guidance recommends an analgesia-first approach to sedation in ventilated adults, treating pain before adding or increasing sedatives (Devlin et al., 2018).
Analgesic: fentanyl infusion, starting at 50 mcg/h, with 25 mcg boluses every 15 minutes as needed for CPOT above 2, and the infusion adjusted by 25 mcg/h every 30 minutes to keep CPOT at 2 or below, up to 200 mcg/h before review. Fentanyl is chosen because its effect does not depend on kidney function; morphine is avoided because its active metabolites accumulate in kidney failure, causing prolonged sedation and respiratory depression even after the infusion stops. Before turns and dressing changes, a 25 mcg bolus is given five minutes ahead.
A Score, Not an Adjective
Target depth: Richmond Agitation-Sedation Scale (RASS) of minus 1 to 0, meaning drowsy but rousable to voice with eye contact for more than 10 seconds, or alert and calm. Assessed every 2 hours and before and after any dose change.
Light sedation is associated with shorter time on the ventilator and in the intensive care unit compared with deep sedation (Devlin et al., 2018). A band allows two nurses on two shifts to aim at the same patient. Deeper sedation, to RASS minus 3 or below, is permitted only for specific reasons named in the order, such as severe ventilator dyssynchrony with dangerous oxygenation or paralysis for refractory hypoxemia, and must be reviewed every shift.
Chosen on Offset
Sedative: propofol, continued at the lowest rate that keeps RASS in the band, starting today at 10 mcg/kg/min and adjusted by 5 mcg/kg/min every 10 minutes, to a maximum of 50 mcg/kg/min before review. Propofol is chosen for its short offset: its effect wears off within minutes after stopping, even after days of infusion, which allows the daily neurological examination and the breathing trial. Benzodiazepines such as midazolam are avoided, because they accumulate, especially when the kidneys have failed, and are associated with more delirium and longer ventilation; guidance suggests propofol or dexmedetomidine over benzodiazepines (Devlin et al., 2018).
Propofol cautions: propofol adds calories as lipid and can raise triglycerides, so a triglyceride level is checked every 48 hours and the nutrition team counts the propofol calories. Propofol also lowers blood pressure, which matters in a patient still on vasopressors; if norepinephrine needs to rise each time propofol is increased, dexmedetomidine is considered as an alternative once the patient is off vasopressin, recognizing that early dexmedetomidine as the main sedative did not lower mortality in a large trial and caused more bradycardia and hypotension (Shehabi et al., 2019). Rarely, high doses for long periods cause propofol infusion syndrome, so rising lactate, new arrhythmia or rising creatine kinase prompt an immediate review.
The Daily Lightening
Every morning at 08:00, if safety criteria are met, the propofol is stopped and the fentanyl reduced to the lowest rate that keeps CPOT at 2 or below: this is the spontaneous awakening trial. Safety criteria: no active seizures, no alcohol withdrawal, no paralytic, no escalation of vasopressors in the past 6 hours, no ongoing cardiac ischemia and no concern about intracranial pressure. If the patient wakes and tolerates it, a spontaneous breathing trial follows immediately. Pairing the awakening trial with a breathing trial reduced time on the ventilator and improved survival compared with breathing trials alone in a randomized trial (Girard et al., 2008). If the patient becomes agitated, distressed or unsafe, sedation restarts at half the previous rate and is then adjusted to the target.
Delirium and the Half Without Drugs
Delirium is screened every shift with the Confusion Assessment Method for the ICU (CAM-ICU). Antipsychotics are not given routinely to prevent or treat delirium, since guidance does not support their routine use (Devlin et al., 2018). The other half of the plan has no drugs in it: the patient's hearing aids and glasses are brought in by the family, a clock and calendar are placed in view, lights are dimmed and noise reduced from 22:00 to 06:00, and the physical therapist begins passive range of motion today and sitting at the edge of the bed once vasopressors are off. Family visits are encouraged, and the family is asked to talk to the patient about familiar things.
What the Night Team Does Differently
The night team is asked to check CPOT before increasing propofol when the patient becomes agitated. If CPOT is above 2, the first step is a fentanyl bolus. If CPOT is 2 or below and RASS is above plus 1, the next step is to check for causes such as hypoxemia, a full bladder, ventilator dyssynchrony or delirium before adding sedative.
Review
The plan is reviewed on rounds every morning: total fentanyl and propofol doses over 24 hours, RASS and CPOT trends, the result of the awakening and breathing trials, and CAM-ICU results. If fentanyl has run for more than seven days, the plan to wean will include a taper to avoid withdrawal.
Communicating the Plan
The plan is written in the order set and read aloud at the bedside on rounds, with the night nurse present when possible, so that the people adjusting the infusions at 03:00 heard the reasoning at 09:00. The family is told that the goal is for the patient to be comfortable and calm but able to respond, and that daily periods of lighter sedation are planned and expected. Families who understand the purpose of the awakening trial are less alarmed when the patient opens their eyes, looks distressed for a few minutes and is then settled again.
References
Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., . . . Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299
Girard, T. D., Kress, J. P., Fuchs, B. D., Thomason, J. W. W., Schweickert, W. D., Pun, B. T., Taichman, D. B., Dunn, J. G., Pohlman, A. S., Kinniry, P. A., Jackson, J. C., Canonico, A. E., Light, R. W., Shintani, A. K., Thompson, J. L., Gordon, S. M., Hall, J. B., Dittus, R. S., Bernard, G. R., & Ely, E. W. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. The Lancet, 371(9607), 126-134. https://doi.org/10.1016/S0140-6736(08)60105-1
Shehabi, Y., Howe, B. D., Bellomo, R., Arabi, Y. M., Bailey, M., Bass, F. E., Bin Kadiman, S., McArthur, C. J., Murray, L., Reade, M. C., Seppelt, I. M., Takala, J., Wise, M. P., & Webb, S. A. (2019). Early sedation with dexmedetomidine in critically ill patients. New England Journal of Medicine, 380(26), 2506-2517. https://doi.org/10.1056/NEJMoa1904710
Reading the NR 567 Week 5 instructions
The sedation and analgesia plan usually asks you to manage comfort, sedation and delirium for a mechanically ventilated patient. Expect the prompt to ask for agents, doses, targets, monitoring and daily interruption. Address pain first, naming its sources and using a validated pain score. Give depth as a score with a band, not an adjective. Choose agents for their offset and for how they behave in the patient's organs, especially the kidneys and liver. Write in a daily lightening with safety criteria, and pair it with a breathing trial. Screen for delirium, and include the nondrug measures that prevent it. Tell the night team what to check before increasing sedation, and cite current guidance.
How this NR 567 Week 5 example is built
The sample opens on day 3 with an agitated, dyssynchronous patient and a night team that had raised propofol. A pain section names the endotracheal tube, lines, pleuritic pain and turning, scores the Critical-Care Pain Observation Tool at 5 and starts fentanyl with bolus and titration rules, explaining why morphine is avoided in kidney failure. A RASS band and its reasons follow. Propofol is kept for its short offset, benzodiazepines are avoided, and triglycerides, hypotension and propofol infusion syndrome are addressed, with dexmedetomidine as an alternative. A daily awakening trial with safety criteria is paired with a breathing trial. Delirium screening, family and environmental measures, instructions for the night team and a communication section complete it.
NR 567 Week 5 rubric: what full points look like
Sedation plans are commonly marked on whether pain is treated before sedation, whether depth is a score with a band, whether agents suit the patient's organ function and offset needs, whether a daily lightening is scheduled and whether delirium is addressed with drug and nondrug measures. Sedating a problem that was pain loses the most, so this sample names each source and scores it first. A RASS band lets every shift aim at the same patient. Choosing fentanyl over morphine because of kidney failure, and propofol for its offset, shows organ-aware selection. A scheduled awakening trial paired with a breathing trial reflects strong evidence. Nondrug delirium measures and specific instructions for the night team show the plan works at the bedside. Guideline and trial citations support each element.
Common NR 567 Week 5 mistakes, and how to avoid them
The heaviest loss in this plan comes from sedating an agitated patient without asking about pain. Another is depth written as calm or comfortable, which two nurses will interpret differently. Some plans choose an agent that accumulates, such as a benzodiazepine or morphine in kidney failure, for a patient whose neurological examination matters. Many forget the daily lightening or leave out its safety criteria. Others treat delirium only with drugs and ignore sleep, glasses, hearing aids and mobility. Name and score the pain, set a RASS band, pick agents by offset and organ function, schedule the awakening trial and cover the nondrug half. A plan for your own ventilated patient can be written from the case details.
Get a NR 567 Week 5 example written to your instructions
Send the Week 5 instructions, the rubric if there is one, and the clinical situation you want the plan written around, and a custom example comes back inside 24-48h with the first one free. If your section wants orders and rationale in separate columns, it is written that way.
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NR 567 Week 5 questions, answered
Why does analgesia come before sedation?
Because an agitated patient in pain who is given a sedative ends up quiet and still in pain. The finished plan treats the source of the pain first, then asks whether anything is left to sedate. Plans written the other way round produce escalating infusions, a patient nobody can assess, and a set of orders that cannot explain what it is treating.
How is the target depth expressed?
As a score with a band, checked at a stated interval, and light unless a reason is written down. The plan names the scale, the acceptable range and the frequency of assessment. Where deep sedation is genuinely required, the reason sits on the same line, because depth with no justification beside it is the most examined item in the week.
Does the plan have to cover delirium?
It should. Screening at a stated interval, the agents on the list that make it likelier, and the measures that reduce it with no prescription at all: light during the day, sleep at night, glasses and hearing aids back on the patient, movement as early as the situation permits. Plans that reach for another drug first read as unfinished.
Where can I find a free NR 567 Week 5 sample paper?
The fentanyl-first plan above, with a RASS band and a daily awakening trial paired with a breathing trial, is the full NR 567 Week 5 sample. A plan for another ventilated patient can be prepared on request.
Why is morphine avoided in the NR 567 Week 5 plan?
The patient's kidneys have failed, and morphine's active metabolites accumulate in kidney failure, prolonging sedation and breathing suppression; fentanyl does not depend on the kidneys.