A composite ventilated adult moves from a midazolam drip to analgesia-first care with propofol, scored on CPOT and RASS at set intervals, in this MN650 Unit 3 case. Searches like "mn 650 unit 3 assignment example", "mn650 unit 3 sample" and "mn650 unit 3 example" land here.
Replacing a Midazolam Infusion on Day Three of ARDS: Analgesia First, Light Sedation and a Nonbenzodiazepine Agent
[Student Name]
Purdue University Global
MN650: Specialized Pharmacology for the AGACNP Acute Care NP
Unit 3 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Rates are bracketed placeholders; nothing here is a prescribing instruction.
Presentation
A composite 49-year-old high school chemistry teacher developed ARDS after influenza and was intubated at another hospital two days ago. On transfer, day three, she is on FiO2 0.6 and PEEP 12, with a midazolam infusion at 5 mg/h and morphine 2 mg intravenously as needed, last given six hours ago. Her RASS is -4: she opens her eyes to a sternal rub but not to voice. No pain assessment has been recorded since intubation. Triglycerides have not been drawn. Her kidney and liver function are normal. Her husband says she has no history of alcohol or drug use.
Problem Statement
She has unassessed pain, sedation deeper than her ventilator requires, and a benzodiazepine infusion that the guideline suggests avoiding.
Why the Current Regimen Exceeds What She Needs
A patient who cannot report pain may still have it, from the endotracheal tube, suctioning, turning and the lines in place. The PADIS guideline recommends assessing pain with a validated behavioral scale when self-report is not possible, and it suggests an analgesia-first approach, treating pain before adding sedatives (Devlin et al., 2018). The Critical-Care Pain Observation Tool, which scores facial expression, body movement, muscle tension and ventilator compliance, has been validated for this purpose (Gélinas et al., 2006).
At RASS -4, she is more deeply sedated than needed for ventilator synchrony at her current settings. PADIS suggests targeting light sedation in mechanically ventilated adults, and it suggests propofol or dexmedetomidine rather than benzodiazepines (Devlin et al., 2018). Each of these is a conditional recommendation in the guideline, not a rule, and the plan treats them as the default from which any departure must be justified.
The Plan
Fentanyl, first. Start at [a composite rate] mcg/h, with bolus doses for procedures, titrated every [30 to 60] minutes to a CPOT below 3. Monitoring: CPOT every [two] hours and before and after procedures; respiratory drive and blood pressure.
Propofol, second. Start at [5] mcg/kg/min and titrate by [5] to [10] mcg/kg/min every [10] minutes toward a RASS of -1 to 0, within a range of [5 to 50] mcg/kg/min. Monitoring: triglycerides at 48 hours and then every [three] days; blood pressure, since propofol lowers it; a ceiling of [50] mcg/kg/min, with review if higher rates are needed for more than 48 hours, because high doses over long periods are associated with propofol infusion syndrome.
Dexmedetomidine, for liberation. As she improves and weaning begins, dexmedetomidine can replace propofol, since it allows lighter, more cooperative sedation and does not suppress breathing.
Midazolam, off over a shift. After four days of continuous benzodiazepine, stopping it abruptly could cause withdrawal and agitation, which might then be treated with more sedation. The infusion is halved when fentanyl and propofol are running, then halved again after [four] hours, then stopped, with the RASS and CPOT watched throughout.
Why Propofol for Her
Propofol is chosen over dexmedetomidine at this stage because she is on FiO2 0.6 and PEEP 12 and may need deeper sedation briefly if her oxygenation worsens, which dexmedetomidine does not reliably provide. Propofol's quick offset also suits a patient expected to begin weaning within days. The triglyceride check and ceiling address its main risks.
Delirium
Delirium is assessed with the CAM-ICU twice a day and with any change in behavior (Ely et al., 2001). Benzodiazepines are associated with delirium in critically ill adults, which is a further reason to move away from midazolam. Nonpharmacologic measures begin today: glasses and hearing aids if she uses them, day and night cues, and her husband's visits.
Daily Awakening and Breathing Trials
Each morning, sedation is paused for a spontaneous awakening trial, and if she passes, a spontaneous breathing trial follows. In the Awakening and Breathing Controlled trial, pairing these two trials shortened time on the ventilator and in intensive care and improved one-year survival compared with usual sedation and a breathing trial alone (Girard et al., 2008). Safety screens are checked first: no active seizures or alcohol withdrawal, no escalating sedation for agitation, no paralytics, no myocardial ischemia and no raised intracranial pressure. Her ARDS is the main barrier to passing the breathing trial now, and the awakening trial can proceed while oxygenation improves.
What Would Change the Plan
Worsening oxygenation that required prone positioning or paralysis would call for deeper sedation for that period, and the plan would pause the RASS target and use a different approach. Rising triglycerides above [a composite threshold] would prompt a switch away from propofol. Persistent agitation despite a CPOT below 3 would be assessed for delirium, withdrawal or another cause before sedation is increased. Her husband will be told each change in the plan and why, since he has asked to understand what the medicines are doing, and his account of her usual personality will help the team recognize delirium when she begins to wake.
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
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., Hart, R. P., & Dittus, R. (2001). Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA, 286(21), 2703-2710. https://doi.org/10.1001/jama.286.21.2703
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
Gélinas, C., Fillion, L., Puntillo, K. A., Viens, C., & Fortier, M. (2006). Validation of the Critical-Care Pain Observation Tool in adult patients. American Journal of Critical Care, 15(4), 420-427. https://doi.org/10.4037/ajcc2006.15.4.420
How this MN650 Unit 3 example is structured
The case follows an argument rather than a drug list. It opens from what the patient needs, pain relief and enough sedation for ventilator synchrony, then shows why the current infusion exceeds both. PADIS supplies the three claims the paper makes: assess pain with a validated behavioral tool when self-report is impossible, target light sedation, and prefer propofol or dexmedetomidine over benzodiazepines for mechanically ventilated adults. Each is reported as a conditional recommendation, which is how the guideline grades them, and none is inflated into a rule. The agent choice is then fitted to this patient: propofol for its quick offset in someone expected to wean within days, with triglycerides checked at 48 hours and a stated ceiling on rate and duration. The move off midazolam is staged over a shift rather than made at once, and the reason is given.
Get an MN650 Unit 3 example written to your instructions
Name the agents your Unit 3 case uses and the scales your MN650 rubric expects, and include the patient data. Modeled on that case, a sample free on a first request and ready within 24-48h ties each drug to a scored goal and explains why the agents it replaces were set aside. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN650 Unit 3 questions, answered
Can the paper choose dexmedetomidine instead of propofol?
Yes, if the reasoning fits the patient. PADIS allows either for mechanically ventilated adults, and the choice usually turns on heart rate, blood pressure, expected time to extubation and whether deeper sedation might be needed. The sample defends one agent and says in a sentence why the other was not chosen for this case, which is the comparison markers look for.
Which pain scale should the case use?
A validated behavioral scale when the patient cannot self-report. PADIS names the Critical-Care Pain Observation Tool and the Behavioral Pain Scale as the best supported. The sample uses whichever the prompt or unit specifies and states the threshold that prompts treatment, since a scale mentioned without an action threshold earns little credit.
Are the infusion rates in the sample real doses?
They are bracketed placeholders drawn from the ranges references publish, included so the structure of a titration plan is visible. The coursework is graded on the reasoning, targets and monitoring. Actual rates for any patient come from the hospital's protocols, its pharmacists and the treating team, and the sample should not be read as a recommendation.