| Course | NU648 Specialized Pharmacology for the AGACNP |
|---|---|
| Unit | Unit 6 |
| Paper type | Multimodal pain plan |
| Length | About 960 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU648 Unit 6
Building on Buprenorphine, Not Around It: A Multimodal Pain Plan for Tibial Plateau Fixation in a 44-Year-Old in Recovery
[Student Name]
Purdue University Global
NU648: Specialized Pharmacology for the AGACNP
Unit 6 Multimodal Pain Plan
[Instructor Name]
[Date]
The patient is composite; doses, scores and days are bracketed, and every opioid decision is shared with his buprenorphine prescriber.
Assessment
Mr. [D.] is a [44]-year-old man who fractured his left tibial plateau in a fall from a ladder at work. Open reduction and internal fixation is planned for [Day 0]. He has taken buprenorphine-naloxone [16 mg] once daily for [three] years, prescribed by [Dr. K.] at an outpatient addiction clinic, and has been in stable recovery throughout. His creatinine is [0.8] mg/dL, he has no history of gastrointestinal bleeding, and he takes no other medications. He is anxious about two things: being in pain, and being given opioids that could threaten his recovery.
His goals, agreed with him before surgery, are functional. He wants to bear weight as the surgeon orders, tolerate physical therapy twice a day, sleep through most of the night and go home by [Day 3]. Pain will be recorded on a 0 to 10 scale alongside a functional score, and a rising number will be read together with what he can and cannot do.
The measure of this plan is whether he can walk to therapy and back, not whether the pain score reaches zero.
Layer One: Continue Buprenorphine and Split the Dose
Decision: continue buprenorphine-naloxone through surgery without a taper; from the evening before surgery, give [8 mg] twice daily instead of [16 mg] once daily.
The pharmacology is the reason. Buprenorphine binds the mu receptor tightly and only partly activates it. Stopping it before surgery would expose him to withdrawal and to relapse risk, and restarting it later would require him to be in withdrawal again. National addiction guidance advises against routine discontinuation of buprenorphine before surgery (American Society of Addiction Medicine, 2020), and a multisociety panel recommends continuing it through the perioperative period, adjusting the dose rather than stopping it (Kohan et al., 2021). Splitting the daily dose makes use of buprenorphine's own analgesic effect, which lasts hours rather than a full day. His prescriber has agreed to the split and to managing the return to once-daily dosing after discharge.
Layer Two: Scheduled Non-Opioids
Decisions: acetaminophen [1,000 mg] every [eight] hours, scheduled, not as needed; ketorolac [15 mg] intravenously every [six] hours for no more than [48] hours after surgery, then ibuprofen [400 to 600 mg] every [eight] hours with food through [Day 5].
These drugs do the main analgesic work in the plan, not a background role. The American Pain Society guideline recommends multimodal analgesia built on acetaminophen and nonsteroidal anti-inflammatory drugs unless contraindicated (Chou et al., 2016). His young age, normal kidney function and absence of ulcer history support a short course. The orthopedic concern that anti-inflammatory drugs may impair bone healing is acknowledged; the evidence is mixed, and the plan limits the course to [five] days and asks the surgeon to confirm the choice before the first dose.
Layer Three: Regional Block and Low-Dose Ketamine
Decisions: a regional block placed by the anesthesia team before surgery, with the technique their choice; ketamine started in the operating room and continued at [0.1 to 0.2] mg/kg per hour for up to [48] hours, reviewed each morning.
A block removes a large part of the early pain signal at the source, and it may spare the full opioid doses that buprenorphine makes less effective. Ketamine works on a different receptor from every other drug in the plan. The ASRA, AAPM and ASA consensus guideline supports subanesthetic ketamine for surgery expected to be painful and for patients who are opioid tolerant, which includes patients on buprenorphine, with infusions not exceeding 1 mg/kg per hour (Schwenk et al., 2018). His dose sits well below that ceiling. Nursing monitoring will include sedation, blood pressure and any dissociative symptoms, and the infusion stops if they appear.
Layer Four: Short-Acting Opioid, Last and Limited
Decision: oxycodone [5 to 10 mg] by mouth every [four] hours as needed for pain that limits therapy or sleep despite layers one to three; stop date [Day 3] in the hospital; a discharge supply only if agreed with his prescriber.
This is the layer patients and nurses both worry about most. Because buprenorphine occupies most mu receptors, a full agonist may need higher doses than in an opioid-naive patient to have an effect, and the plan says so openly, so that an ordered dose that does not work is not mistaken for drug-seeking. The plan also says what the opioid is for: function, not a number. If he needs more than [four] doses in a day, the team reviews the block, the ketamine rate and the fixation before increasing the opioid.
Mr. [D.] will be told exactly what he is receiving and why. Patients in recovery often fear that any opioid will undo their progress, and the plan treats his fear as information rather than an obstacle.
Discharge and Handoff
Discharge orders include scheduled acetaminophen and ibuprofen through [Day 5], a bowel regimen while on any opioid, naloxone nasal spray with teaching for him and his partner, and no benzodiazepines or sedating sleep aids. His buprenorphine prescriber will receive a summary on the day of discharge that states his current split dose, any oxycodone given in the last [24] hours, and a plan to return to once-daily dosing at the first follow-up visit on [Day 7].
Pain management that ends at the hospital door is unfinished. The handoff to the addiction clinic is the last line of the plan because it is the one that protects his recovery after the incision heals.
References
American Society of Addiction Medicine. (2020). The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. Journal of Addiction Medicine, 14(2S), 1-91. https://doi.org/10.1097/ADM.0000000000000633
Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., Carter, T., Cassidy, C. L., Chittenden, E. H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M. F., Suresh, S., Sluka, K., Strassels, S., . . . Wu, C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2), 131-157. https://doi.org/10.1016/j.jpain.2015.12.008
Kohan, L., Potru, S., Barreveld, A. M., Sprintz, M., Lane, O., Aryal, A., Emerick, T., Dopp, A., Chhay, S., & Viscusi, E. (2021). Buprenorphine management in the perioperative period: Educational review and recommendations from a multisociety expert panel. Regional Anesthesia & Pain Medicine, 46(10), 840-859. https://doi.org/10.1136/rapm-2021-103007
Schwenk, E. S., Viscusi, E. R., Buvanendran, A., Hurley, R. W., Wasan, A. D., Narouze, S., Bhatia, A., Davis, F. N., Hooten, W. M., & Cohen, S. P. (2018). Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Regional Anesthesia & Pain Medicine, 43(5), 456-466. https://doi.org/10.1097/AAP.0000000000000806
The Purdue Global NU648 Unit 6 instructions
The Unit 6 assignment asks you to design an analgesic plan for an acute care patient whose history complicates pain control. You assess the pain and the patient, set goals, choose agents from more than one class, justify each with evidence, name monitoring and adverse effects to watch for and plan the transition home. When the patient takes buprenorphine or methadone for opioid use disorder, the plan must address that treatment directly rather than stop it by default. Expect a length of three to four pages, supported by guidelines published in the last several years. A plan that relies on one class of drug, or on opioids alone, rarely meets the multimodal requirement.
Inside the NU648 Unit 6 example
The example is laid out in four layers, each with a decision line and a justification. An assessment paragraph comes first with the buprenorphine dose, the prescriber, kidney function and his two fears: pain and relapse. The buprenorphine layer explains the pharmacology that makes continuing safer than stopping and cites the addiction guideline and the multisociety panel. The non-opioid layer is treated as the main analgesic work, with contraindications checked against his age and kidneys. The ketamine rate is set against the consensus ceiling. The opioid layer explains why ordered doses may need to be higher and why that is not drug-seeking. Discharge closes the plan, with naloxone, a bowel regimen and a summary sent to his prescriber on the day he leaves.
Reading the NU648 Unit 6 grading rubric
The Unit 6 rubric divides its points among assessment, choice of agents, evidence, safety monitoring and discharge planning. Assessment earns full credit when it records function as well as a pain score. Choice of agents is judged on whether the classes work by different mechanisms and whether each is justified for this patient. Evidence counts when guidelines are current, such as the 2020 addiction guideline and the 2018 ketamine consensus. Safety covers sedation, respiratory depression, kidney function and bleeding. Discharge planning is often weighted more than students expect; naloxone, a bowel regimen and a handoff to the buprenorphine prescriber each count toward it.
NU648 Unit 6 help: mistakes that cost points
The biggest error in this unit is stopping buprenorphine before surgery, or planning to, which the current guidance advises against. Another is building the plan around the opioid and adding acetaminophen as an afterthought. Students often give ketamine without a dose ceiling or monitoring. Some omit the patient's own goals, so the plan cannot tell when it is working. Plans also forget that buprenorphine blunts full agonists, and then read an unrelieved patient as drug-seeking. Finally, the handoff at discharge is frequently missing, which leaves the patient's recovery unprotected once the fracture pain settles. Check that every drug in the plan has a stop point or a review date, since open-ended orders are where graders look for gaps.
Get an NU648 Unit 6 example written to your instructions
Send your NU648 Unit 6 case with its surgery or injury, the patient's background and home medications, and the rubric. Free the first time and finished inside 24-48h, the plan sample builds analgesia in layers around function, justifies every agent against the patient's risks, and plans discharge as part of the pain plan. 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.
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NU648 Unit 6 questions, answered
Does every multimodal pain plan need an opioid?
No. Many plans for moderate pain use none, and the unit often rewards showing that an opioid was considered and not needed. When one is included, as in this case, the sample bounds it with an indication, a stop date and monitoring, and explains what the other layers could not provide on their own.
Is continuing buprenorphine through surgery settled practice?
Current guidance leans that way. The 2020 ASAM focused update and several multisociety consensus statements advise against routine discontinuation, though approaches to dose and splitting vary by institution. The sample cites the guidance, notes the variation, and treats coordination with the patient's prescriber as part of the plan rather than an afterthought.
Are the analgesic doses in the sample meant for clinical use?
They are illustrative placeholders in brackets, included so the layered structure reads clearly. Actual analgesic orders depend on the surgical and anesthesia teams, pharmacy review and hospital protocols. The sample is a composite coursework plan, and it models how a plan is justified rather than what any particular patient should receive.
Where can I find a free NU648 Unit 6 sample paper?
The complete NU648 Unit 6 multimodal pain plan is on this page, with buprenorphine continued, three further layers of analgesia and a discharge handoff. If your patient or procedure differs, request a free sample built from your own case details.
Should buprenorphine be stopped before surgery in NU648 Unit 6?
The sample continues it. Current addiction guidance and a multisociety panel advise against routine discontinuation, because stopping risks withdrawal and relapse and restarting later requires withdrawal again. Splitting the daily dose uses buprenorphine's own analgesic effect.