Mr. B. is a 52-year-old man in the surgical intensive care unit after liver transplantation the previous day. He has a 15-year history of hepatic cirrhosis secondary to alcohol abuse. He is intubated...

Mr. B. is a 52-year-old man in the surgical intensive care unit after liver transplantation the previous day. He has a 15-year history of hepatic cirrhosis secondary to alcohol abuse. He is intubated and is receiving multiple vasopressor medications for hypotension. At 6:30 am, he follows simple commands and denies pain or anxiety with simple head nods. At 7:00 am, Mr. B. is kicking his legs and places his arms outside the side rails. Attempts by the nurse to reorient him result in his pulling at his endotracheal tube. His wrists are restrained with soft restraints. At this time, he does not follow any simple commands. He continually shakes his head back and forth. Facial grimacing is noted, and he is biting down on the endotracheal tube, which is causing the ventilator to sound the highpressure alarm. His blood pressure is 185/110 mm Hg, with a mean arterial pressure of 135 mm Hg. The monitor displays sinus tachycardia at a rate of 140 beats per minute. Medication infusions include epinephrine (3 mcg/min), norepinephrine (15 mcg/min), dopamine (2 mcg/kg/min), and fentanyl (100 mcg/hr). His only other medications are his immunosuppressive drug regimen.

Questions

1. Score Mr. B.’s pain and/or anxiety using the objective tools listed below:

2. Would complementary or alternative medicine therapies be appropriate at this time? If not, what therapies would be appropriate?

3. What type of medication is Mr. B. receiving for pain?

4. Is this an appropriate dose of pain medication for Mr. B.?

5. What other medications could be given to manage his agitated state?