THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH

THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM.  REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH APPROPRIATE REFERENCE WITHIN 5 YEARS AND 7TH EDITION APA STYLE . MINIMUM OF 350 WORDS WITH AT LEAST 2 PEER REVIEW REFERENCE. 

Please answerer all four point of the question summary in detail

 You are a new AGACNP at an urban, tertiary referral center working in the emergency department. You are presented with the following case.

1. Patient is a 45-year-old, White male, acute care nurse practitioner (ACNP) who comes in with a chief complaint of back pain, acute on chronic. He describes severely compromising, debilitating lumbar spine pain due to a fall from a 20-foot scaffolding. There is MRI evidence of multilevel degenerative spine disease and bulging discs, with a dx of “failed back surgery.”
2. He is prescribed the following by a local pain clinic: OxyContin 20 mg BID, with oxycodone 5 mg q. 3 hours breakthrough pain, Lyrica 100 mg at HS, Lexapro 10 mg daily, and Xanax 0.5 mg BID prn anxiety.
3. He is receiving physical therapy as well as intermittent epidural blocks (last one was 2 weeks ago).

Summarize your actions for the following, in detail:

1. This patient received #60 OxyContin 20 mg and #60 oxycodone 5 mg 2 weeks ago, but is saying that he has been out of medication x 2 days. He would like another prescription. What is your response?
2. He is nauseated with emesis episodes that are too numerous to count this morning. He also has intractable diffuse abdominal pain, intermittent piloerection, and diaphoresis. What is your diagnosis for these symptoms?
3. He admits to using many more pills than prescribed due to increased pain following a fall at home. He wants help, admits to opioid addiction, and is accepting of inpatient admission. What are your initial orders and appropriate referrals? He is requesting methadone. Can you prescribe methadone for acute/chronic pain or addiction as an AGACNP?
4. Ethically and professionally, what are your concerns for this patient and his own ACNP practice? What resources are available to you as a prescriber to track this patient’s opioid use/abuse? What resources are available to a provider of medical care who suffers from addiction?