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CCRN Critical Care Register Nurse study help | http://babelouedstory.com/

CCRN study help - Critical Care Register Nurse Updated: 2024

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Exam Code: CCRN Critical Care Register Nurse study help January 2024 by Killexams.com team

CCRN Critical Care Register Nurse

A criterion-referenced standard setting process, known as the modified Angoff, is used to establish the passing point/cut score for the exam. Each candidates performance on the exam is measured against a predetermined standard.

The passing point/cut score for the exam is established using a panel of subject matter experts, an exam development committee (EDC), who carefully reviews each exam question to determine the basic level of knowledge or skill that is expected. The passing point/cut score is based on the panels established difficulty ratings for each exam question.

Under the guidance of a psychometrician, the panel develops and recommends the passing point/cut score, which is reviewed and approved by AACN Certification Corporation. The passing point/cut score for the exam is established to identify individuals with an acceptable level of knowledge and skill. All individuals who pass the exam, regardless of their score, have demonstrated an acceptable level of knowledge.



I. CLINICAL JUDGMENT (80%)

A. Cardiovascular (17%)

1. Acute coronary syndrome:

a. NSTEMI

b. STEMI

c. Unstable angina

2. Acute peripheral vascular insufficiency:

a. Arterial/venous occlusion

b. Carotid artery stenosis

c. Endarterectomy

d. Fem-Pop bypass

3. Acute pulmonary edema

4. Aortic aneurysm

5. Aortic dissection

6. Aortic rupture

7. Cardiac surgery:

a. CABG

b. Valve replacement or repair

8. Cardiac tamponade

9. Cardiac trauma

10. Cardiac/vascular catheterization

11. Cardiogenic shock

12. Cardiomyopathies:

a. Dilated

b. Hypertrophic

c. Idiopathic

d. Restrictive

13. Dysrhythmias

14. Heart failure

15. Hypertensive crisis

16. Myocardial conduction system abnormalities

(e.g., prolonged QT interval, Wolff-ParkinsonWhite)

17. Papillary muscle rupture

18. Structural heart defects (acquired and congenital, including valvular disease)

19. TAVR



B. Respiratory (15%)

1. Acute pulmonary embolus

2. ARDS

3. Acute respiratory failure

4. Acute respiratory infection (e.g., pneumonia)

5. Aspiration

6. Chronic conditions (e.g., COPD, asthma, bronchitis, emphysema)

7. Failure to wean from mechanical ventilation

8. Pleural space abnormalities (e.g., pneumothorax, hemothorax, empyema, pleural effusions)

9. Pulmonary fibrosis

10. Pulmonary hypertension

11. Status asthmaticus

12. Thoracic surgery

13. Thoracic trauma (e.g., fractured rib, lung contusion, tracheal perforation)

14. Transfusion-related acute lung injury (TRALI)



C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (20%)

1. Endocrine

a. Adrenal insufficiency

b. Diabetes insipidus (DI)

c. Diabetes mellitus, types 1 and 2

d. Diabetic ketoacidosis (DKA)

e. Hyperglycemia

f. Hyperosmolar hyperglycemic state (HHS)

g. Hyperthyroidism

h. Hypoglycemia (acute)

i. Hypothyroidism

j. SIADH

2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC, HIT)

c. Immune deficiencies

d. Leukopenia

e. Oncologic complications (e.g., tumor lysis syndrome, pericardial effusion)

f. Thrombocytopenia

g. Transfusion reactions

3. Gastrointestinal

a. Abdominal compartment syndrome

b. Acute abdominal trauma

c. Acute GI hemorrhage

d. Bowel infarction, obstruction, perforation (e.g., mesenteric ischemia, adhesions)

e. GI surgeries (e.g., Whipple, esophagectomy, resections)

f. Hepatic failure/coma (e.g., portal hypertension, cirrhosis, esophageal varices, fulminant hepatitis, biliary atresia, drug-induced)

g. Malnutrition and malabsorption

h. Pancreatitis

4. Renal and Genitourinary

a. Acute genitourinary trauma

b. Acute kidney injury (AKI)

c. Chronic kidney disease (CKD)

d. Infections (e.g., kidney, urosepsis)

e. Life-threatening electrolyte imbalances

5. Integumentary

a. Cellulitis

b. IV infiltration

c. Necrotizing fasciitis

d. Pressure injury

e. Wounds:

i. infectious

ii. surgical

iii. trauma

D. Musculoskeletal/Neurological/



Psychosocial (14%)

1. Musculoskeletal

a. Compartment syndrome

b. Fractures (e.g., femur, pelvic)

c. Functional issues (e.g., immobility, falls, gait disorders)

d. Osteomyelitis

e. Rhabdomyolysis

2. Neurological

a. Acute spinal cord injury

b. Brain death

c. Delirium (e.g., hyperactive, hypoactive, mixed)

d. Dementia

e. Encephalopathy

f. Hemorrhage:

i. intracranial (ICH)

ii. intraventricular (IVH)

iii. subarachnoid (traumatic or aneurysmal)

g. Increased intracranial pressure (e.g., hydrocephalus)

h. Neurologic infectious disease (e.g., viral, bacterial, fungal)

i. Neuromuscular disorders (e.g., muscular dystrophy, CP, Guillain-Barré, myasthenia)

j. Neurosurgery (e.g., craniotomy, Burr holes)

k. Seizure disorders

l. Space-occupying lesions (e.g., brain tumors)

m. Stroke:

i. hemorrhagic

ii. ischemic (embolic)

iii. TIA

n. Traumatic brain injury (TBI): epidural, subdural, concussion

3. Behavioral and Psychosocial

a. Abuse/neglect

b. Aggression

c. Agitation

d. Anxiety

e. Suicidal ideation and/or behaviors

f. Depression

g. Medical non-adherence

h. PTSD

i. Risk-taking behavior

j. Substance use disorders (e.g., withdrawal, chronic alcohol or drug dependence)

E. Multisystem (14%)

1. Acid-base imbalance

2. Bariatric complications

3. Comorbidity in patients with transplant history

4. End-of-life care

5. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

6. Hypotension

7. Infectious diseases:

a. Influenza (e.g., pandemic or epidemic)

b. Multi-drug resistant organisms (e.g., MRSA, VRE, CRE)

8. Life-threatening maternal/fetal complications (e.g., eclampsia, HELLP syndrome, postpartum hemorrhage, amniotic embolism)

9. Multiple organ dysfunction syndrome (MODS)

10. Multisystem trauma

11. Pain: acute, chronic

12. Post-intensive care syndrome (PICS)

13. Sepsis

14. Septic shock

15. Shock states:

a. Distributive (e.g., anaphylactic, neurogenic)

b. Hypovolemic

16. Sleep disruption (including sensory overload)

17. Thermoregulation

18. Toxic ingestion/inhalations (e.g., drug/alcohol overdose)

19. Toxin/drug exposure (including allergies)



II. PROFESSIONAL CARING 7 ETHICAL PRACTICE (20%)

A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



CLINICAL JUDGMENT

General

• Recognize normal and abnormal:

o developmental assessment findings and provide developmentally appropriate care

o physical assessment findings

o psychosocial assessment findings

• Recognize signs and symptoms of emergencies, initiate interventions, and seek assistance as needed

• Recognize indications for, and manage patients requiring:

o capnography (EtCO2)

o central venous access

o medication reversal agents

o palliative care

o SvO2 monitoring

• Manage patients receiving:

o complementary/alternative medicine and/or nonpharmacologic interventions

o medications (e.g., safe administration, monitoring, polypharmacy)

• Monitor patients and follow protocols for pre- and postoperative care

• Assess pain

• Evaluate patients response to interventions

• Identify and monitor normal and abnormal diagnostic test results

• Manage fluid and electrolyte balance

• Manage monitor alarms based on protocols and changes in patient condition Cardiovascular

• Apply leads for cardiac monitoring

• Identify, interpret and monitor cardiac rhythms

• Recognize indications for, and manage patients requiring:

o 12-lead ECG

o arterial catheter

o cardiac catheterization

o cardioversion central venous pressure monitoring

o defibrillation

o IABP

o invasive hemodynamic monitoring

o pacing: epicardial, transcutaneous, transvenous

o pericardiocentesis

o QT interval monitoring

o ST segment monitoring

• Manage patients requiring:

o endovascular stenting

o PCI Respiratory

• Interpret blood gas results

• Recognize indications for, and manage patients requiring:

o modes of mechanical ventilation

o noninvasive positive pressure ventilation (e.g., BiPAP, CPAP, high-flow nasal cannula)

o oxygen therapy delivery devices

o prevention of complications related to mechanical ventilation (ventilator bundle)

o prone positioning

o pulmonary therapeutic interventions related to mechanical ventilation: airway clearance, extubation, intubation, weaning

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2 )

o thoracentesis

o tracheostomy Hematology and Immunology

• Manage patients receiving transfusion of blood products

• Monitor patients and follow protocols:

o pre-, intra-, post-intervention (e.g., plasmapheresis, exchange transfusion, leukocyte depletion)

o related to blood conservation Neurological

• Recognize indications for, and manage patients requiring neurologic monitoring devices and drains (e.g., ICP, ventricular or lumbar drain)

• Use a swallow evaluation tool to assess dysphagia

• Manage patients requiring:

o neuroendovascular interventions (e.g., coiling, thrombectomy)

o neurosurgical procedures (e.g., pre-, intra-, post-procedure)

o spinal immobilization Integumentary

• Recognize indications for, and manage patients requiring, therapeutic interventions (e.g. wound VACs, pressure reduction surfaces, fecal management devices, IV infiltrate treatment) Gastrointestinal

• Monitor patients and follow protocols for procedures pre-, intra-, post-procedure (e.g., EGD, PEG placement)

• Intervene to address barriers to nutritional/fluid adequacy (e.g., chewing/swallowing difficulties, alterations in hunger and thirst, inability to self-feed)

• Recognize indications for, and manage patients requiring:

o abdominal pressure monitoring

o GI drains

o enteral and parenteral nutrition Renal and Genitourinary

• Identify nephrotoxic agents

• Monitor patients and follow protocols pre-, intra-, and post-procedure (e.g., renal biopsy, ultrasound)

• Recognize indications for, and manage patients requiring, renal therapeutic intervention (e.g., hemodialysis, CRRT, peritoneal dialysis)

Musculoskeletal

• Manage patients requiring progressive mobility

• Recognize indications for, and manage patients requiring, compartment syndrome monitoring

Multisystem

• Manage continuous temperature monitoring

• Provide end-of-life and palliative care

• Recognize risk factors and manage malignant hyperthermia

• Recognize indications for, and manage patients undergoing:

o continuous sedation

o intermittent sedation

o neuromuscular blockade agents

o procedural sedation - minimal

o procedural sedation - moderate

o targeted temperature management (previously known as therapeutic hypothermia)

Behavioral and Psychosocial

• Respond to behavioral emergencies (e.g., nonviolent crisis intervention, de-escalation techniques)

• Use behavioral assessment tools (e.g., delirium, alcohol withdrawal, cognitive impairment)

• Recognize indications for, and manage patients requiring:

o behavioral therapeutic interventions

o medication management for agitation

o physical restraints



I. CLINICAL JUDGMENT (80%)

A. Cardiovascular (14%)

1. Cardiac infection and inflammatory diseases

2. Cardiac malformations

3. Cardiac surgery

4. Cardiogenic shock

5. Cardiomyopathies

6. Cardiovascular catheterization

7. Dysrhythmias

8. Heart failure

9. Hypertensive crisis

10. Myocardial conduction system defects

11. Obstructive shock

12. Vascular occlusion

B. Respiratory (18%)

1. Acute pulmonary edema

2. Acute pulmonary embolus

3. Acute respiratory distress syndrome (ARDS)

4. Acute respiratory failure

5. Acute respiratory infection

6. Air-leak syndromes

7. Apnea of prematurity

8. Aspiration

9. Chronic pulmonary conditions

10. Congenital airway malformations

11. Failure to wean from mechanical ventilation

12. Pulmonary hypertension

13. Status asthmaticus

14. Thoracic and airway trauma

15. Thoracic surgery



C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (20%)

1. Endocrine

a. Adrenal insufficiency

b. Diabetes insipidus (DI)

c. Diabetic ketoacidosis (DKA)

d. Diabetes mellitus, types 1 and 2

e. Hyperglycemia

f. Hypoglycemia

g. Inborn errors of metabolism

h. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC)

c. Immune deficiencies

d. Myelosuppression (e.g., thrombocytopenia, neutropenia)

e. Oncologic complications

f. Sickle cell crisis

g. Transfusion reactions

3. Gastrointestinal

a. Abdominal compartment syndrome

b. Abdominal trauma

c. Bowel infarction, obstruction and perforation

d. Gastroesophageal reflux

e. GI hemorrhage

f. GI surgery

g. Liver disease and failure

h. Malnutrition and malabsorption

i. Necrotizing enterocolitis (NEC)

j. Peritonitis

4. Renal and Genitourinary

a. AKI

b. Chronic kidney disease (CKD)

c. Hemolytic uremic syndrome (HUS)

d. Kidney transplant

e. Life-threatening electrolyte imbalances

f. Renal and genitourinary infections

g. Renal and genitourinary surgery

5. Integumentary

a. IV infiltration

b. Pressure injury

c. Skin failure (e.g., hypoperfusion)

d. Wounds



D. Musculoskeletal/Neurological/Psychosocial (15%)

1. Musculoskeletal

a. Compartment syndrome

b. Musculoskeletal surgery

c. Musculoskeletal trauma

d. Rhabdomyolysis

2. Neurological

a. Acute spinal cord injury

b. Agitation

c. Brain death

d. Congenital neurological abnormalities

e. Delirium

f. Encephalopathy

g. Head trauma

h. Hydrocephalus

i. Intracranial hemorrhage

j. Neurogenic shock

k. Neurologic infectious disease

l. Neuromuscular disorders

m. Neurosurgery

n. Pain: acute, chronic

o. Seizure disorders

p. Space-occupying lesions

q. Spinal fusion

r. Stroke

s. Traumatic brain injury (TBI)

3. Behavioral and Psychosocial

a. Abuse and neglect

b. Post-traumatic stress disorder (PTSD)

c. Post-intensive care syndrome (PICS)

d. Self-harm

e. Suicidal ideation and behavior



E. Multisystem (13%)

1. Acid-base imbalance

2. Anaphylactic shock

3. Death and dying

4. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

5. Hypovolemic shock

6. Post-transplant complications

7. Sepsis

8. Submersion injuries (i.e. near drowning)

9. Hyperthermia and hypothermia

10. Toxin and drug exposure



II. Professional Caring & Ethical Practice (20%)

A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



CLINICAL JUDGMENT

General

• Manage patients receiving:

o continuous sedation

o extracorporeal membrane oxygenation (ECMO)

o nonpharmacologic interventions

o pharmacologic interventions

o intra-procedural and post-procedural care

o post-operative care

o vascular access

• Conduct physical assessment of critically ill or injured patients

• Conduct psychosocial assessment of critically ill or injured patients

• Evaluate diagnostic test results and laboratory values

• Manage patients during intrahospital transport

• Manage patients undergoing procedural sedation

• Manage patients with temperature monitoring and regulation devices

• Provide family-centered care Cardiovascular

• Manage patients requiring:

o arterial catheterization (e.g., arterial line)

o cardiac catheterization

o cardioversion

o CVP monitoring

o defibrillation

o epicardial pacing

o near-infrared spectroscopy (NIRS)

o umbilical catheterization (e.g., UVC, UAC)

• Manage patients with:

• cardiac dysrhythmias

• hemodynamic instability Respiratory

• Manage patients requiring:

o artificial airways (e.g., endotracheal tubes, tracheotomy)

o assistance with airway clearance chest tubes

o high-frequency oscillatory ventilation (HFOV)

o mechanical ventilation

o noninvasive positive-pressure ventilation (e.g., CPAP, nasal IMV, high-flow nasal cannula)

o prone positioning

o respiratory monitoring devices (e.g., SpO2, SVO2, EtCO2)

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2)

o thoracentesis

Hematology and Immunology

• Manage patients receiving:

o plasmapheresis, exchange transfusion or leukocyte depletion

o transfusion

Neurological

• Conduct pain assessment of critically ill or injured patients

• Manage patients with seizure activity

• Provide end-of-life and palliative care

• Manage patients requiring:

o neurologic monitoring devices and drains (e.g., ICP, ventricular drains, grids)

o spinal immobilization Integumentary

• Manage patients requiring wound prevention and/or treatment (e.g., wound VACs, pressure reduction surfaces, fecal management devices, IV infiltrate treatment)

Gastrointestinal

• Manage patients with inadequate nutrition and fluid intake (e.g., chewing and swallowing difficulties, alterations in hunger and thirst, inability to self-feed)

• Manage patients receiving:

o enteral and parenteral nutrition

o GI drains

o intra-abdominal pressure monitoring Renal and Genitourinary

• Manage patients requiring:

o electrolyte replacement

o renal replacement therapies (e.g., hemodialysis, CRRT, peritoneal dialysis)

Multisystem

• Manage patients requiring progressive mobility

Behavioral and Psychosocial

• Conduct behavioral assessment of critically ill or injured patients (e.g., delirium, withdrawal)

• Manage patients requiring behavioral and mental health interventions

• Respond to behavioral emergencies (e.g., nonviolent crisis intervention, de-escalation techniques)



I. CLINICAL JUDGMENT (80%)

A. Cardiovascular (5%)

1. Acute pulmonary edema

2. Cardiac surgery (e.g., congenital defects, patent ductus arteriosus)

3. Dysrhythmias

4. Heart failure

5. Hypovolemic shock

6. Structural heart defects (acquired and congenital, including valvular disease)



B. Respiratory (21%)

1. Acute respiratory distress syndrome (ARDS)

2. Acute respiratory failure

3. Acute respiratory infection (e.g., pneumonia)

4. Air-leak syndromes

5. Apnea of prematurity

6. Aspiration

7. Chronic conditions (e.g., chronic lung disease/bronchopulmonary dysplasia)

8. Congenital anomalies (e.g., diaphragmatic hernia, tracheoesophageal fistula, choanal atresia, tracheomalacia, tracheal stenosis)

9. Failure to wean from mechanical ventilation

10. Meconium aspiration syndrome

11. Persistent pulmonary hypertension of the newborn (PPHN)

12. Pulmonary hemorrhage

13. Pulmonary hypertension

14. Respiratory distress (RDS)

15. Thoracic surgery

16. Transient tachypnea of the newborn



C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (27%)

1. Endocrine

a. Adrenal insufficiency

b. Hyperbilirubinemia

c. Hyperglycemia

d. Hypoglycemia

e. Inborn errors of metabolism

2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC)

c. Immune deficiencies

d. Leukopenia

e. Polycythemia

f. Rh incompatibilities, ABO incompatibilities, hydrops fetalis

g. Thrombocytopenia

3. Gastrointestinal

a. Bowel infarction/obstruction/perforation (e.g., mesenteric ischemia, adhesions)

b. Feeding intolerance

c. Gastroesophageal reflux

d. GI abnormalities (e.g., omphalocele, gastroschisis, volvulus, imperforate anus, Hirshsprung disease, malrotation, intussusception, hernias)

e. GI surgeries

f. Hepatic failure (e.g., biliary atresia, portal hypertension, esophageal varices)

g. Malnutrition and malabsorption

h. Necrotizing enterocolitis (NEC)

i. Pyloric stenosis

4. Renal and Genitourinary

a. Acute kidney injury (AKI)

b. Chronic kidney disease

c. Congenital genitourinary conditions (e.g., hypospadias, polycystic kidney disease, hydronephrosis, bladder exstrophy)

d. Genitourinary surgery

e. Infections

f. Life-threatening electrolyte imbalances

5. Integumentary

a. Congenital abnormalities (e.g., epidermolysis bullosa, skin tags)

b. IV infiltration

c. Pressure injury/ulcer (e.g., device, incontinence, immobility)

d. Wounds:

i. non-surgical

ii. surgical



D. Musculoskeletal/Neurological/Psychosocial (13%)

1. Musculoskeletal

a. Congenital or acquired musculoskeletal conditions

b. Osteopenia

2. Neurological

a. Agitation

b. Congenital neurological abnormalities (e.g., AV malformation, myelomeningocele, encephalocele)

c. Encephalopathy

d. Head trauma (e.g., forceps and/or vacuum injury)

e. Hemorrhage:

i. intracranial (ICH)

ii. intraventricular (IVH)

f. Hydrocephalus

g. Ischemic insult (e.g., stroke, periventricular leukomalacia)

h. Neurologic infectious disease (e.g., viral, bacterial, fungal)

i. Neuromuscular disorders (e.g., spinal muscular atrophy)

j. Neurosurgery

k. Pain (acute, chronic)

l. Seizure disorders

m. Sensory impairment (e.g., retinopathy of prematurity, hearing impairment, visual impairment)

n. Stress (e.g., noise, overstimulation, sleep disturbances)

o. Traumatic brain injury (e.g., epidural, subdural, concussion, physical abuse)

3. Behavioral and Psychosocial

a. Abuse and neglect

b. Families in crisis (e.g., stress, grief, lack of coping)



E. Multisystem (14%)

1. Birth injuries (e.g., hypoxic-ischemic encephalopathy, brachial plexus injury, lacerations)

2. Developmental delays

3. Failure to thrive

4. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

5. Hypotension

6. Infectious diseases (e.g., influenza, respiratory syncytial virus, multidrugresistant organisms)

7. Life-threatening maternal/fetal complications (e.g., eclampsia, HELLP syndrome, maternal-fetal transfusion, placental
abruption, placenta previa)
8. Low birth weight/prematurity

9. Sepsis

10. Terminal conditions (e.g., end-of-life, palliative care)

11. Thermoregulation

12. Toxin/drug exposure (e.g., neonatal abstinence syndrome, fetal alcohol syndrome, maternal or iatrogenic).



II. Professional Caring & Ethical Practice (20%)

A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



CLINICAL JUDGMENT

General

• Assess pain considering patients gestational age

• Follow protocol for newborn car seat testing, hearing and congenital heart disease screening

• Follow protocol for feeding and supplementation

• Identify and monitor normal and abnormal diagnostic test results

• Implement interventions to keep neonates safe (e.g., transponder use, safe sleep)

• Manage monitor alarms based on protocol and change in patient condition

• Manage patients receiving complementary alternative medicine and/or nonpharmacologic interventions

• Manage patients receiving medications (e.g., safe administration, monitoring, polypharmacy)

• Monitor patients and follow protocols for pre- and postoperative care

• Recognize indications for, and manage patients requiring, central venous access

• Recognize normal and abnormal:

o developmental assessment findings and provide developmentally appropriate care

o family psychosocial assessment findings

o physical assessment findings

• Recognize signs and symptoms of emergencies, initiate interventions, and seek assistance as needed

Cardiovascular

• Apply leads for cardiac monitoring

• Identify, interpret and monitor cardiac rhythms

• Monitor hemodynamic status and recognize signs and symptoms of hemodynamic instability

• Recognize early signs of decreased cardiac output

• Recognize normal fetal circulation and transition to extra-uterine life

Recognize indications for, and manage patients requiring:

o 12-lead ECG

o arterial catheter

o cardioversion

o invasive hemodynamic monitoring Respiratory

• Interpret blood gas results

• Manage medications and monitor patients requiring rapid sequence intubation (RSI)

• Recognize indications for, and manage patients with, tracheostomy

• Recognize indications for, and manage patients requiring:

o assisted ventilation

o bronchoscopy

o chest tubes

o endotracheal tubes

o non-invasive positive pressure ventilation (e.g., bilevel positive airway pressure, CPAP, high-flow nasal cannula)

o oxygen therapy delivery device

o prone positioning (lateral rotation therapy)

o rescue airways (e.g., laryngeal mask airway [LMA])

o respiratory monitoring devices (e.g., SpO2, EtCO2) and report values

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2)

o thoracentesis

Hematology and Immunology

• Manage patients receiving transfusion of blood products

• Monitor and manage patients with bleeding disorders

• Monitor patients and follow protocols:

o pre-, intra-, post-intervention (e.g., exchange transfusion)

o related to blood conservation

Neurological

• Manage patients with congenital neurological abnormalities
Critical Care Register Nurse
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Medical
CCRN
Critical Care Register Nurse
https://killexams.com/pass4sure/exam-detail/CCRN
Answer: D
Section 20: Sec Twenty (351 to 355)
Details:Critical Care Nursing Neonatal Exam
Question: 351
If a newborn's stroke volume is about 5 mL, what is the average pulse required to ensure
adequate cardiac output?
A. 100 bpm.
B. 145 bpm.
C. 180 bpm.
D. 195 bpm.
Answer: B
Question: 352
A neonate has a differential diagnosis of congenital muscular dystrophy (CMD) (laminin
alpha-2 deficiency) and exhibits hypotonia at birth with poor feeding and mild respiratory
distress. Which tests are necessary to establish the diagnosis?
A. Creatinine kinase.
B. Electromyogram, nerve conduction studies, and muscle biopsy.
C. Muscle biopsy only.
D. MRI only.
Answer: B
Question: 353
The nurse is inserting a PICC for an infant who requires extended IV therapy because of very
low birth weight. During the procedure, the infant must be monitored for which of the
following?
A. Tachycardia and tachypnea.
B. Bradycardia and hypoxia.
C. Atrial fibrillation.
D. Blood pressure.
Answer: B
Question: 354
A mixed venous oxygen saturation (SvO2) level of less than 60% can indicate which of the
following?
A. Increased hemoglobin, PaO2, and/or cardiac output.
B. Decreased hemoglobin, PaO2, and/or cardiac output.
C. Decreased oxygen consumption.
D. Sepsis.
Answer: B
Question: 355
A 21-day-old neonate develops green-bronze jaundice, dark urine, claycolored stools,
abdominal distention with distended abdominal veins, and hepatosplenomegaly with firm
liver. Liver biopsy and test shows extrahepatic biliary atresia, and a hepatoportoenterostomy
(Kasai procedure) is done to create a conduit between the liver and small intestine. Which
added vitamin(s) or minerals should the baby receive postoperatively?
A. Water-soluble vitamins (B-complex, C).
B. Fat-soluble vitamins (A, D, E, K).
C. Calcium.
D. Potassium.
Answer: B
Section 21: Sec Twenty One (356 to 360)
Details:Progressive Care Certified Nurse (PCCN) Practice
Question: 356
Thoracic electrical bioimpedence monitoring with 4 sets of bioimpedence electrodes and 3
ECG electrodes is used to evaluate hemodynamic status of a postsurgical cardiac patient.
Where are the bioimpedence electrodes placed?
A. One set on the arms, one set on the legs, and one set on the sides of the chest.
B. Two sets bilaterally at the base of the neck and two sets on each side of the chest.
C. One set on the legs and three sets on each side of the chest.
D. One set on the arms, one set bilaterally at the base of the neck, and two sets on each side
of the chest.
Answer: B
Question: 357
A 52-year-old female with a history of bipolar disease is one-day post-operative following a
hip replacement. The patient slept only one or two hours during the night and is speaking
rapidly, throwing her belongings at the nurses, and insisting she is going to leave the hospital
against medical advice. The nurse should notify:
A. The mental health crisis team
B. Social services
C. A home health agency
D. The patient's husband
Answer: A
Question: 358
If all patients who develop urinary infections are evaluated per urine culture and sensitivities
for microbial resistance, but only those with clinically-evident infections are included, then
those with subclinical infections may be missed, skewing results. This is an example of:
A. Information bias
B. Selection bias
C. Hypothesis testing
D. Generalizability
Answer: B
Question: 359
A 28-year-old male with extensive second and third-degree burns develops abdominal
discomfort and vomits coffee ground emesis and frank blood. The most likely cause is:
A. A peptic ulcer
B. The erosion of the esophagus from burns
C. Paralytic ileus
D. Stress-related erosive syndrome
Answer: D
Question: 360
Beck's triad (increased central venous pressure with distended neck veins, muffled heart
sounds, and hypotension) is indicative of which condition?
A. Myocardial infarction
B. Aortic valve prolapse
C. Cardiac tamponade
D. Pulmonary embolism
Answer: C
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Medical Critical study help - BingNews https://killexams.com/pass4sure/exam-detail/CCRN Search results Medical Critical study help - BingNews https://killexams.com/pass4sure/exam-detail/CCRN https://killexams.com/exam_list/Medical Study: Disrupted sleep in early middle age linked to cognitive decline No result found, try new keyword!People who have more interrupted sleep in their 30s and 40s are more than twice as likely to have memory and thinking problems a decade later, a new study shows. Thu, 04 Jan 2024 06:14:00 -0600 en-us text/html https://www.msn.com/ Treating hearing loss is associated with a 24% decrease in risk of early death, study shows No result found, try new keyword!Data shows not enough people wear hearing aids, which could be a problem for long-term health. Experts explain how the devices help and when to get them. Wed, 03 Jan 2024 09:30:25 -0600 en-us text/html https://www.msn.com/ Critical Care News and Research

AI Integration in the Fight Against Age-Related Macular Degeneration

In this interview, Wen Hwa Lee, CEO, and Chief Scientist at Action Against Age-Related Macular Degeneration (AAAMD), offers an enlightening perspective on merging AI with ophthalmology to forge new paths in healthcare and drug discovery.

Thu, 14 Dec 2023 10:00:00 -0600 en text/html https://www.news-medical.net/?tag=/Critical-Care
New AI tool may help better detect, treat cancers: Study NEW DELHI: Researchers have developed a new artificial intelligence (AI) tool that interprets medical images with unprecedented clarity and may help clinicians diagnose and better treat cancers that might otherwise go undetected. The tool, called iStar (Inferring Super-Resolution Tissue Architecture), and developed by researchers at the University of Pennsylvania, US, provides both highly detailed views of individual cells and a broader look at the full spectrum of how people's genes operate.
The imaging technique, described in the journal Nature Biotechnology, would allow doctors to see cancer cells that might otherwise have been virtually invisible, the researchers said.
This tool can be used to determine whether safe margins were achieved through cancer surgeries and automatically provide annotation for microscopic images, paving the way for molecular disease diagnosis at that level, they said.
The researchers said iStar has the ability to automatically detect critical anti-tumor immune formations called "tertiary lymphoid structures," whose presence correlates with a patient's likely survival and favourable response to immunotherapy, which is often given for cancer and requires high precision in patient selection.
This means that iStar could be a powerful tool for determining which patients would benefit most from immunotherapy, they said.
"The power of iStar stems from its advanced techniques, which mirror, in reverse, how a pathologist would study a tissue sample," said Mingyao Li, a professor at the University of Pennsylvania.
"Just as a pathologist identifies broader regions and then zooms in on detailed cellular structures, iStar can capture the overarching tissue structures and also focus on the minutiae in a tissue image," Li explained.
To test the efficacy of the tool, the researchers evaluated iStar on many different types of cancer tissue, including breast, prostate, kidney, and colorectal cancers, mixed with healthy tissues.
Within these tests, iStar was able to automatically detect tumour and cancer cells that were hard to identify just by eye, according to the researchers.
Clinicians in the future may be able to pick up and diagnose more hard-to-see or hard-to-identify cancers with iStar acting as a layer of support, they said.
In addition to the clinical possibilities presented by the iStar technique, the tool moves extremely quickly compared to other, similar AI tools.
For example, when set up with the breast cancer dataset the team used, iStar finished its analysis in just nine minutes.
By contrast, the best competitor AI tool took more than 32 hours to come up with a similar analysis, making iStar 213 times faster.
"The implication is that iStar can be applied to a large number of samples, which is critical in large-scale biomedical studies," Li added.
Wed, 03 Jan 2024 17:39:00 -0600 en text/html https://timesofindia.indiatimes.com/home/science/new-ai-tool-may-help-better-detect-treat-cancers-study/articleshow/106523437.cms
Telehealth filling critical need for pediatric mental health, study finds

Photo: Westend61/Getty Images

Pediatric telehealth for mental health needs filled a critical deficit in the immediate period following the emergence of COVID-19, and continues to account for a substantial portion of pediatric mental health service utilization and spending, according to a new research letter in JAMA Network Open.

Because of that, commercial health insurers should use telehealth to make up for the lack of mental health providers focusing on youth, the research determined.

Focusing on children and youths younger than 19 who have received common pediatric mental health diagnoses (anxiety, adjustment disorder, attention-deficit/hyperactivity disorder, etc.), the team quantifies trends and changes in monthly utilization and spending rates between three phases of COVID-19: pre-pandemic, the midst of the pandemic before vaccine availability, and post-pandemic. 

Monthly medical claims data provided by Castlight Health were used to measure trends in utilization per 1,000 beneficiaries and spending (accounting for inflation by indexing 2020 to 2022 rates to 2019) per 10,000 beneficiaries among roughly 1.9 million children and youths with commercial insurance throughout the U.S.

Utilization and spending trends were generally consistent across pediatric mental health diagnoses. Compared with pre-pandemic, in-person pediatric mental health services declined by 42% during the pandemic's acute phase, while pediatric telehealth services increased 30-fold (3,027%), representing a 13% relative increase in overall utilization.

By August 2022, in-person services returned to 75% of pre-pandemic levels and telemental health utilization was 2,300% higher than pre-pandemic levels.

During the post-pandemic period, there was a gradual increase in spending rates compared with pre-pandemic for in-person, telehealth and total visits. From January 2019 to August 2022, mental health service utilization increased by 21.7%, while mental health spending rates increased by 26.1%.

WHAT'S THE IMPACT?

The COVID-19 pandemic severely tested the mental health of children and youths due to unprecedented school closures, social isolation and distancing, and COVID-19-related mortality among families, according to research in JAMA Pediatrics

In response, health systems offered telehealth to increase access to pediatric mental healthcare, but the extent to which telehealth availability led to greater utilization and spending was largely unknown.

As it turns out, utilization and spending increased over the entire timeframe. ADHD, anxiety disorders, and adjustment disorder accounted for most visits and spending in all phases.

Supported by evidence that telehealth can effectively deliver mental health treatment for children and youths, the findings have important implications for telehealth sustainability beyond the effects of COVID-19, authors said.

THE LARGER TREND

A stark generation gap has emerged between millennials and baby boomers when it comes to telehealth, with younger patients driving the highest overall satisfaction scores and older patients experiencing significantly lower levels of satisfaction, according to the J.D. Power 2023 U.S. Telehealth Satisfaction Study, published last month.

The satisfaction gap is widest in digital channels and appointment scheduling, suggesting that older telehealth users are having problems using telehealth providers' digital interfaces.

Also in September, Epic Research determined that despite being able to be reimbursed for telehealth services at the higher facility rate for another year, providers are frequently billing for these virtual visits at a lower level-of-service code, a trend that holds true for both primary and specialty care. Telehealth visits are more frequently coded with a lower level-of-service billing code than in-person office visits of the same specialty.

In October 2022, after three months of relative stability, national telehealth utilization declined 3.7%. Looking at one specific metric, telehealth went from 5.4% of medical claim lines in September, to 5.2% in October, according to FAIR Health's Monthly Telehealth Regional Tracker.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com

Tue, 10 Oct 2023 03:50:00 -0500 en text/html https://www.healthcarefinancenews.com/news/telehealth-filling-critical-need-pediatric-mental-health-study-finds
Robotic surgery improves outcomes for most colon cancer patients, finds study No result found, try new keyword!Robotic surgery offers significant benefits over laparoscopic procedures for many patients undergoing colectomies for colon cancer, according to a study by UT Southwestern Medical Center. Thu, 04 Jan 2024 08:23:04 -0600 en-us text/html https://www.msn.com/ New study reinforces skin-to-skin contact is critical for premature babies No result found, try new keyword!The study, published Thursday in the Journal of the American Medical Association, found that premature babies who were held close to their mother or father's skin right after birth showed better ... Wed, 29 Nov 2023 09:59:00 -0600 en-us text/html https://www.yahoo.com/gma/study-finds-skin-skin-contact-172208460.html Study reveals low rates of social factors documentation in healthcare No result found, try new keyword!A new study provides the latest data on the low rates for screening and documenting Social Determinants of Health (SDOH) in healthcare settings. Wed, 20 Dec 2023 03:06:00 -0600 en-us text/html https://www.msn.com/ Head zaps help surgeons transfer skills from VR to IRL

Researchers found that applying gentle, non-invasive electrical stimulation to the brain during virtual reality training helped budding surgeons to more easily transfer the skills they’d learned to a real-life setting. In addition to training better future surgeons, the approach could help skill acquisition in other industries.

Motor learning allows us to develop new skills, like mastering a tennis serve or, in the case of a surgeon, developing precision suturing skills. These days, surgeons are likely to learn these types of skills in a virtual reality (VR) environment before they transition to the real world.

Researchers at Johns Hopkins University in the US have developed a method of improving how medicos learn surgical skills in a virtual environment so that their learned skills are transferred more effectively to a real-life scenario.

“Training in virtual reality is not the same as training in a real setting, and we’ve shown with previous research that it can be difficult to transfer a skill learning in a simulation into the real world,” said Jeremy Brown, a study co-author. “It’s very hard to claim statistical exactness, but we concluded people in the study were able to transfer skills from virtual reality to the real world much more easily when they had this stimulation.”

By “this stimulation”, Brown is talking about a gentle electric current delivered to the head, more specifically, the cerebellum, a part of the brain that plays a critical role in error-based learning. Non-invasive brain stimulation (NIBS) has been used before in attempts to Improve motor learning. One form of NIBS, the one that was used in the current study, is anodal transcranial direct current stimulation (atDCS), the application of a constant electric current to specific areas of the brain. Anodal stimulation depolarizes the neurons, increasing the probability of an action potential – a rapid sequence of voltage changes – occurring. The action potential and subsequent neurotransmitter release enable one neuron to communicate with others.

The researchers recruited 36 participants, 17 females and 19 males, with a mean age of 27. While 12 had medical backgrounds, none had prior experience with laparoscopy, robotic surgery, or any other teleoperation device. Each was asked to perform a complex visuomotor surgical training task in a real or virtual environment and then switch to the opposite training environment. The task involved driving a curved surgical needle through three rings with a 2 mm radius distributed at 45-degree increments inside the vertical plane. ‘Real’ training environment in the context of this study meant performing the task using the da Vinci Research Kit (dVRK), an open-source research robot, to control the surgical instruments.

Participants received either atDCS or sham cerebellar stimulation during the training task, which they had to perform at three speeds: fast, medium, and slow. While all participants showed improvement from baseline, groups receiving cerebellar atDCS showed significantly improved skill transfer from the virtual to the real environment at fast and moderate speeds, whereas groups receiving the sham stimulation did not.

“The group that didn’t receive stimulation struggled a bit more to apply the skills they learned in virtual reality to the real robot, especially the most complex moves involving quick motions,” said Guido Caccianiga, the study’s lead and corresponding author. “The groups that received brain stimulation were better at those tasks.”

The researchers say validating their findings using a larger sample could significantly impact robotic surgery training programs. Enhancing skill transfer through NIBS could speed up training time and shorten the learning curve. Outside of training surgeons, the approach could help with skill acquisition in other industries or learning more generally.

“What if we could show that with brain stimulation, you can learn new skills in half the time?” Caccianiga said. “That’s a huge margin on the costs because you’d be training people faster; you could save a lot of resources to train more surgeons or engineers who will deal with these technologies frequently in the future.”

The study was published in the journal Nature Scientific Reports, and the below video, produced by Johns Hopkins, shows a participant receiving cerebellar atDCS during training.

Could an Electric Nudge to the Head Help Your Doctor Operate a Surgical Robot?

Source: Johns Hopkins University

Thu, 21 Dec 2023 16:21:00 -0600 en-US text/html https://newatlas.com/medical/transcranial-electrical-stimulation-cerebellum-training-skill-acquisition/
Hearing aids reduce the risk of death - study No result found, try new keyword!Hearing loss is very common, affecting an estimated 1·6 billion people around the world, and its prevalence is expected to increase to 2.5 billion by 2050. Wed, 03 Jan 2024 21:14:55 -0600 en-us text/html https://www.msn.com/




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