2-Day CCRN Certification Prep course Study Guide

2-Day CCRN Certification Prep course Cyndi Zarbano, MSN, BSN, CCRN, CMSRN, CLNC, NLCP Rehab ZNM 4/14 This manual was printed on 10% post consumer recycled paper Rehab 2-Day CCRN Certification Prep course Cyndi Zarbano, MSN, BSN, CCRN, CMSRN, CLNC, NLCP Copyright © 2014 PESI, INC. PO Box 1000 3839 White Ave. Eau Claire, Wisconsin 54702 Printed in the United States PESI, Inc. strives to obtain knowledgeable authors and faculty for its publications and seminars. The clinical recommendations contained herein are the result of extensive author research and review. Obviously, any recommendations for client care must be held up against individual circumstances at hand. To the best of our knowledge any recommendations included by the author reflect currently accepted practice. However, these recommendations cannot be considered universal and complete. The authors and publisher repudiate any responsibility for unfavorable effects that result from information, recommendations, undetected omissions or errors. Professionals using this publication should research other original sources of authority as well. PESI, Inc. offers continuing education programs and products under the brand names PESI HealthCare, CMI Education Institute, Premier Education Solutions, PESI, MEDS-PDN, HeathEd and Ed4Nurses. For questions or to place an order, please visit: www. or call our customer service department at: (800) 844-8260. 4/14 pp Rehab MATERIALS PROVIDED BY Cyndi Zarbano, MSN, BSN, CCRN, CMSRN, CLNC, NLCP is an intensive care nurse with twenty years of nursing experience who is currently practicing in the Twin Cities area of Minnesota. She is a nationally-recognized seminar speaker who has opened multiple national symposiums and speaks on several topics for PESI, as well as a variety of other companies in the US and Canada. Her national acclaim is well deserved for her ability to make knowledge practical, as well as encouraging knowledge retention by her frequent use of stories, humor and case studies. In addition to her speaking engagements, Cyndi was recently published through PHC publishing (Clinical Nursing Assessment Skills Pocket Guide) and has two more books currently in editorial stages. Her products include pocket guides, textbooks, webcasts and webinars. Along with her MS and BSN in nursing, she has 3 other undergraduate degrees. She served as a US Naval Officer for ten years, leaving service as an LCDR (Lieutenant Commander) in 2001. Prior to nursing, she worked as a counselor with the mentally ill and dangerous in a facility in southern Minnesota. She returned to that facility as a Lead Psychiatric Nurse for two years after leaving the military. Additionally, Cyndi has a legal nurse consulting business and continues to serve as a testifying expert in medical related cases. Disclosures: Financial: Cyndi Zarbano receives a speaking honorarium from PESI, Inc. Nonfinancial: Cyndi Zarbano has no relevant nonfinancial relationships to disclose. CCRN Prep Class CCRN Prep Class 2014 Cyndi Zarbano MSN, BSN, CCRN, CLNC, CMSRN, NLCP DAY 1 MORNING SESSION DAY 2 MORNING SESSION CCRN Exam Cardiovascular Break Endocrine Lunch Hematologic/Immunologic Neurologic Break Pulmonary Lunch Lunch AFTERNOON SESSION AFTERNOON SESSION Renal Break Gastrointestinal Behavioral/Psychosocial Pulmonary (Cont.) Break Multisystem Questions Through out sections there are included sample questions for y p ou to use to practice that section. CCRN Exam 2014 Facts  To take exam must meet criteria – ◦ Unrestricted RN License in US, NOT BSN only ◦ Meet criteria for practice hours – 1750 in last 2 years, 875 in last year ◦ Pass 89 of 150 questions (71%) – 25 experimental ?’s ◦ T i t i tifi ti To maintain certification – renew every 3 years  Either re-take the exam or meet CEU guidelines put out by AACN - Practice as an RN or APRN is required for 432 hours in direct bedside care of acutely and/or critically ill patients during the 3- year certification renewal period, with 144 hours accrued in the last year of the certification renewal period. Applying for CCRN Examination  Get the application at Wait for authorization to test letter ◦ 2-3 weeks – faster by internet  Once you receive that letter you have 90 days to take exam! Can reschedule for free once!  Many options for locations for testing – Sylvan testing sites, etc… Fees to Take Exam  If a AACN Member exam is $220  If not a AACN Member $325  AACN membership normally AACN membership normally $78/year  Can re-take 4 times in1year 1 Benefits of Membership to AACN ◦ Access to the Members Only information on the AACN Web site, including clinical references and CINAHL Literature Searches ◦ Unlimited FREE CE credits for offerings from AACN print journals and online CEU databases ◦ Subscriptions to Critical Care Nurse, American Journal of Critical Care, AACN Bold Voices, and AACN's e-newsletter Critical Care Newsline ◦ Discounted $35 subscriptions to AACN Advanced Critical Care The Actual CCRN Exam  150 questions (including 25 experimental questions) – need 89 right to pass!  All multiple choice/guess  Can move back and forth between questions  Those not answered are wrong - so answer all even if you need to guess  Get 3 full hours to complete exam from starting test ◦ Remember to read all instructions! See Blue Print for Areas and %  Allocate your time for each area accordingly  Utilize other resources to study from such as: ◦ AACN’s Essentials of Critical Care Nursing or a study guide. ◦ Focus on Advanced Sections. ◦ Test Prep Books! Some have CD Rom’s and practice tests. ◦ I-tunes CCRN podcast – free. Practice Questions/Sample Exams ◦ Practice questions – AACN has a practice exam on website  190 questions ◦ CCRN SAE (Self-Assessment Exam)  under certification exam section  60 questions for $50.00  Identical look and format as actual exam  If you pass you get CEU’s Tips to Taking the CCRN Exam  Practice, practice, practice! ◦ SAE Exam gives you a breakdown of results  Create a study plan – helps keep studying disciplined!  Study 6-8 weeks prior to exam and DON’T CRAM  Night before…. Relax ◦ Good night sleep ◦ Avoid alcohol ◦ Finish studying early Tips to Taking the CCRN Exam Tips to Taking the CCRN Exam - Cont’d  Day of the exam ◦ Eat a light breakfast so you don’t feel sedated coming to exam ◦ Arrive early – stay in a hotel overnight if needed to avoid a final rush… ◦ Bring two forms of ID to take exam – one with a picture ◦ Dress in layers to avoid being distracted by being too hot or cold 2 During the Exam  Focus – What is the question really asking?  The therapeutic response is what they are looking for…  Acknowledge and validate the patients feelings  Maslow’s Hierarchy – most primitive needs first! ◦ ABC’s ◦ Safety ◦ Psychological needs After the Exam!  You will find out immediately if you passed!  Subject scores for each area are included so you can identify your strongest and weakest areas on exam.  CCRN certificate within a few weeks, but you can start using your CCRN title right away  Synergy Model  Per ACCN guidelines – “Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies.”  Resiliency is the capacity to return to a restorative level of functioning using compensatory/coping mechanisms; the ability to bounce back quickly after an insult. Patient and Families Needs Nurses Competencies Patient’s Outcome (Synergy) Synergy Model Focuses on…..  Nursing characteristics – such as critical thinking, decision making, priority setting, and global understanding of the situation ◦ Nurses as advocates – for both patient and family and family ◦ Caring practices and ability to offer therapeutic environment for healing and learning ◦ Collaboration across disciplines ◦ Therapeutic response to diversity Synergy Model Continued….  Clinical inquiry and facilitating learning ◦ Using EBP at the bedside ◦ Keeping up on recent research ◦ Facilitating learning Facilitating learning  Ethical Clinical Practice ◦ Respect for all ◦ Beneficence – Do good for patients ◦ Non-maleficense – Do no harm! ◦ Justice 3 Ethical Practice Goal per AACN  Goal - “Promote patient centered decision making centered decision making that supports the rights and interests of the patient.” AACN Core Curriculum Synergy Model Key Points  Best answer is ALWAYS culturally sensitive  It is usually an open-ended question  Involves something the RN can do right now! Not something for someone else to do later  If used and a system issue is raised, think of a multi-disciplinary solution to the problem. DAY 1  CCRN Prep section  Cardiovascular  Break  Endocrine  Lunch 21  Renal  Break  GI  Behavioral/Psychosocial Hint……  When you see a star on the slide it is a subject frequently covered on th CCRN the CCRN Exam  Be very comfortable with that information! Cardiovascular Topics 23 20% of CCRN Exam 30 Questions Cardiac Anatomy 4 Cardiac Anatomy  Papillary Muscles: Attach the ventricular chambers to the chordae tendinae.  Chordae Tendinae: Fibrous connective tissue attached to the mitral & tricuspid valves. Prevent valve prolapse into the atria. 25 Murmurs Stenotic: stiff valves don’t OPEN well  Insufficiency: (regurgitation) floppy valves don’t CLOSE well ◦ Graded on I-VI murmur scale  Lower the number the softer ◦ Can be systolic or diastolic Valve Disorders Right Heart Left Heart Diastolic Murmurs Tricuspid Stenosis: Decreased blood flow to RV Mitral Stenosis: Decreased blood flow to LV Pulmonic Aortic Insufficiency: Insufficiency: Blood backflows into RV Blood backflows into LV Systolic Murmurs Tricuspid Insufficiency: Blood backflows into RA Mitral Insufficiency: Blood backflows into LA Pulmonic Stenosis: Decreased blood flow into Pulmonary artery Aortic Stenosis: Decreased blood flow into the Aorta 27 Cardiac Blood Flow 28 Coronary Arterial Tree Left Coronary Artery Right Coronary Artery 29 Right Coronary Artery (RCA)  Supplies blood to: ◦ Right atrium (posterior MI lead to atrial dysrhythmias) ◦ Right ventricle ◦ SA d no e ◦ AV node (AV block is common, esp. second degree Type I) ◦ Bundle of HIS ◦ Part of the left ventricle 30 5 Left Coronary Artery (LCA) AKA: Left Main (Widow Maker) 2 Main Branches: ◦Left Anterior Descending (LAD) ◦Circumflex 31 Left Anterior Descending (LAD) Supplies blood to: ◦ ANTERIOR wall of left ventricle ◦ Intra-ventricular septum ◦ Ri ht b dl b h Right bundle branch ◦ Small portion of left bundle branch ◦ MobitzType II (Classic) Second degree AV block can occur. 32 CircumflexCircumflex  Supplies blood to: ◦ Lateral walls of the left ventricle ◦ Left atrium  MI here can cause AV block, but more commonly causes LV dysfunction (hypokinesis/akinesis) 33 34 Coronary Blood Flow 35  Coronary arteries dilate in response to increased oxygen demand 36 CAPP = Diastolic BP - PCWP (Wedge)  Normal is 60-80 mmHg  Monitor your DBP! 6 Cardiac Output CO = HR x SV (stroke volume) Determinants of SV ◦ Preload ◦ Afterload ◦Contractility 37 Manipulating CV parameters  Heart rate  Preload (CVP) ◦ Measures volume and pressure  Afterload ◦ How hard the heart has to work to empty  Contractility ◦ How hard the heart muscle squeezes  Ejection fraction – (LVEF) – 55-75% 38 Heart RateHeart Rate  Slowing the heart increases filling time and coronary perfusion  Affected by the ANS – autonomic nervous system ◦ Parasympathetic – slows down HR slows down HR ◦ Sympathetic – speeds up HR  Temperature/Pain/Anxiety/Meds  Meds ◦ Beta blockers, Ca+ CB, Digoxin, Amio ◦ Atropine, Dopamine 39 Preload Defined as the amount of fiber stretch before systole ◦Measured by CVP (Normal 2-6) 40 Starling’s Law a.) Increased stretch = increased volume = better ejection b.) Stretch is within physiological Preload is Impacted by Starling’s Law 41 py g limits Preload = Volume in ventricle before contraction •Impacted by volume and pressure •Increased peep will decrease CVP Preload Hypovolemia: ◦ goal is to improve cardiac output by increasing end-diastolic ventricular volume (preload).