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Medical CCRN : Critical Care Register Nurse Exam

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Exam Number : CCRN
Exam Name : Critical Care Register Nurse
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CCRN test Format | CCRN Course Contents | CCRN Course Outline | CCRN test Syllabus | CCRN test Objectives


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 test is measured against a predetermined standard.
The passing point/cut score for the test is established using a panel of subject matter experts, an test development committee (EDC), who carefully reviews each test 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 test 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 test 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



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Medical Nurse Cheatsheet

Comskil: communication skills practising application & research Laboratory | CCRN Latest subjects and test dumps

VIDEO | 06:56

An introduction to the verbal exchange talents practicing program and analysis Laboratory

Video details

on account that 2005, Memorial Sloan Kettering’s resourceful Comskil software has been instructing clinicians, across all disciplines, the way to talk with cancer sufferers and their families in difficult cases. because the nation’s first formally structured communication initiative at a complete cancer center, the program goals to discover essentially the most constructive and lasting methods for steering clinicians in serving sufferers throughout the cancer trajectory. every yr, greater than 100 clinicians take part in their Comskil practicing application.

This wonderful application has a committed crew of academics, facilitators, and software staff. working towards periods encompass didactic lectures, adopted by way of small group role play sessions with standardized sufferers led by using experienced school and facilitators. They consider all trainings to perpetually enhance individuals’ experiences. Their facilities include a conference room and six state-of-the-art video-recording practicing rooms. digital training options are additionally accessible.

while the curriculum changed into developed for featuring melanoma care, it is adaptable for experts in hospice settings, or those treating americans with other persistent or vital health situations.

among the many areas of guide lined are:

  • Sharing severe information
  • Discussing prognoses and remedy alternate options
  • Responding to affected person and caregiver anger
  • settling on and addressing palliative needs
  • handling considerations related to conclusion-of-life care, loss of life, and death
  • Responding to challenging interactions with households
  • Responding empathically to sufferers’ feelings and issues
  • improving crew communication
  • The Comskil program is essentially provided to nurses, faculty, clinical trainees, superior follow suppliers and other workforce who always have interaction with patients at MSK. working towards opportunities are once in a while offered to clinicians at other institutions as well. if you have an interest in researching more, please contact the Comskil software at comskil@mskcc.org.

    Upcoming Trainings:

    faculty members

    Affiliated college

    Publications

    Foundational Publications

    Kissane DW, Bylund CL, Banerjee SC, Bialer PA, Levin TT, Maloney EK, D’Agostino TA. communication expertise practising for oncology specialists. J Clin Oncol 2012 Apr 10;30(11):1242-7.

    Bylund Cl, Brown RF, Bialer PA, Levin TT, Lubrano di Ciccone B, Kissane DW. constructing and imposing an advanced conversation practising program in oncology at a comprehensive cancer middle. J cancer Educ 2011 Dec;26(4):604-eleven.

    Brown RF, Bylund CL. communique capabilities practising: Describing a new conceptual mannequin. Acad Med 2008 Jan;eighty three(1):37-forty four.

    Publications 2017-current

    Banerjee, S. C., Staley, J. M., Howell, F., Malling, C., Moreno, A., Kotsen, C., Parikh, D., & Parker, P. A. (2021). communicating conveniently by way of tele-oncology (Comskil TeleOnc): A e-book for finest practices for conversation skills in digital melanoma care. Journal of cancer training : The authentic Journal of the American association for cancer education, 1–6. increase online booklet.

    Cannity, k. M., Banerjee, S. C., Hichenberg, S., Leon-Nastasi, A. D., Howell, F., Coyle, N., Zaider, T., & Parker, P. A. (2021). Acceptability and efficacy of a communication advantage training for nursing college students: constructing empathy and discussing complex situations. Nurse education in apply, 50, 102928.

    Banerjee, S. C., Haque, N., Bylund, C. L., Shen, M. J., Rigney, M., Hamann, H. A., Parker, P. A., & Ostroff, J. S. (2021). Responding empathically to patients: A communique potential training module to cut back lung cancer stigma. Translational Behavioral drugs, eleven(2), 613–618.

    Shen, M. J., Manna, R., Banerjee, S. C., Nelson, C. J., Alexander, ok., Alici, Y., Gangai, N., Parker, P. A., & Korc-Grodzicki, B. (2020). Incorporating shared choice making into verbal exchange with older adults with cancer and their caregivers: development and comparison of a geriatric shared determination-making verbal exchange talents practising module. affected person education and Counseling, 103(eleven), 2328–2334.

    Korc-Grodzicki, B., Alici, Y., Nelson, C., Alexander, okay., Manna, R., Gangai, N., Shen, M. J., Parker, P. A., & Banerjee, S. C. (2020). Addressing the exceptional of communication with older melanoma sufferers with cognitive deficits: construction of a communique capabilities practising module. Palliative & Supportive Care, 18(4), 419–424.

    Banerjee, S. C., Haque, N., Schofield, E. A., Williamson, T. J., Martin, C. M., Bylund, C. L., Shen, M. J., Rigney, M., Hamann, H. A., Parker, P. A., McFarland, D. C., Park, B. J., Molena, D., Moreno, A., & Ostroff, J. S. (2020). Oncology care company training in empathic communique abilities to in the reduction of lung cancer stigma. Chest, S0012-3692(20)35308-three. enhance on-line publication.

    Bylund CL, Banerjee SC, Bialer PA, Manna R, Levin TL, Parker PA, Schofield E, Li Y, Bartell A, Chou A, Hichenberg S, Dickler M, Kissane DW. A rigorous contrast of an institutionally-primarily based communique capabilities software for submit-graduate oncology nurses. patient Educ Couns 2018 Jun 1. pii: S0738-3991(18)30274-X.

    Publications prior to 2017

    Banerjee SC, Manna R, Coyle N, Penn S, Gallegos TE, Zaider T, Krueger CA, Bialer PA, Bylund CL, Parker PA. The implementation and comparison of a communication advantage practicing application for oncology nurses 2017. Transl Behav Med 2017 Sep;7(3):615-623.

    Banerjee SC, Manna R, Coyle N, Johnson Shen M, Pehrson C, Zaider T, Hammonds S, Krueger CA, Parker PA, Bylund CL. Oncology nurses’ conversation challenges with sufferers and households: A qualitative examine. Nurse Educ Pract 2016 Jan;16(1):193-201.

    Pehrson C, Banerjee SC, Manna R, Johnson Shen M, Hammonds S, Coyle N, Krueger CA, Maloney E, Zaider T, Bylund CL. Responding empathically to sufferers: construction, implementation, and contrast of a conversation competencies working towards module for oncology nurses. patient Educ Couns 2016 Apr;ninety nine(4):610-616.

    Zaider TI, Banerjee SC, Manna R, Coyle R, Pehrson C, Hammonds S, Krueger CA, Bylund CL. Responding to challenging interactions with households: A working towards module for inpatient oncology nurses. Fam Syst health 2016 Sep;34(3):204-12.

    Coyle N, Manna R, Shen M, Banerjee SS, Penn S, Pehrson C, Krueger CA, Maloney EK, Zaider T, Bylund CL. Discussing loss of life loss of life and conclusion-of-lifestyles goals of care: A verbal exchange advantage practising module for oncology nurses. Clin J Oncol Nurs 2015 Dec;19(6):697-7

    As tricky as role enjoying is for me, it's such a great tool. The video adventure, assist from colleagues, and critique from the facilitators become a fantastic adventure. you have got managed to create a safe environment the place true getting to know and acquisition of new skills can take location.

    …I walked away feeling like I learned conversation thoughts that are only as crucial if not greater essential than medical talents… In SACU, they communicate complex news and have problematic conversations generally. When their population requires an Excellerate in care, it could elicit concern and nervousness and having the right reply on what to claim in these instances is essential. every now and then they only have one shot to claim the correct factor and being educated in navigating difficult conversations can make an enduring affect for their patients and their families. I believe that on account that the Comskil direction, I actually have had more structured and useful conversations with my sufferers and their families…

    Very useful and engaging position play that truly made me consider my technique. helpful session.

    all through working towards as a new SACU NP, they focused on the scientific point of training but now not as a good deal the psychosocial factor and coping with families, which is such an important a part of their job, chiefly for the ventilated sufferers. This direction gave me the equipment to readily talk with my sufferers and their households all over problematic times and at conclusion of life meetings.

    This category became outstanding! I failed to understand it except I joined this type, but I have been feeling overwhelmed by using complicated conversations and think that I've recently backed off on facilitating them in addition to i was/may well be. This has all given me extra self belief and made me suppose like I really can make a change and help my patients get via cases. every part of this route is helpful…

    …As medical trials nurses they are sometimes worried in tricky conversations and interactions, and they do not really have any usual practicing on a way to handle these instances once they come up. I discovered all of the issues primary, and have labored to comprise them into my observe. I have >10 years of adventure as a RN and found so much I could take returned to my observe. It seems so basic, but the core communique cheat sheet has helped me prepare for interactions with patients/families I actually have had difficulty with during the past or to remind me of latest options to are trying when I need to get more assistance from my patients…

    MSK clinical Trials Nurse

    basically good to go through this. a part of burnout is the emotional burden of conclusion of existence decision making, and they do it all of the time within the ICU. improving this ability and having a plan in increase to handle these discussions is terribly beneficial. It gives us equipment in their toolbelt for navigating discussions.

    MSK Fellow on 'Discussing dying, death and end of life'

    awesome communicators and academics, thank you for the lots obligatory adventure! There should be a few mandatory classes like this a 12 months, probably the most valuable and unique practising obtainable.

    It was once that no one ever basically in fact taught us a way to have challenging conversations with their patients, however being capable of talk naturally and easily is so simple to the art of medication. The capability to teach and apply these competencies is an immense aid, and critical to what we're and aspire to be at MSKCC.

    Dr. Matthew Matasar, MSK scientific Oncologist and Comskil Facilitator

    it is an honor for me to take part in the Comskil program. assisting residents and fellows in practicing to greater keep in mind the pearls and pitfalls of company/patient verbal exchange is all the time wonderful and pleasurable. NYC is happily wealthy in theatrical skill, and the Comskil software offers an unparalleled possibility for physicians, nurses, and allied fitness care experts to develop, work on their advantage in a safe and supportive atmosphere, and study from one another. As a facilitator, I study as a lot, if now not extra, from the trainees and actors, concerning the many challenges they face in affected person care in a cancer core, as I could ever offer the members within the program.

    Dr. Alan C. Carver, MSK Neurologist and Comskil Facilitator




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