NR574 Final Exam Acute Care Practicum Review |
Week 5-8 | Chamberlain | 2026/2027 Updated |
350+ Questions & Verified Answers | 100%
Correct
Comprehensive Synthesis of Acute Care Management | Focus: Advanced
Cardiovascular, Pulmonary, & Multisystem Failure
Chamberlain University | NR 574 AGACNP Practicum | Weeks 5-8 Cumulative Review
PART 1: Weeks 5-8 Acute Care Synthesis (2026/2027 Update)
1. Advanced Cardiovascular & Hemodynamic Monitoring
● Cardiogenic Shock (CS) 2026 AHA/ACC Update: Rapid phenotyping with POCUS
(EF < 30 %, RV dilatation), immediate MCS algorithm: IABP Class IIb, Impella CP
Class IIa for severe CS (SBP < 70 mmHg) if revascularization planned within 2 h.
● PA Catheter 2026: SvO₂ target ≥ 65 %, CI > 2.2 L/min/m², PCWP < 18 mmHg;
waveform artifact auto-detected by 2026 digital transducers → confirm leveling &
re-zero before acting.
● Malignant Arrhythmias: Early VT storm (≥ 3 VT episodes/24 h) post-MI →
escalate to esmolol → lidocaine → procainamide (2026 AHA ACLS update);
consider quinidine if channelopathy.
● Temporary MCS: Impella 5.5 requires surgical cut-down; monitor for hemolysis
(plasma-free Hb > 500 mg/dL → device exchange).
2. Acute Respiratory Failure & Mechanical Ventilation
, ● ARDS 2026 Berlin-plus: Driving pressure (ΔP) ≤ 14 cmH₂O target; RP ratio
(RR/ΔP) > 0.8 predicts mortality → escalate to paralysis & prone within 6 h if PF <
100.
● Ventilator Graphics 2026: Auto-PEEP detected if flow not returned to zero →
decrease RR, increase exp time, bronchodilate.
● PEEP Titration 2026: Esophageal manometry or POCUS-guided (recruitability if
diaphragm excursion > 15 mm).
● ECMO 2026: VV-ECMO if Murray > 3, PF < 80 on FiO₂ 1.0, RR 35; heparin 200
units/kg bolus → ACT 180–220 s; monitor for HIT day 4–10.
● Difficult Airway 2026: VL first-pass mandate (success > 95 %); if VL fail × 2 →
SGA rescue → surgical airway ready.
3. Sepsis & Septic Shock 2026
● Sepsis-4 2026: SOFA ≥ 2 + qSOFA ≥ 2 → 1-h bundle (ABX within 45 min, 30 mL/kg
crystalloid, lactate & cultures).
● Norepinephrine 2026: Start if MAP < 65 mmHg after 30 mL/kg; peripheral 20G
antecubital safe for 30 min while central line placed.
● Vitamin C controversy 2026: LOST-VitC RCT negative → no longer routine;
consider only if adrenal insufficiency suspected.
● Immunoparalysis marker 2026: mHLA-DR < 30 % → consider GM-CSF or
interferon-gamma (trial) if ongoing shock day 3.
4. Acute Kidney & Hepatic Failure 2026
● CRRT Indications 2026: KDIGO AKI Stage 2 + life-threatening complication
(hyperkalemia, acidosis, pulmonary edema) OR urine output < 100 mL/8 h
despite resuscitation.
● Hepatic Encephalopathy 2026: Grade III → intubate for airway protection;
lactulose target 2–3 soft stools/day; rifaximin 550 mg BID reduces recurrence
(2026 AASLD).
● Acute-on-Chronic Liver Failure (ACLF) 2026: CLIF-C ACLF score ≥ 64 → consider
early LT listing; avoid nephrotoxic drugs.
5. End-of-Life & Communication 2026
● REMAP 2026 framework: (Reframe, Expect, Map, Align, Plan) for goals-of-care
conversations during Week 7 family meetings.
Week 5-8 | Chamberlain | 2026/2027 Updated |
350+ Questions & Verified Answers | 100%
Correct
Comprehensive Synthesis of Acute Care Management | Focus: Advanced
Cardiovascular, Pulmonary, & Multisystem Failure
Chamberlain University | NR 574 AGACNP Practicum | Weeks 5-8 Cumulative Review
PART 1: Weeks 5-8 Acute Care Synthesis (2026/2027 Update)
1. Advanced Cardiovascular & Hemodynamic Monitoring
● Cardiogenic Shock (CS) 2026 AHA/ACC Update: Rapid phenotyping with POCUS
(EF < 30 %, RV dilatation), immediate MCS algorithm: IABP Class IIb, Impella CP
Class IIa for severe CS (SBP < 70 mmHg) if revascularization planned within 2 h.
● PA Catheter 2026: SvO₂ target ≥ 65 %, CI > 2.2 L/min/m², PCWP < 18 mmHg;
waveform artifact auto-detected by 2026 digital transducers → confirm leveling &
re-zero before acting.
● Malignant Arrhythmias: Early VT storm (≥ 3 VT episodes/24 h) post-MI →
escalate to esmolol → lidocaine → procainamide (2026 AHA ACLS update);
consider quinidine if channelopathy.
● Temporary MCS: Impella 5.5 requires surgical cut-down; monitor for hemolysis
(plasma-free Hb > 500 mg/dL → device exchange).
2. Acute Respiratory Failure & Mechanical Ventilation
, ● ARDS 2026 Berlin-plus: Driving pressure (ΔP) ≤ 14 cmH₂O target; RP ratio
(RR/ΔP) > 0.8 predicts mortality → escalate to paralysis & prone within 6 h if PF <
100.
● Ventilator Graphics 2026: Auto-PEEP detected if flow not returned to zero →
decrease RR, increase exp time, bronchodilate.
● PEEP Titration 2026: Esophageal manometry or POCUS-guided (recruitability if
diaphragm excursion > 15 mm).
● ECMO 2026: VV-ECMO if Murray > 3, PF < 80 on FiO₂ 1.0, RR 35; heparin 200
units/kg bolus → ACT 180–220 s; monitor for HIT day 4–10.
● Difficult Airway 2026: VL first-pass mandate (success > 95 %); if VL fail × 2 →
SGA rescue → surgical airway ready.
3. Sepsis & Septic Shock 2026
● Sepsis-4 2026: SOFA ≥ 2 + qSOFA ≥ 2 → 1-h bundle (ABX within 45 min, 30 mL/kg
crystalloid, lactate & cultures).
● Norepinephrine 2026: Start if MAP < 65 mmHg after 30 mL/kg; peripheral 20G
antecubital safe for 30 min while central line placed.
● Vitamin C controversy 2026: LOST-VitC RCT negative → no longer routine;
consider only if adrenal insufficiency suspected.
● Immunoparalysis marker 2026: mHLA-DR < 30 % → consider GM-CSF or
interferon-gamma (trial) if ongoing shock day 3.
4. Acute Kidney & Hepatic Failure 2026
● CRRT Indications 2026: KDIGO AKI Stage 2 + life-threatening complication
(hyperkalemia, acidosis, pulmonary edema) OR urine output < 100 mL/8 h
despite resuscitation.
● Hepatic Encephalopathy 2026: Grade III → intubate for airway protection;
lactulose target 2–3 soft stools/day; rifaximin 550 mg BID reduces recurrence
(2026 AASLD).
● Acute-on-Chronic Liver Failure (ACLF) 2026: CLIF-C ACLF score ≥ 64 → consider
early LT listing; avoid nephrotoxic drugs.
5. End-of-Life & Communication 2026
● REMAP 2026 framework: (Reframe, Expect, Map, Align, Plan) for goals-of-care
conversations during Week 7 family meetings.
