CCRN

Introduction and Test Overview 1. Why Become Certified? A study conducted by the Nursing Credentialing Research Coalition found that certification has a profound impact on the personal, professional and practice outcomes of certified nurses. Overall, nurses in the study stated that certification enabled them to experience fewer adverse events and errors in patient care than before they were certified. Additional results revealed that certified nurses: • expressed more confidence in detecting early signs of complications; • reported more personal growth and job satisfaction; • believed they were viewed as credible providers; • received high patient satisfaction ratings; • reported more effective communication and collaboration with other health care providers; and • experienced fewer disciplinary events and work-related injuries. 2. What is “CCRN”? a. Registered service mark of AACN. b. Credential for certified critical care nurses. 3. What to Expect from “The Test” AACN – Certification Corporation Fees: $300 non-member $220 member of AACN Test dates: Year-round Requirements: RN license 1750 hours of clinical experience with acute and critical care patients within the previous 2 years (875 within the past year). Exam is computer-based, 150 questions, with a 3-hour time limit Paper-based testing is offered at the NTI Certification is for 3 years. Recertification can be by CERPs or re-testing. Cost of recertification is: $250 non-member, $170 member 4. Testing Dates, Places and Times AACN Certification Corporation 101 Columbia Aliso Viejo,CA Phone: (800) 899-2226 E-mail: Web: Applied Measurement Professionals Inc. (AMP) 8310 Nieman Road Lenexa, KS Phone: (800) 345-6559 Fax: (913) 541-0156 Business Hours: 8:30 am - 5:00 pm CST Monday-Friday E-mail: Web: Over 100 testing centers nationwide 5. What to bring with you: a. Photo ID i. Driver’s license ii. State ID card iii. Military ID card b. Second ID without photo c. Do not bring any personal items with you d. Please Note: This is a focused 90-day program designed to assure your success on the ANCC Med- Surg certification exam. You must register for the guarantee and complete the “Certification Checklist” within 90 days to be eligible for the guarantee. Hematologic / Immunologic (3%) 4 questions 1. The nurse is caring for a 32-year-old experiencing organ rejection after a kidney transplant. Which of the following signs will the patient exhibit? a. Decreased BUN/Creatinine b. Increased transaminase level c. Increased urine output d. Increased BUN/Creatinine 2. A primary chemical mediator in anaphylactic reaction is? a. Myocardial Depressant Factor b. Histamine c. Complement d. Interferon 3. Which of the following laboratory diagnostic findings will most likely be seen in DIC? a. PT and PTT prolonged b. Fibrinogen increased c. Platelet count increased d. D-dimer normal 4. The beneficial effects of heparin in DIC are thought to be due to its: a. Stimulating effect on platelet manufacture b. Neutralizing of free-circulating thrombin c. Antifibrinolysin activity d. Inhibition of platelet factor XII release Hematology 1. Functions: a. Medium for transport of O2 and CO2 and nutritients b. Maintains hemostatsis c. Maintains internal environment d. Immune e. Inflammation f. Stress Response i. Impaired skin barrier or irritated mucous membrane ii. Impaired gag, cough or swallow iii. Increased gastric pH, colonization = aspiration iv. Acute Stress Reactions 1. Catabolism 2. Decreased healing 3. Inhibit immune response 4. Inflammatory Response g. Hemostasis i. Termination of bleeding ii. Vascular response iii. Platelet response iv. Coagulation 1. Platelets 2. Thrombocytopenia 3. HITT response Disseminated Intravascular Coagulation (DIC) 1. Definition 2. Factors Triggering DIC 3. Etiology: a. Bleeding b. Trauma c. Sepsis d. Abrupto Placenta 4. Clinical Presentation a. Bleeding b. Signs of Thrombosis c. Clinical Presentation i. Petechiae ii. Ecchymosis iii. Purpura d. Labs in DIC i. Platelets ii. PTT iii. PT iv. Fibrinogen v. FDP/FSP vi. D-dimer vii. Antithrombin III 5. Medical Management a. Maintain ABC’s b. Careful or oral and mucosal bleeding c. Treat stimuli d. Correct hypovolemia, hypotension, hypoxia, and acidosis e. Stop microclotting to maintain perfusion f. Stop Bleeding g. Stop Thrombosis h. Administer IV Heparin i. Plasmapheresis j. Nursing Management k. Nursing Care of the Bleeding Patient l. Blood Products i. Risks of transfusion ii. PRBC’s iii. Platelets iv. FFP v. Cryoprecipitate vi. Adverse Reactions 6. Complications of DIC a. Mortality b. Hypovolemic Shock c. Acute Renal Failure d. Infection e. Acute Respiratory Distress Syndrome f. Stroke g. GI dysfunction 7. Nursing a. Administer Vitamin K and Folic Acid b. Treat Ischemic Pain c. Maintain skin integrity Acquired Immunodeficiency Syndrome (AIDS) 1. Etiology a. HIV, CD4 retrovirus b. High-risk groups i. High-risk sexual behavior ii. Infected sex partners iii. IV drug users iv. Recipients of blood products before 1985 c. Pathophysiology i. Invasion and destruction of T4 (helper) cells ii. Incubation 6 months to 10 years iii. Decreased immune response iv. Opportunistic infection 2. General principles for management a. Universal precautions b. Protect from infection c. Inflammatory response will be muted Transplantation Criteria for organ transplantation 1. Recipient criteria a. End-stage organ disease b. Absence of: i. Infection ii. Malignancy iii. Other failing organs iv. Substance abuse 1. Donor criteria a. Free of sepsis, cancer, prolonged hypotension b. Free of communicable disease Anti-rejection medications Drug Major Effects Side Effects Corticosteriods ↓ Inflammation ↑ Risk of infection GI bleed Hyperglycemia Adrenal suppression Cyclosporine ↓ Immune and inflammatory responses Potentiates other immunosuppressives Hepatotoxicity Nephrotoxicity Hyperkalemia Hypomagnesemia ATgam (antithymocyteglobulin) Reduces T-cell production ↑ Risk of infection Thrombocytopenia Imuran (azathioprine) ↓ Immune response ↑ Risk of infection Oral and gastric erosion Hepatotoxicity OKT3 (muromonab-CD3) Alters T-cell recognition of antigens ↑ Risk of infection Symptoms of infection ↓ WBC, platelet levels Prograf (tacrolimus) ↓ Inflammatory response GI distress HTN, chest pain Hyperkalemia Hypomagnesemia Nephrotoxicity Hepatotoxicity CellCept (mycophenolate) ↓ Immune response GI distress ↓ WBC, platelet levels Hypertension Hypokalemia 1. General patient care a. Support transplanted organ i. Heart Transplant ii. Lung iii. Liver iv. Pancreas v. Kidney b. Watch for signs of infection i. May be  due to  immune response