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Medical CCRN : Critical Care Register Nurse Exam

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CCRN exam Format | CCRN Course Contents | CCRN Course Outline | CCRN exam Syllabus | CCRN exam 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 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-Barrι, 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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Column: Do you basically want Amazon's new drugstore understanding your clinical situation? | CCRN Cheatsheet and exam Questions

Benjamin Franklin wearing a hat: The new Amazon Pharmacy offers customers convenience and potentially lower prices. But experts warn that users could be jeopardizing their privacy. (Mysupplementmedicare.com) Β© (Mysupplementmedicare.com) the new Amazon Pharmacy offers clients convenience and doubtlessly reduce expenses. however experts warn that users may well be jeopardizing their privateness. (Mysupplementmedicare.com)

For months, Amazon has been signaling that it planned to open an Amazon-branded on-line pharmacy to compete with the likes of CVS, Walgreens and ceremony aid. This week, it did.

for a lot of consumers, this represents superior convenience and the opportunity of paying much less for prescription drugs.

It additionally capacity what little privateness you've got left is abruptly disintegrating.

"Most people trust their clinical advice to be the information they are most sensitive about," spoke of Peter Winkelstein, executive director of the Institute for Healthcare Informatics at the institution of Buffalo.

"At this aspect," he advised me, "we don't have any conception what is going on to occur when you tell Amazon that you simply want a certain medicine. The most effective thing that looks reasonable to assert is that they will monetize this information any way they can."

There it is.

Amazon is perhaps essentially the most information-pushed company within the historical past of the world β€” a company so adept at gathering consumer suggestions and crunching numbers, it might probably suggest with alarming accuracy purchases of stuff you might also no longer even have regular you wanted.

And now we're going to add to the combine intimate particulars of their health and well-being, their existence and habits, even how long they may additionally live.

An Amazon spokeswoman, asking that I not use her identify, observed Amazon Pharmacy may not share patient facts with other ingredients of the enterprise. extra on that in a moment.

Winkelstein is an Amazon leading member. I requested if he'd switch his prescriptions to Amazon Pharmacy in return for superior comfort and probably decrease expenses.

He needed to believe about that for a moment.

"I simply don't know," Winkelstein eventually replied. "I do not know if or not it's worth it."

it's a question thousands and thousands of Amazon valued clientele quickly can be wrestling with.

"Amazon does not want a pharmacy to make predictions about your health," pointed out Anna Lauren Hoffmann, an assistant professor of tips and records ethics on the institution of Washington.

but running what might conveniently end up being the world's largest on-line pharmacy "does allow them to make selections, manipulate expenses and raise purchaser dependency on Amazon in ever-increasing ways," she instructed me.

feel about it. if you are an Amazon customer (and you doubtless are), above all if you are a first-rate member (ditto), the company already knows extra about you than any client-dealing with enterprise has ever popular about its consumers.

In my case, Amazon knows what clothes I wear. It knows the own-hygiene products I decide on and the way regularly i exploit them.

It is aware of the books I study, the movies I watch, the tune I hearken to.

And now, if I decide to take competencies of quickly free transport and maybe decrease fees for prescription drugs, Amazon will recognize essentially the most sensitive details of my health and every thing that entails, together with how neatly I care for myself and any problems i could event.

"There are lots of talents hazards to buyers besides the 'creepiness' element that companies know every little thing about us," pointed out Florencia Marotta-Wurgler, a legislation professor at big apple college who makes a speciality of digital commerce.

She noted a 2015 records breach involving Ashley Madison, a skeevy web site that helped users cheat on their spouses. Hackers accessed the own information of about 32 million registered consumers.

a few months ago, some of those shoppers received "sextortion" emails demanding $1,000 in bitcoin if the recipients wanted to maintain their identities secret.

"because the Ashley Madison data breach confirmed, the liberate of deepest tips may end up in excessive and painful personal costs," Marotta-Wurgler spoke of.

That does not worry me as a good deal as a further eye-opening incident.

In 2012, goal analyzed buy records to figure out that a teenage lady residing close Minneapolis became pregnant. It despatched her coupons for maternity put on and child gadgets, much to the consternation of her fogeys, who had no conception their daughter turned into in a family means.

Amazon has been getting the dangle of drug revenue considering the fact that buying the online pharmacy PillPack in 2018. besides the fact that children, it has operated PillPack as an independent subsidiary, break away its other retail offerings.

the new Amazon Pharmacy is built-in with the relaxation of the business's online superstore. It presents prime contributors the prospect of more straightforward looking for meds and lessen prices for money purchases that don't use assurance β€” an strategy already in use at Costco and some different huge-box sellers.

One purpose Amazon is so wildly a hit is since it's in fact, in fact respectable at making at online purchases handy and bother-free.

however healthcare is different. Federal legislations prevents clinical providers from sharing patients' facts with others.

The Amazon spokeswoman pointed out all affected person information will reside within the pharmacy and not be purchasable via other Amazon divisions.

however there may be a potential loophole in Amazon Pharmacy's privateness policy, which permits for sharing of tips with "business associates," including "accounting functions, consulting services or tips technology features."

There are lots of unknowns here. Amazon is an assistance technology company. Will affected person information be purchasable to constituents of Amazon that allow an online drugstore to feature? Can an additional Amazon division serve as a "consulting service" for the pharmacy?

What if Amazon moves to purchase an coverage company, as CVS fitness did with its 2018 buy of Aetna? Would the retailer use its insights about consumers to alter coverage costs on a person basis (as it reportedly does with many consumer products)?

"this is why they need a new, finished privacy legislation in the u.s.," observed Alan Butler, intervening time executive director of the digital privacy tips middle.

"Being area to invasive statistics assortment and profiling may still no longer be treated as a essential cost of the use of services online," he referred to.

that you may are trying to avoid anybody company from figuring out too a lot about you via, say, spreading purchases amongst distinctive marketers. but all that sooner or later does is sluggish the statistics gathering, not stop it.

within the case of Amazon, some privateness consultants say, it could be a case of in for a penny, in for a pound.

"if you already had hundreds of thousands of gold bullion bars saved at fortress Knox, would you intellect backing up the truck and unloading an additional thousand bars there?" asked Merrill Warkentin, a professor of assistance methods at Mississippi State tuition.

"I could argue that you simply could have more risk by using diversifying the areas where your delicate counsel is kept," he referred to.

fair factor. If Amazon already knows every thing else about me, what's the damage in it figuring out about my clinical fame as well?

The reply is they simply do not know. there's not ever before been an organization like Amazon, and their laws and rules under no circumstances expected a business this powerful and this distinctive, dominating just about each promote it enters.

or not it's no coincidence that almost immediately after Amazon Pharmacy become announced, shares in CVS, Walgreens and different drugstores immediately plunged.

I choose now not to are living in worry. My preliminary take is that Amazon has earned my have faith, so it's not unthinkable i may now share my medical tips with the company.

That mentioned, adulterous Ashley Madison clients likely felt at ease as well.

This story at first regarded in l. a. instances.


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