CLASS 1 LESSON PLAN

CLASS 1 LESSON PLAN

BY KATE RACIAK MSN, RN

TESTING: ENVIRONMENT & EXPECTATIONS

• computer screens are monitored with NetSupport and the instructor reserves the right to blackout screens to maintain academic integrity

• taking the assessment at an alternate location or in an non-proctored environment is considered academic misconduct

​The following, but not limited to, are prohibited:

• earbuds (EXCEPT FOR FOAM)

• bluetooth hearing devices

• head coverings [pursuant to religious/cultural accommodation]

• wrist devices

• AI devices

• electronic devices

• recording devices (ie: glasses, cell phones etc.)

• calculators

• paper

• writing utensils

• Communication of quiz specifics (question items and answers) is considered academic misconduct

• Complete targeted remediation with the individualized quiz debrief if provided
  

​COMPLETE THE PRACTICE QUIZ IN CANVAS

• practice NGN items

• be familiar with grading

• locate the calculator

TICKET 1 VISUAL.pdf - Google Drive

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NCSBN NCLEX 2026 test plan

STAFFING AND ASSIGNMENT

NCLEX activity statement:
"Report, intervene and/or escalate unsafe practice of staff (e.g., substance misuse, improper care, staffing practices)"


"Keep the patient alive till 705"

C

​s

Terminology

• "Know your ABC's-and don't forget A"

• Ventilation (volume)

• Respiratory rate (frequency, effort, and don't forget pattern)

• Respiration (process of gas exchange)

• PEEP

Match

Match the following definitions:

• VENTILATION

• RESPIRATION

• RESPIRATORY RATE

• PEEP

INHALATION AND EXHALATION (VOLUME)

GAS EXCHANGE (OXYGEN AND CARBON DIOXIDE)

NUMBER OF BREATHS PER MINUTE

POSITIVE END EXPIRATORY PRESSURE

• INHALATION AND EXHALATION (VOLUME)

• GAS EXCHANGE (OXYGEN AND CARBON DIOXIDE)

• NUMBER OF BREATHS PER MINUTE

• POSITIVE END EXPIRATORY PRESSURE

Respiratory distress

BLOCK 4: HOW DO WE KNOW WHEN SOMEONE IS IN RESPIRATORY FAILURE?

"Know your ABC's-and don't forget A" 

1. non-patent airway

• 'universal sign of choking'

• trachea, bronchi (sounds)

• foreign body, anaphylaxis, burns, etc.

• condition that affects airway

"If GCS less than 8-maybe intubate?" 

2. SPO2 less than 90%

• keep sats above 94/95% per the AHA

​3. PO2 less than 60

​"Minus 30 rule"

• ​When ABG not available, estimate the PO2 based on SPO2

4. P/F (PO2/FiO2) ratio less than 300 on oxgyen

• PO2 level divided by the FiO2

Drag and Drop

A client's PO2 is 50 and the client is on 10 liters of oxygen. The P/F ratio is ​

Placeholder

. The client is ​

Placeholder

.

Drag these tiles and drop them in the correct blank above

83

in critical respiratory failure

1.2

120

30

experiencing hypoxemia

in respiratory failure

in severe respiratory failure

• change position (elevate head of bed)

• administer oxygen

​2. SPO2 less than 90%

• back thrusts, compressions

• foreign body removal (forceps, coca cola,EGD)

• head tilt, chin lift

• jaw thrust

• OPA/NPA

• intubation

• cricoidotomy

• albuterol

​1. Non patent airway

Generate solutions

• blood products

• keep alveoli open (PEEP)

• ECMO

​4. P/F ratio decreased

• administer oxygen

• blood products

• keep alveoli open (PEEP, furosemide)

• ECMO

​3. PO2 less than 60

Generate solutions

Why doesn't oxygen always help?

SHUNTING

***You learned about anatomical shunts with newborns: foramen ovale and ductus arteriosus

-ARDS
-COPD
-pneumonia
-lung cancer
-smoking

alveolar collapse (atelectasis) you get Refractory Hypoxemia!!! aka physiological shunting

1. Each team shoud organize the diagnoses and solutions by primary respiratory failure pathophysiology

(approx. 10 minutes)

'IS IT HYPER OR HYPO' ACTIVITY​

​

shunting, ARDS, pulmonary edema, PE, sepsis, pneumonia, hepatopulmonary syndrome, anemia, heart failure

HYPOXEMIC (respiration-gas exchange)

neuromuscular diseases (Guillain Barre, ALS (amiotrophic lateral sclerosis aka Lou Gehrig's etc), drug/alcohol overdose, traumatic diaphragm rupture, traumatic flail chest, spinal cord injury, obesity 

​HYPERCAPNIC (ventilation)

CLINICAL JUDGMENT: ANALYZE HYPOTHESES

biPAP/CPAP, intubation and ventilator with PEEP, prone positioning, treat underlying cause (COMPLEX MANAGEMENT!!!)

HYPOXEMIC (respiration-gas exchange)

BVM, intubation, antidote, root cause

​HYPERCAPNIC (ventilation)

GENERATE SOLUTIONS

"Don't hate-ventilate; medicate can wait"

Match

Match the following criteria to the primary type of respiratory failure

• CO2 is greater than 45-50 and pH less than 7.35

• PO2 less than 60

• My favorite instructor!!!

Hypercapnic

Hypoxemic

Professor Kate

• Hypercapnic

• Hypoxemic

• Professor Kate

Rationale

Hypercapnic failure is CO2 greater than 45-50 and pH less than 7.35. Remember to ventilate! Hypoxemic failure is a PO2 less than 60. Some authors indicate < 50. Take care of the client because he/she/they are complex. And Professor Kate better be your favorite instructor.....or else. :)

Clinical Judgment learning activity


(on the class dry erase boards-approx. 15 minutes)

• Just received a 4G bolus of magnesium sulfate bolus for preeclampsia

• 3+ pitting edema, clonus

• Heart rate 110

• Pupils sluggish unresponsive

• Pulse oximetry 80%

• Respiratory rate 2

PATIENT A

What is the hypothesis?

respiratory failure-hypercapnic (ventilatory)

"Don't hate-ventilate; medicate can wait"

BLS ALGORITHM.pdf - Google Drive

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Respiratory rate

once every 6 seconds (10 breaths/minute) (normal respiratory rate 10-20)

Tidal volume

6-10 mL/kg

depends on hand size

if alone do the 'chicken'

FiO2

Initially high flow (10-15 liters)

PEEP

start with 5 and titrate up

Each team should demo Skill 14-16

1. head tilt/jaw thrust

2. OPA/NPA insertion

3. bag valve mask (BVM) ventilation

​(aprox. 10 minutes)

• Despite BVM and calcium gluconate administration the patient does not respond

PATIENT A

​Generate Solutions (or what doctor's refer to as differential diagnoses)

• Just received a 4G bolus of magnesium sulfate for preeclampsia

• 3+ pitting edema, clonus

• Heart rate 112
  states "help me, I can't breathe!"

• Pulse oximetry 79%

• Respiratory rate 32

​

PATIENT B

What is the hypothesis?

Generate solutions

Now's your chance to experience CPAP/BiPAP so you know how it feels and it's purpose

Multiple Choice

In NCLEX world, can an RN intubate?

• NO!!!!

• Yes

Multiple Choice

In Arizona, can an RN intubate with an ETT and/or LMA?

• No

• Yes, but.........

​Let's do a search for AZBN advisory opionions to learn about the but....

Ventilator Think-Pair-Share

(approx. 15 minutes)

​Assist Professor Kate with inbutation

(approx. 10 minutes)

Pressure Support (PS)

makes it easier to breathe by overcoming the resistance of the tubing

Challenge: breath through the straw for 5 minutes

​Come on...say it like a pirate..

ADVANCED TELE AND 12 LEAD EKG

• 12 lead interpretation

• additional rhythm interpretation (junctional rhythms, irregular rhythms, heart blocks, wolf parkinson white, etc.

ACLS CERTIFICATION

• taught in 2 days

• learn how to intubate (based on instructor)

• interpret heart blocks

• additional rhythm management

NEW:

1. RHYTHM WITH PVC'S

2. VENRICULAR TACHYCARDIA (POLY/MONO)

3. ASYSTOLE

4. VENTRICULAR FIBRILLATION

5. AFIB RVR

   and because they are common

6. ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA (AVNRT) AKA SVT

7. THE CONCEPT OF PEA

BLOCK 2 CURRICULUM

1. SINUS

2. SINUS TACH

3. SINUS BRADY

4. STABLE ATRIAL FIBRILLATION

5. ATRIAL FLUTTER

Identify the rhythms

• Quiz 1 management: related to hypoxia/hypoxemia

  • stop suctioning after vagal response

  • administer oxygen

  • continue to reassess

  • document
    

1. As a team review telemetry concepts (6 second strip, intervals, block 2 and 4 rhythms)

2. Rotate to the simulator station as a team

   
   (approx. 15 minutes)

Rhythm simulator

​

DEBRIEF

• non proctored assignment mock interview reflection

• highly suggested

  • Passpoint 1-5 

  • CCCJ

    • Gabe, ED charge nurse

    • Jordan, ED charge nurse

    • Terrance, ICU charge nurse

        

(SUBJECT TO CHANGE)

​

QUIZ 1 TEST PLAN-CLICK TO ACCESS