CLASS 1 LESSON PLAN

CLASS 1 LESSON PLAN

BY KATE RACIAK MSN, RN

-Pre-brief
-Debrief (1. post quiz, 2. filter session feedback, 3. guided reflection, 4. formative eval in Tracprac)

-

​

​VR review

​CCCJ
(Client Cases for Clinical Judgment)

1. QUESTION 1

2. QUESTION 2

3. QUESTION 3

​TESTING: ENVIRONMENT & EXPECTATIONS

-IF NOT ALL STUDENTS HAVE TAKEN THE QUIZ, DISCUSSION OF QUESTIONS ARE CONSIDERED ACADEMIC MISCONDUCT (NURSING STUDENT HANDBOOK, P. 15)

-DO NOT FIXATE ON CLASS AVERAGE IN CANVAS. OFTENTMES, THERE ARE MULTIPLE TEST VARIATIONS USED, BUT CANVAS ONLY SHOWS THE AVERAGE FOR THE SMALL SAMPLE SIZE

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

earbuds (EXCEPT FOR FOAM), bluetooth hearing devices, head coverings [pursuant to religious/cultural accommodation], wrist devices, electronic devices, smart glasses, calculators, paper, writing utensils etc.

 -glasses may be inspected for recording abilities
-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

COMPLETE THE PRACTICE QUIZ IN CANVAS


-practice NGN items
-be familiar with grading
-locate the calculator

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​EPSLOs
(End of Program Student Learning Outcomes)

Conflict resolution

​CODE OF ETHICS

• ​Non biased approach

• Ask the client, don't assume

• Address spiritual needs

• Advocate for the client

• Encourage the client to obtain information to make an informed decision

​INFORMATICS AND TECHNOLOGY

​-Aims to improve communication and safety

​THIS IS A REAL CHART!!!!

• Is the client able to make decisions

• Are there advance directives/living will?

• Are family or POA present?

• 2 provider consent

Referrals:

social work, occupational therapy, dietary etc.

​Care map (aka clinical pathway )




-goal: standardize expected client outcomes based on clinical guidelines

LEADERSHIP:STAFFING ASSIGNMENT

"Keep the patient alive till 705"

• WHAT MAKES A STAFFING ASSIGNMENT SAFE?​

• CCCJ: Leadership-Laura skilled charge nurse
  *similar to test questions

​

​

DOES OXYGEN REQUIRE A PROVIDER'S ORDER?

Multiple Choice

Does oxygen require a provider's order/prescription?

• Yes

• No

​Yes.

"Oxygen is considered a medication and must be prescribed by a health care provider."

Taylor, C., Lynn, P., & Bartlett, J. L. (2022). Lippincott CoursePoint Enhanced for Taylor's Fundamentals of Nursing (10th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975204280

​"However, in situations where there is a clear clinical indication, such as decreasing oxygen saturations or tachypnea, or an emergency situation, the absence of a prescription should not delay the administration of oxygen to the patient."

Taylor, C., Lynn, P., & Bartlett, J. L. (2022). Lippincott CoursePoint Enhanced for Taylor's Fundamentals of Nursing (10th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975204280

aka CLINICAL JUDGMENT

​-Because of the risk of retaining carbon dioxide, never apply the simple face mask with a delivery flow rate of less than 5 L/min

-​For patients with chronic lung disease, limit rate to the minimum needed to raise arterial oxygen saturation to maintain a level of 88–92%

​-A malfunction of the bag or oxygen flow could cause carbon dioxide buildup and suffocation.

DECISION SUPPORT TOOLS (DST)

AZBN ADVISORY OPINION (AO)- STANDING ORDER PROTOCOLS

"STANDING ORDERS, ORDER SETS, PROTOCOLS, PRE-PRINTED ORDERS"

DELEGATION EVALUATION

"The administration of oxygen is not delegated to assistive personnel (AP). Reapplication of the nasal cannula during nursing care activities, such as during bathing, may be performed by AP. Depending on the state’s nurse practice act and the organization’s policies and procedures, administration of oxygen by nasal cannula may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient’s needs and circumstances as well as the qualifications of the person to whom the task is being delegated."

Taylor, C., Lynn, P., & Bartlett, J. L. (2022). Lippincott CoursePoint Enhanced for Taylor's Fundamentals of Nursing (10th ed.). Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975204280

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TOP 1/3, EDUCATION, TRANSFERRABLE SKILLS, PROFESSIONAL GROWTH, NO PERSONAL IDENTIFIERS​

​

'WOULD YOU HIRE ME' RESUME ACTIVITY​

​

SUBMIT YOUR RESUME IN CANVAS

MOCK INTERVIEW ASSIGNMENT IN CANVAS

Terminology

• ABC's, and D...and for newborns ABCTG

• Ventilation

• Respiratory rate

• Respiration

• PEEP

​CPAP AND BIPAP (MODE)

Match

Match the following definitions:

• VENTILATION

• RESPIRATION

• RESPIRATORY RATE

• PEEP

INHALATION AND EXHALATION

GAS EXCHANGE (OXYGEN AND CARBON DIOXIDE)

NUMBER OF BREATHS PER MINUTE

positive end expiratory pressure

• INHALATION AND EXHALATION

• GAS EXCHANGE (OXYGEN AND CARBON DIOXIDE)

• NUMBER OF BREATHS PER MINUTE

• positive end expiratory pressure

Why doesn't oxygen always help?

-REFRACTORY HYPOXEMIA aka SHUNTING

***YOU LEARNED ABOUT ANATOMICAL SHUNTS WITH NEWBORNS FORAMEN OVALE AND DUCTUS ARTERIOSUS?

C

​s

-ARDS
-COPD
-Pneumonia
-lung cancer

understand alveolar collapse (atelectasis) and/or shunting

ARDS is more fun if you say it as a pirate"

"6 is the fix"

BLS ALGORITHM.pdf - Google Drive

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Match

Match the following definitions:

• respiratory rate

• tidal volume

• fiO2

• PEEP

number of breaths per minute

amount of air during ventilation

% of air inspired

positive end expiratory pressure

• number of breaths per minute

• amount of air during ventilation

• % of air inspired

• positive end expiratory pressure

Multiple Select

Which of the following cues could indicate respiratory distress? Select all that apply

• Skin color changes (cyanosis)

• Tachypnea or bradypnea

• Tripod head bobbing (babies)

• Decreased pulse ox

• Stridor, wheezes, retractions, grunting, nasal flaring, dysarthria

​ASSESSMENT TOOLS

• PULSE OXIMETRY- TO KEEP SATS ABOVE GENERALLY 94/95% PER THE AHA

  ***NOT ACCURATE IN THE CASE OF

  CO (CARBON MONOXIDE)

  POISONING/TOXICITY

  "CO makes your pulse ox lie"

• CAPNOGRAPHY (END TIDAL CO2) 35-45 RANGE

• ABGs

​"MINUS 30 RULE"

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

Or, use the calculator

CLINICAL JUDGMENT: GENERATE SOLUTIONS

• HEAD OF BED 90 DEGREES

• SUPPLEMENTAL OXYGEN

• HUMIDIFICATION (BREAKS UP SECRETION)

• ADEQUATE HYDRATION

• SUCTIONING

• EXPECTORANTS (EX. MUCINEX, GUANEFICIN)

• PERCUSSION AND POSTURAL DRAINAGE

• BRONCHODILATORS (EX. ALBUTEROL)

​

"GCS less than 8 maybe intubate?" 

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

1. Non-patent airway

2. PaO2 or PO2 < 60 mm Hg

3. SPO2 < 90% room air

4. P/F (PO2/FiO2) ratio <300 on oxygen

RESPIRATORY FAILURE

​***Any or all of the following;

P/F RATIO:
YOU DO NOT NEED TO CALCULATE THIS FOR TESTING PURPOSES, BUT YOU MUST KNOW WHAT THE RESULTS INDICATE

​"3, 2, 1, you're done-if you have ARDS"

Drag and Drop

A client's PO2 is 50 and the client is on 10 liters of oxygen (FiO2 60%). 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

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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

Explanation Slide...

Hypercapnic failure is CO2 is less 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. :)

1. 10 minutes

2. Organize the diagnoses by primary respiratory failure pathophysiology

'IS IT HYPER OR HYPO' ACTIVITY​

​

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

HYPOXEMIC (respiration-gas exchange)

CAUSES: 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

SOLUTIONS: consider biPAP/CPAP if not contraindicated, intubation and ventilator with specific settings, prone positioning, treat underlying cause (COMPLEX MANAGEMENT)

HYPOXEMIC (respiration-gas exchange)

SOLUTIONS: "don't hate-ventilate"
(BVM or intubation and ventilator), consider antidotes

​HYPERCAPNIC (ventilation)

CLINICAL JUDGMENT: GENERATE SOLUTIONS

Multiple Select

WHICH OF THE FOLLOWING IS A CONDITION THAT COULD RESULT IN PRIMARILY HYPERCAPNIC RESPIRATORY FAILURE? SELECT ALL THAT APPLY

• Heroin overdose

• Flail chest

• Guillain Barre

• Brain tumor

• ALS (amylotrophic lateral sclerosis)

Pregnant patient B
-Just received a 4g bolus of magnesium sulfate for preeclampsia
-3+ pitting edema, clonus
-Pulse oximetry 79%
-Heart rate 112
-Crackles bilaterally
states "help me, I can't breathe!"
-Respiratory rate 22

Pregnant patient A
-Just received a 4g bolus of magnesium sulfate bolus for preeclampsia
-3+ pitting edema, clonus
-Pulse oximetry 80%
-Heart rate 110
-Pupils sluggish unresponsive
-Respiratory rate 2

Clinical judgment application

Skill 14-16

• Respiratory rate adult once every 6 seconds (Skill 14-16) (10-20 breaths/minute

• Tidal volume 8-10 mL/kg

• PEEP adult 5 +

• FiO2 least amount necessary

-Team 1 Airways
-Team 2 PS, alarms, complications
-Team 3 AC PPV
-Team 4 Intubation

​THINK-PAIR-SHARE

10 MINUTE PREP/10 MINUTE TEACH

​

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ADVANCED TELE/EKG

-IDENTIFYING HEART BLOCKS

-12 LEAD INTERPRETATION

-ADDITIONAL RHYTHM INTERPRETATION (JUNCTIONAL RHYTHMS, REGULARLY IRREGULAR RHYTHMS, WOLF PARKINSON WHITE, ETC.)

ACLS CERTIFICATION

-TAUGHT IN 2 DAYS
-LEARN TO INTUBATE (DEPENDS ON THE INSTRUCTOR)

-INTERPRET HEART BLOCKS

-IN DEPTH RHYTHM MANAGEMENT

CRISP REFERENCE.pdf - Google Drive

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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

​

RHYTHMS YOU MUST KNOW-TELE SIMULATOR

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For quiz 1, focus on basic management for dysrhythmias related to hypoxia/hypoxemia
-stop suctioning
-administer oxygen

DEBRIEF

• ALL OR NOTHING ASSIGNMENTS

  • SUBMIT RESUME BY 1900

  • PASSPOINT TICKET 1 ASSIGNMENTS 1-5

  • CCCJ

    • laura skilled care charge  

    • steven med unit charge 

    • terrance icu charge

    • mary surgical care charge

    • emily vonlander (fracture/PE)

    • matthew winters (GB/trach/ventilation)

    • olivia mains (RD/ventilation)

    • shana delco (MG/ABG/ventilation)

    • ada montgomery (pneumothorax/chest tube)

    • declan mcgee (trauma/pneumothorax/chest tube/ABG)

    • isabella marinucci (premie/RDS/brady)

            

• HIGHLY SUGGESTED

  • UNFOLDING CASE STUDY CHALLENGE

  • DELEGATION CHALLENGE

  • VSIMs

    • JENNIFER HOFFMAN (ASTHMA, RD)

    • CHARLES JONES (HEART FAILURE, CPAP)        

-THE TEST PLAN IS CODED TO MULTIPLE VARIATIONS

-SUBJECT TO CHANGE PER THE SYLLABUS

​

QUIZ 1 TEST PLAN-CLICK TO ACCESS