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

• electronic devices

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

• calculators

• paper

• writing utensils

• drinks

• Specific discussion and/or posting of exam content/concepts is considered academic misconduct (NURSING STUDENT HANDBOOK, P. 15)

• Complete targeted remediation with the indvidualized quiz debrief
  

​COMPLETE THE PRACTICE QUIZ IN CANVAS

• practice NGN items

• be familiar with grading

• locate the calculator

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NCSBN NCLEX 2026 test plan

• make recommendation to the provider

• requires an order from a provider

• social work, occupational therapy, dietary etc.

REFERRALS

ADVANCED DIRECTIVE REFERENCE.pdf - Google Drive

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ADVANCE DIRECTIVE

• Is the client able to make decisions?

• Are there advance directives/living will?

• Are family or POA present?

• 2 provider consent

CONFLICT RESOLUTION

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"

1. 15 minutes

2. Complete each case 2 times:

   1. Gabe, ED charge nurse

   2. Jordan, ED charge nurse

   3. Terrance, CC charge nurse

CLIENT CASES FOR CLINICAL JUDGMENT

​

DOES OXYGEN REQUIRE A PROVIDER'S ORDER?

​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

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NON-PROCTORED MOCK INTERVIEW ASSIGNMENT

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

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

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

1. Non-patent airway

2. SPO2 < 90% room air

3.PaO2 or PO2 < 60 mm Hg

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

RESPIRATORY FAILURE

​***Any or all of the following;

"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.

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!!!

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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

Rationale

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 and solutions by primary respiratory failure pathophysiology

'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)

"don't hate-ventilate. medicate can wait"
BVM, intubation, antidote

​HYPERCAPNIC (ventilation)

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)

Clinical Judgment practice




dry erase board activity

​

• 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 (10-20 breaths/minute)

Tidal volume

8-10 mL/kg

depends on hand size

if alone do the 'chicken'

FiO2

Initially high flow

PEEP

start with 5 and titrate

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

Skill 14-16 (10 minutes)

• 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?

respiratory failure-hypoxemic (gas exchange)

Generate solutions

AIRWAY (10 minutes)

1. head tilt, chin lift, jaw thrust

   1. When is head tilt contradindicated?

2. OPA and NPA insertion
   

"GCS less than 8 maybe intubate?" 

In NCLEX world, can a nurse intubate?

Can a nurse intubate with an LMA or ETT in Arizona?

​Ventilator Think-Pair-Share (15 minutes)

​Station rotation

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..

​"with ARDS it's 3, 2, 2-your'e done"

"6 is the fix" (lower tidal volume)

higher PEEP


prone positioning

ECMO

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

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

Identify the rhythms

• Quiz 1 management: related to hypoxia/hypoxemia

  • stop suctioning after vagal response

  • administer oxygen

  • continue to reassess

  • document
    

DEBRIEF

• non proctored assignment mock interview

• highly suggested

  • passpoint assignments 1-5 

      

-SUBJECT TO CHANGE PER THE SYLLABUS

​

QUIZ 1 TEST PLAN-CLICK TO ACCESS