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Pediatric CCRN Review Blog

News and information from Pediatric CCRN Review

Live Pediatric CCRN Review Course coming to Rockville, MD 11/3/19!



Get your ticket now for the live course in Rockville, MD on 11/3/19! The class will decrease test anxiety related to the pediatric CCRN exam, review test content, identify resources, and review practice questions with rationales. 



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The Pediatric CCRN Review Study Guide is now on Amazon!

pediatric ccrn study guide amazon

This study guide includes test content and more than 400 practice questions with rationales. Order yours today! 



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Live Review Courses Coming Soon!

Check back to see the dates and locations of the live one day Pediatric CCRN Review Courses! These classes will review test content and test strategies. 

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Pain and Sedation Assessment

The June 2019 Pediatric Care section of Critical Care Nurse features an article called Using Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients (Miller-Hoover, 2019), which discusses appropriate use of several different pain and sedation scales. Nurses must understand the scales used in their facilities and ensure that the proper scale is used for different scenarios to decrease the risk of adverse events, improve pain management, and meet regulatory standards. 

Uses of the scales discussed include sedation, procedural sedation, mechanical ventilation, and pain. Age and developmental level of the child assists the nurse in choosing an appropriate scale. Assessment of delirium is vital in differentiating pain in an agitated patient who is verbally responsive. New standards from The Joint Commission’s Standard Revisions Related to Pain Assessment and Management in January 2018 include monitoring safe opioid prescribing oversight, assessing high-risk patients, collaborating pain goals with patients, creating more access to prescription drug monitoring programs, and creating competency validation focusing on increased safety and quality improvement. 

Miller-Hoover, S.R. (2019). Using Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients. Critical Care Nurse, 39(3), 59-66.

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Standardization of Neurological Exams


The June cover of Critical Care Nurse features an article on Routine Neurological Assessments by Nurses in the Pediatric Intensive Care Unit (Kirschen et al., 2019) which discusses a quality improvement intervention over a 1-year period. The goal was to standardize neurological assessments by nursing staff, improve the compliance of providers entering orders, improve nursing documentation, and assess the frequency of neurological decline before admission and after discharge. The study successfully improved ordering and documenting neurological assessments and found that patients with developmental disabilities were more likely to experience a decline in neurological status than patients who do not have a developmental disability. 

How is this relevant to the pediatric CCRN exam? Clinical inquiry includes questioning the appropriateness of policies, guidelines, and current practices to continuously improve patient outcomes. Identifying and addressing differences in practice are important in clinical inquiry to ensure that best practices are followed. Standardization in ordering and documenting neurological assessments is important in identifying objective patient declines in order to intervene early and appropriately. While blood pressure, heart rate, and intracranial pressure are objective measures of neurological assessment, the use of the Glasgow Coma Scale may vary from nurse to nurse. 

Clinical inquiry is a Professional Caring and Ethical Practice in the American Association of Critical Care Nurses (AACN) synergy model, which defines patient characteristics and nurse characteristics explaining how they can best be combined to improve outcomes. Professional Caring and Ethical Practice encompasses 20% (80 questions) of the pediatric CCRN exam. 

Kirschen, M. P., Lourie, K., Snyder, M., Agarwal, K., DiDonato, P., Kraus, B., ...Topjian, A. (2019). Routine Neurological Assessments by Nurses in the Pediatric Intensive Care Unit. Critical Care Nurse, 39(3), 20-32. 

Photo credit: http://boneandspine.com/wp-content/uploads/2013/08/pediatric-glsagow-coma-scale.png

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