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Clinical Management of Category III Fetal Heart Rate Tracings
The National Institute of Child Health and Human Development (NICHD) workgroup standard for fetal heart rate monitoring assessment and categorization, first proposed in 1997 and subsequently updated in 2008 was meant to promote commonality of FHR tracing nomenclature and interpretation. Based on these recommendations, a three-tiered categorization pattern based on the visual assessment of the fetal heart rate pattern was adopted. This module aims to review and apply essential FHR content in several clinical scenarios to highlight an important Clinical Pearl: The Category III tracing is a rare intrapartum FHR pattern that is highly associated with fetal acidemia and adverse neonatal outcomes.
Consistently apply 1997 and 2008 NICHD definitions and terminology when describing intrapartum fetal heart rate patterns.
Identify intrapartum fetal heart rate tracings using the 2008 NICHD 3-tiered system.
Recognize the fetal heart rate characteristics that define a Category III pattern.
Review the diagnostic imprecision and clinical significance of minimal fetal heart rate variability.
Clinical Management of Uterine Atony
A case of obstetrical hemorrhage due to uterine atony, requiring medical and surgical interventions and blood component replacement therapy is presented. Emphasis: A review of obstetrical hemorrhage, etiologies, and treatments is provided. The importance of early recognition and response to excessive blood loss is stressed. Medical and surgical interventions for uterine atony are reviewed. Current recommendations for blood component replacement therapy for massive hemorrhage are discussed.
List common risk factors for OH.
Review medical treatments for uterine atony.
Identify pre-surgical and surgical treatments for uterine atony.
Describe blood component therapy for massive hemorrhage.
Fetal Heart Tracing Pattern Evolution
Intrapartum fetal heart rate monitoring is an integral part of modern day obstetrics and when properly interpreted, may provide valuable insight into the fetal metabolic state. During labor, the physiologic stress posed by regular uterine contractions and maternal expulsive efforts may adversely impact the fetal acid-base status, leading to changes in the fetal heart rate pattern.
This module aims to review and apply essential FHR content in several clinical scenarios to highlight an important Clinical Pearl: Management of the laboring patient requires that the FHR pattern trends are interpreted in context with the clinical scenario and progress of labor.
Consistently apply 1997 and 2008 NICHD definitions when describing intrapartum fetal heart rate patterns.
Identify the importance of FHR variability evolution when assessing the FHR pattern.
Review the importance of FHR tracing trend assessment when managing the abnormal intrapartum FHR tracing.
Recognize the importance of clinical scenario, FHR pattern evolution, and stage of labor when managing the Category II tracing in labor.
Economic Stability: Social Determinants of Health
Economic stability is defined as a domain of social determinants of health in the Healthy People 2030 campaign. It relates to an individual’s ability to access resources such as food, adequate housing, and healthcare. Each component of economic stability, including poverty, employment, food security, and housing stability, is linked to individual health outcomes.
Describe the four components of economic stability.
Explain how economic stability affects health and health outcomes.
Identify strategies for helping patients overcome barriers to economic stability and how they positively impact health outcomes.
Emergent Delivery of Infant
The management of the female who presents to the emergency department (ED) in active labor is stressful and overwhelming. Ideally, the ED has a plan in place, based on hospital resources, for the imminent delivery of a newborn. Decisions regarding delivery in the ED or transferring the patient to labor and delivery are based on a variety of factors. Knowledge of the possible complications of delivery will provide anticipatory guidance to improve maternal and fetal outcomes.
Know the clinical presentation and physical exam findings associated with pregnancy.
Recognize the common complications associated with pregnancy. Plan the steps to prepare the process of delivery of a newborn.
Recognize common complications of delivery of a newborn.
Improving Nurse Retention
While much of the responsibility for nurse retention has been placed on the administration hierarchy, nurses themselves must take an active role in understanding why colleagues choose to remain in their jobs. Nurses play a vital role in developing and implementing strategies that create an engaging and rewarding work culture. Improving nurse retention also directly improves patient outcomes.
Discuss the benefits of retention on the quality of patient care and the reasons nurses leave an organization.
Recall strategies for retaining nurses in the workplace.
Preventing Medical Errors: Culture of Safety
Medical errors and substandard care occur often in today’s complex healthcare organizations. Errors are usually due to multiple factors at the system-level rather than a single factor from an individual. Healthcare organizations that are committed to patient safety are high-reliability organizations. These organizations remain alert for ways to protect patients from harm even though they have few adverse events. This course will offer suggestions for reducing medical errors and maintaining a culture of safety.
Describe how the culture of healthcare organizations and the roles of healthcare professionals affect patient safety.
Identify three examples of medical errors and how they may occur.
The Dangers of Alarm Fatigue
This course provides nurses with information regarding safety concerns associated with alarm fatigue along with evidence-based research strategies to reduce the fatigue.
Describe the national patient safety goals set by The Joint Commission as they relate to alarm management.
Discuss evidence-based strategies to reduce alarm fatigue.
Social Determinants of Health: Education Access and Quality
Education access and quality is a pillar of the social determinants of health for Healthy People 2030 (U.S. Department of Health and Human Services, n.d.). This course outlines the effects of education on an individual’s health. The four components of education access and quality include early childhood education and development, high school graduation, enrollment in higher education, and language and literacy.
Identify the components of education access and quality and their effects on health.
Recall patient care and education related to education access and quality.
CEN: Communicable Diseases
he purpose of this course is to inform the emergency nurse of communicable diseases, including a comprehensive assessment and appropriate interventions.
Identify alterations in the biological, physiological, and psychological status of patients experiencing communicable disease emergencies.
Describe a comprehensive plan for the care of communicable disease conditions including diagnostic and treatment interventions, and patient education.
An Overview of Trial of Labor After Cesarean Section
This course provides an overview about the safety of patients undergoing a trial of labor after cesarean (TOLAC) to attempt a vaginal birth after cesarean delivery (VBAC). Research evidence has influenced where VBACs are performed, which women are eligible and how the practice is conducted, including the safe use of induction/augmentation medications. The safety of VBAC for mother and newborn always remains the primary underlying principle that guides care.
Identify three risk factors and benefits associated with TOLAC and recommendations for safe TOLAC.
Recall essential components of nursing education, informed consent, safe medication administration, and fetal assessment related to TOLAC.
Care Teams: Depression and Anxiety
The goal of this course is to provide nurses and prescribing providers (physicians) in all healthcare settings with best practices to improve their care team approach to patients with depression and anxiety.
Recall care team best practices, including collaboration, communication, and roles.
Identify how care team best practices can improve outcomes for patients with depression and anxiety.
Ambulatory Preceptor: Integrity, Ethics, and Legal Considerations
The world of legalities, red tape, and ethics can be a daunting one. We have all heard about the importance of confidentiality and trust in healthcare. How do these issues apply to preceptorships? This educational activity addresses integrity in preceptorships and gives you information you can share with preceptees to enhance professional and personal character, confidence, and wisdom in nursing practice. It also reviews important ethical and legal considerations that should be reviewed and incorporated into a preceptorship. The goal of this course is to provide nurses and nurse preceptors in ambulatory care settings with information about integrity, ethical conduct, and legal considerations in nursing practice and preceptorships.
Identify core competencies of preceptors, ethical principles, and potential boundaries to ethical practice in preceptoring others.
Recall at least three legal considerations important for preceptorships in ambulatory care settings.
Shoulder Dystocia: Teamwork and Training
This content is intended for all members of the obstetric team and is based on the educational theory that team performance is enhanced when all members of the team have the same understanding of the task and procedure to be performed.
Enhance situational awareness for patients at increased risks for shoulder dystocia (SD). Design a team-based SD simulation drill. Improve obstetrical team performance through enhanced cooperation in deliveries complicated by SD. Review methods to enhance communications with teams.
Culture and Mental Health
Culture affects how individuals talk about and recognize their mental health symptoms. It also affects how providers conceptualize and work with individuals with diverse backgrounds. It is important to recognize how culture influences the ways individuals and providers approach mental health. Healthcare providers should be encouraged to use interventions and strategies that assist in delivering culturally competent care.
This course will examine the reasons for healthcare disparities among culturally diverse individuals, how both the cultural backgrounds of patients and their providers can impact patients’ mental health outcomes, and what kinds of actions providers can take to provide more effective care to patients of diverse cultures.
Distinguish between some of the different assumptions and values that mental health providers and individuals hold, which influence their approaches to mental health. Explain why patients of diverse cultures with mental health needs are encountering disparities. Select assessment and intervention strategies that promote culturally competent care.
Clinical Management of Category II Fetal Heart Tracing
Three different obstetrical scenarios, complicated by a Category II Fetal Heart Rate pattern, are presented to illustrate the importance of clinical context when formulating management plans. Emphasis, characteristics, and potential etiologies of Category II fetal heart rate tracings are reviewed. Management of the patient with a Category II fetal heart rate pattern is discussed, with special emphasis on the importance of the clinical context and fetal heart rate pattern evolution.
Describe characteristics of Category II FHR tracings.
Identify common etiologies for Category II FHR tracings during labor.
Examine clinical interventions for Category II FHR tracings.
Review the etiology-based management of Category II FHR tracings.
Perioperative Series: Intro to Perioperative Nursing
As defined by the Association of periOperative Registered Nurses (AORN) (2019), the perioperative nurse’s goal is to help patients achieve or exceed the level of well-being they had at the pre-procedural baseline. The nurse is required to have the clinical knowledge, judgment, and clinical reasoning skills necessary to safely plan, deliver, and evaluate care for surgical patients.
The goal of this course is to equip perioperative nurses with knowledge of the nursing process and the roles and responsibilities within the perioperative team.
Identify the perioperative nursing process throughout the phases of surgery.
Define the roles and responsibilities of the members within the surgical team and the AORN standards of perioperative practice.
The Professional Nurse and Social Media
For many of us, social media is a fun way to stay in touch with friends and family. We share photos and stories with people across town and around the world. However, nurses need to be cautious as they engage in social media as it can affect their careers in ways never imagined. Content taken in the wrong context can damage a nurse’s professional reputation.
Recognize commonly used social media platforms.
Identify the risks and benefits of using social media for professional and personal purposes.
Indicate best practices for communicating effectively and ethically on social media platforms.
Managing Coagulopathies
The focus of this course is coagulopathies. In general, the term coagulopathy refers to bleeding disorders. This course will provide a review of the components of a clot. It will also provide you with valuable information about how to care for those with coagulopathies such as immune thrombocytopenia (ITP), disseminated intravascular coagulopathy (DIC), heparin-induced thrombocytopenia (HIT), and warfarin-induced coagulopathy.
The goal of this course is to provide nurses in the critical care setting with a general overview of coagulopathies, including the recognition and nursing management of ITP, DIC, HIT, and warfarin-induced coagulopathy.
Describe the etiology and presentation of DIC, ITP, HIT, and warfarin-induced coagulopathy.
Identify proper nursing care for those with DIC, ITP, HIT, and warfarin-induced coagulopathies.
Identify emergency findings in those with coagulopathies and discuss the appropriate nursing interventions.
Intimate Partner Violence in Pregnant Women
Healthcare professionals often feel unprepared to ask about abuse or to counsel a pregnant woman who is being abused, although they are in a unique position to assess for IPV and to support women who experience it. As such, it is necessary for clinicians to skillfully screen for IPV and offer effective interventions when appropriate.
Recognize three barriers to and three recommendations for assessing IPV.
Recall four questions that are used to assess for IPV.
Identify three intervention strategies for women experiencing IPV.
Reducing Medical Errors in the OR
The OR is a complex environment. Highly trained individuals interact in a specialized setting with sophisticated and technically complicated devices, instruments, and equipment. There are also substantial differences among team members related to education, experience, skill level, influence, and formal and informal power. This course will inform nurses and surgical technologists of the evidence-based steps to take to create a culture of safety in the OR.
Identify the communication processes that aid in reducing medical errors and review recommendations for the safe transfer of patient care information.
Name organizations that are helping to create a culture of patient safety and their recommendations to meet this goal.
Determine the components of a just culture that promote trust and accountability and recall a 10-step process for creating a culture of safety in the OR.
SIADH Management
Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition that occurs when the body produces too much antidiuretic hormone (ADH), which causes fluid retention and electrolyte imbalance. SIADH can have various causes and manifestations and can lead to serious complications if not recognized and treated promptly. This course will provide you with the knowledge to thoroughly assess and manage patients with SIADH in the hospital setting.
Explain the pathophysiology, causes, and diagnosis of SIADH.
Identify the signs and symptoms of SIADH and potential complications.
Review common treatments and nursing interventions for patients with SIADH.
Innovation in Acute Care: Excellence Series
The goal of the course is to discuss how innovations can be recognized, developed, adopted, and disseminated amongst staff, as well as review areas where innovations are likely to change the provision of care. We will also explore the patient’s role in innovation, and how patient and family-centered care will drive ongoing changes.
Review the process of innovation development and dissemination.
Summarize innovations that are modifying the current healthcare environment.
Discuss the nurse, patient, and family roles in the future of care delivery.
Adult Obesity in the U.S.
Obesity rates in the U.S. have risen to the level of an epidemic, as 1 in 3 adults are affected by this disease. Obesity is a disease that significantly affects a person’s health and is not simply due to poor diet and lack of exercise. This course introduces healthcare professionals to the causes, management, and treatment options for adult obesity.
The goal of this course is to familiarize healthcare professionals with the growing epidemic of obesity among adults in the U.S.
Identify the current problem and contributing factors of obesity in the U.S.
Describe the management and treatment options for obesity.
Acute Heart Failure
Heart failure (HF) treatment is costly and requires a multidisciplinary approach. Evidence-based treatment guidelines improve patient outcomes, and it is essential to become familiar with these guidelines to reduce patient mortality. Healthcare team members play a significant role in treating acute HF (AHF), helping to reduce the morbidity and mortality of the disease and decrease the use and costs associated with care. This course aims to educate nurses and nutrition and dietetics professionals in the acute care setting about evidence-based heart failure treatment guidelines.
Describe heart failure, including its classification systems, presentation, treatment, and evidence-based therapies.
Describe strategies for patient self-management.