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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.
Social Determinants of Maternal-Fetal Health
The goal of this course is to educate nurses and physicians about key social determinants of health (SDOH) and health disparities affecting maternal and fetal outcomes.
Identify at least four social determinants/disparities of health impacting maternal-fetal health outcomes.
Describe at least two clinical and/or social support interventions to be used in clinical practice to decrease bias regarding social determinants and improve maternal-fetal health outcomes.
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.
Obstetric Hemorrhage: Mitigating Risk to Improve Outcomes
Two cases are presented. Risk factors, including recurring and nonrecurring, for obstetrical hemorrhage, are reviewed. Delivery preparations and preventative strategies are discussed. Methodologies that better quantify blood loss, allowing for earlier recognition of excessive blood loss, are presented. Management of the patient experiencing obstetric hemorrhage, including a review of current guidelines for blood component replacement therapy, are reviewed.
List recurring and nonrecurring risk factors for obstetrical hemorrhage. List the four Ts of OH.
Identify low, medium and high risk patients for OH.
Review blood component therapy for large volume blood loss.
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.
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.
Neonatal Respiratory Emergencies
Neonatal emergencies are frightening and challenging to almost all acute care providers. Recognizing the presentation of common neonatal respiratory emergencies is essential to acute care providers. This issue will focus on the neonate and provide a succinct review of respiratory emergencies pertinent to clinical practice and board preparation/review.
The goal of this course is to present healthcare providers in the acute care setting with a succinct review of neonatal respiratory emergencies.
Know the anatomy and pathophysiology relevant to emergency management of neonatal respiratory emergencies.
Know the indications and contraindications for acute management options for neonatal respiratory emergencies.
Plan the key steps and know the potential pitfalls in the acute management of neonatal respiratory emergencies.
Recognize the complications associated with the acute management of neonatal respiratory emergencies.
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.
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.
Opioid Use During Pregnancy
Americans are using opioids at an alarming rate, whether through prescriptions or illegal means. Parallel to this problem is the use of opioids during pregnancy.
The goal for this course is to present RNs, PAs, physicians, and entry-level drug and alcohol counselors in inpatient or outpatient settings with best practices for identifying and managing pregnant women who are using opioids.
Recognize the risks and complications related to opioid use disorder during pregnancy.
Identify evidence-based treatment recommendations for opioid use disorder during pregnancy.
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.
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.
Common Brain Disorders and CT Scans
Computed tomography (CT) scans of the head are essential for diagnosing brain disorders in the acute care setting. This course will cover the different types of CT scans indicated for a person with a brain disorder and the signs of abnormalities in those CT scans. A review of brain anatomy will help improve awareness of common brain disorders that can be diagnosed with a CT scan. This course also reviews how to prepare patients for CT scans and basic techniques for performing CT scans. By the end of this course, learners will be able to apply knowledge of CT scans and brain disorders to provide appropriate patient care.
Recall the basic anatomy of the brain and the changes that occur after brain disorders.
Identify the different types of CT scans indicated for a person with a brain disorder and the preparation and care for patients undergoing CT scans.
Apply knowledge of common brain disorders and CT scans' role in managing brain disorders.
Acute Stroke and the Latest Information
In patients with symptoms of acute stroke, early recognition and interventions have been identified as critical factors in stroke outcomes. Evidence-based care can identify, manage, and prevent stroke-related complications. Nurses and physicians must understand stroke management to prevent disability and death. This course aims to present the most up-to-date practices for managing patients with acute stroke.
Discuss current diagnostic practices in patients with acute stroke.
Recall best practice protocols for early identification of acute stroke.
Stroke: Recognition and Management
This course equips healthcare professionals with essential knowledge and skills to promptly and effectively manage stroke in the acute care setting. Participants will gain insight into how to recognize an acute stroke and the initial steps to take for emergency treatment of stroke. In addition, learners will know the different acute treatment options for ischemic and hemorrhagic stroke as well as patient care for acute stroke.
Recall the benchmark diagnosis and treatment times for acute stroke.
Differentiate the treatment of ischemic stroke and hemorrhagic stroke.
Indicate interventions in the care of a patient presenting with an acute stroke.
Emergency Department: HIPAA and CFR42
In an emergency department, information often flows amongst providers and patients quickly because of urgent, sometimes life-threatening, situations. Due to the volume of information being shared, as well as the need for it to be shared quickly and accurately, emergency department providers must be especially careful to safeguard patient information.
The goal of this course is to update nursing professionals in the acute care setting with basic information about the Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR Part 2.
Identify information sharing standards under HIPAA and 42 CFR Part 2.
Define the concept of consent, when you must obtain it to share or receive information, and the types of information that may not be available to you.
A Look at Malignant Hyperthermia
Malignant hyperthermia (MH) is a life-threatening syndrome associated with an anesthetic trigger. Awareness of MH by all perioperative team members, from those working in the preoperative holding area to those in the Post Anesthesia Care Unit (PACU), is important in preventing negative patient outcomes.
Define risk factors for MH and preventive measures for improving patient outcomes.
Identify the signs and symptoms of MH along with diagnostic and genetic considerations.
Describe the best practices for managing and treating MH.
Perioperative Specimen Handling
Proper surgical specimen handling is essential for patient safety. This course covers best practices for intraoperative personnel to prepare, label, and transfer specimens accurately. Adhering to these protocols ensures that specimens are identified and handled appropriately, minimizing the risk of harm to the patient.
This course provides OR nurses and surgical technologists with knowledge of best practices for specimen handling.
Describe the considerations and methods of preparing specimens for various pathologic and examination types.
Recall care standards for the appropriate handling, labeling, and transportation of specimens.
Identify common mistakes made during specimen management and prevention methods to avoid these errors.
Cultural Perspectives in Childbearing
As the population of the U.S. soars in diversity, healthcare professionals must be prepared to care for childbearing families from many different cultures. All cultures and families should be given the same respect, be assured of the highest quality of care, have their religious, ethnic, and cultural values respected and integrated into their care, and have their physical and educational needs met in a way that honors their spiritual beliefs and individuality. Knowledge of the cultures one is serving and the influence they have on women’s perceptions of childbirth are important for achieving positive outcomes. Equally and perhaps more important is applying the principles of cultural humility to nursing care.
The goal of this continuing education course is to improve the ability of nurses and health educators in acute care settings to assess and meet the sociocultural needs of childbearing families of diverse cultural and social groups.
Recall the relationship of culture, subculture, acculturation, assimilation, ethnocentrism, cultural relativism, and cultural humility to healthcare practice.
Recognize elements of cultural assessment and respectful maternity care that can improve quality of care and meet the unique needs of culturally diverse families.
CEN: Cardiovascular Emergencies
The Certified Emergency Nurse (CEN®) is required to demonstrate competency in the domain of emergency nursing which includes knowledge of cardiovascular conditions and emergencies, such as acute coronary syndrome, aortic aneurysm/dissection, and cardiopulmonary arrest.
Identify signs and symptoms of cardiovascular emergencies and conditions.
Describe a comprehensive plan for the care of cardiovascular emergencies, including diagnostic and treatment interventions, and patient education.
CEN: Environmental and Toxicological Emergencies
The Certified Emergency Nurse (CEN®) is required to demonstrate competency in the domain of emergency nursing which includes knowledge of cardiovascular conditions and emergencies, such as acute coronary syndrome, aortic aneurysm/dissection, and cardiopulmonary arrest.
The goal of this course is to inform the emergency nurse of cardiovascular conditions and emergencies, including a comprehensive assessment and appropriate intervention.
Identify signs and symptoms of cardiovascular emergencies and conditions.
Describe a comprehensive plan for the care of cardiovascular emergencies, including diagnostic and treatment interventions, and patient education.