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Exam Name : MSNCB Medical-Surgical Nursing Certification
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Our affiliated professional association, the Academy of Medical-Surgical Nurses, offers the Medical-Surgical Nursing Certification Review Course. It is a 2-day course designed for nurses preparing to take the Certified Medical-Surgical Registered Nurse (CMSRN®) Certification Exam.

In order to meet the varied needs of nurses and facilities, AMSN offers the course in a number of live and independent study formats, including bringing it to your facility or accessing it through the AMSN Online Library.

An alternative to nurses preparing for the CMSRN exam is the Focused CE Series, a collaboration between AMSN and The Focused CE Series is a blended learning model that combines weekly online CE course readings, weekly live webinar presentations, and an online forum for information exchange and networking with peers.

1. Helping Role

- Maintain an environment in which patient confidentiality is assured.

- Assess patient's level of comfort/pain.

- Act as an advocate to help patient meet needs/goals.

- Acknowledge, respect, and support emotional state of patient and/or family as they experience and/or express their emotions.

- Assist patients to achieve optimal level of comfort, using an interdisciplinary approach.

- Modify plan of care to achieve patient's optimal level of comfort, i.e., pharmacological interventions, heat, cold, massage, positioning, touch, etc.

- Provide a therapeutic environment, considering privacy, noise, light, visitors'/providers' interaction with patients.

- Provide culturally competent patient care, including education.

- Support family involvement in accordance with patient's wishes regarding caregiving and decision making.

- Assess for potential for self-harm.

- Identify need of patient/family for support systems/resources and make appropriate referrals.

- Work on behalf of patient/family to help resolve ethical and clinical concerns.

- Coordinate care across multiple settings.

- Identify, acknowledge, support, and facilitate patient/family decisions regarding end-of-life care.

- Identify signs of domestic or intimate partner violence.

- Assess and provide for spiritual needs of patients and families.

- Identify ethical issues in clinical practice and facilitate a resolution with patient, family, and staff.

2. Teaching/Coaching Function

- Assess the patient's and family's readiness and ability to learn.

- Identify barriers to learning.

- Prepare/educate patient for transition in care, e.g., discharge to home or other facility.

- Provide information and rationales related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.

- Utilize opportunities for spontaneous education.

- Encourage patient's and family's participation in establishing educational goals.

- Develop and implement an individualized teaching plan for patient and/or family.

- Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.

- Assist staff in identifying educational needs of patients and their families.

- Assist staff in selecting/developing educational materials appropriate for intended learner(s).

- Teach patient and family about available community resources.

3. Diagnostic and Patient Monitoring

- Conduct and document a comprehensive baseline exam.

- Anticipate patient's response to treatment and monitor for potential problems.

- Reassess patient based on established standards of care at appropriate intervals.

- Interpret results of laboratory and diagnostic studies and take appropriate action.

- Use invasive and non-invasive methods to collect data.

- Analyze all patient data in formulating a plan of care.

- Participate in medication reconciliation at transitions of care.

- Anticipate the patient's response and needs related to physiological, psychosocial sexual, spiritual, and cultural aspects of his/her illness.

- Prioritize identified problems and modify the plan of care to achieve the best possible outcomes.

- Develop an individualized plan of care congruent with patient goals.

- Identify purpose and appropriateness of diagnostic studies.

4. Administering and Monitoring Nursing Interventions

- Administer medications accurately and safely.

- Identify subtle changes in patient's exam to prevent deterioration of patient status.

- Assess patient's level of consciousness.

- Monitor patients for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.

- Implement measures to ensure adequate oxygenation and gas exchange.

- Monitor and implement measures to prevent alterations in skin integrity.

- Initiate, maintain, and monitor intravenous therapy.

- Identify, document, and report deviations from expected findings.

- Monitor for signs and symptoms of complications of disease processes.

- Implement measures to address threats to patient safety, e.g., falls, seizures.

- Maintain patent airway.

- Maintain integrity and prevent infection of invasive drainage systems, e.g., catheters, percutaneous drains.

- Implement measures to maintain adequate hydration and electrolyte balance.

- Provide care to patients on continuous cardiac monitoring.

- Use adaptive/assistive devices for mobility, immobility, positioning, and comfort.

- Interpret cardiac rhythm strips.

- Monitor for complications of musculoskeletal trauma and surgical procedures.

- Perform a neurovascular exam, e.g., extremities, flaps, grafts.

- Provide optimum nutrition during hospitalization, allowing for cultural and individual preferences.

- Identify and implement transmission-based precautions based on patient's history and symptoms.

- Monitor effectiveness of nutritional interventions.

- Develop and implement a wound management strategy.

- Care for patient receiving IV patient-controlled analgesia

- Perform central line dressing change.

- Administer heparin drip

- Apply and/or monitor devices used to immobilize affected area, e.g., cast, splint, collar, etc.

- Care for patient receiving epidural analgesia

- Provide care for patients who have chest drainage systems.

5. Effective Management of Rapidly Changing Situations

- Recognize signs that a patients condition is deteriorating and take appropriate action.

- Obtain appropriate orders to address a change in the patients condition,

- Determine priorities in rapidly changing situations.

- Use existing guidelines/protocols/policies to respond to changing patient situations, e.g., hypoglycemia, wound dehiscence.

- Use existing guidelines/protocols/policies to respond to urgent and emergent situations, e.g., acute chest pain, stroke.

- Initiate basic life support.

6. Monitoring/Ensuring Quality Health Care Practices

- Communicate effectively to the healthcare team.

- Question/clarify orders as appropriate.

- Incorporate evidence-based practice into the patient's plan of care.

- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.

- Report system failures, e.g., chain of command, equipment, safety, medication administration, computer systems.

- Assist nursing staff in incorporating evidence-based practice and quality improvement into practice.

- Participate in quality improvement activities.

- Identify clinical problems for further investigation.

7. Organizational and Work-Role Competencies

- Practice in accordance with the rules and regulations of the state board of nursing in state(s) of licensure.

- Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.

- Utilize electronic/computer resources to optimize patient care.

- Set priorities based on assignment, unit, and institutional needs.

- Act as a professional role model.

- Participate as an active member of the interdisciplinary healthcare team.

- Delegate patient care assignments based on competency levels and scope of practice of healthcare team members.

- Act as a resource for other nurses on the unit.

- Provide collaborative, interdisciplinary, coordinated care.

- Incorporate strategies that support effective team dynamics in a caring and nurturing environment.

- Evaluate own practice based on established standards of care.

- Evaluate nursing care based on outcome criteria.

- Recognize unsafe work practices (nurse/patient ratio, ergonomics, standard precautions, etc.) and intervene appropriately.

- Identify, develop, and implement strategies to reduce readmissions.

- Use the chain of command appropriately.

- Serve as consultant to nursing staff and other disciplines.

- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.

- Identify, develop, and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.

- Provide expert support to unit educators, preceptors, and nurse managers.

- Follow institutional policies and procedures in response to an internal or external crisis or event.

- Serve as preceptor/mentor for students and staff.

- Assist with data collection (e.g., patient outcomes, nurse-sensitive indicators).

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Medical Nursing Free PDF


Paxlovid Cuts Covid Death Risk. But Those Who Need It Are Not Taking It.

As Covid rises again, killing about 1,500 Americans each week, medical researchers are trying to understand why so few people are taking Paxlovid, a medicine that is stunningly effective in preventing severe illness and death from the disease.

A study of a million high-risk people with Covid found that only about 15 percent who were eligible for the drug took it. If instead half of the eligible patients in the United States had gotten Paxlovid during the time period of the research, 48,000 deaths could have been prevented, the authors of the study, conducted by the National Institutes of Health, concluded.

It’s not because people don’t know about the drug — most do — but the reluctance seems to come from doctors worried about interactions with other drugs and people wary of a possible rebound case or the metallic aftertaste.

Regional differences offer a clue, with uptake highest in the Democratic strongholds of the Northeast and Pacific Northwest regions of the United States and lowest in deep red areas including Florida and Indiana. Yet no careful study has clarified why so few people used the medication, which cut the risk of death by 73 percent for high-risk patients in the N.I.H. study.

“I don’t know why there is such variability and why uptake isn’t higher across the board,” said Dr. Josh Fessel, a senior clinical adviser on the National Institutes of Health team that studied the drug’s use. “If you can take Paxlovid and you do take Paxlovid within the recommended time frame, the likelihood of death or hospitalization are significantly reduced. That’s a big deal.”

Covid deaths have been elevated since September at about 1,200 to 1,300 deaths per week, inching up to about 1,500 per week in December. Researchers say they will most likely continue to rise unless more people get the updated Covid vaccines and antiviral treatments.

Dr. Fessel said that over the course of the entire million-person N.I.H. study, about 10 percent of high-risk patients eligible for Paxlovid took it, though the rate rose to about 15 percent toward the end of the study period in early 2023. All told, the N.I.H. authors estimated that about 135,000 hospitalizations and 48,000 deaths could have been avoided if half of the patients eligible for the antiviral got it.

Paxlovid, made by Pfizer, is a two-medication treatment meant to be taken within five days of the onset of Covid symptoms to quash viral spread within the body. It was approved for adults who are at high risk for severe Covid, which tends to include those 65 and older and people with diabetes, obesity, asthma and other conditions.

Reasons for not prescribing or taking it have varied: Doctors balk at the long list of medications not to be mixed with Paxlovid, including common drugs meant to lower blood pressure or prevent blood clots. Patients tend to complain about the drug’s metallic aftertaste. Many wave off the drug in the early days of Covid, when symptoms tend to be mildest, bypassing the chance to limit early viral growth.

“They want to wait and see if things get worse, but if you wait and see it’s not effective,” said Dr. David Gifford, chief medical officer of the American Health Care Association, which represents nursing homes. People think, “‘It’s just a cold and I’ll tough it out,’” he said. “And that needs to change.”

Price has also become a factor. The federal government provided the five-day course of the medications at no cost in the months since its initial emergency authorization in December 2021. (The Food and Drug Administration fully approved the drug in May.) Federal officials still have more than one million free doses out to pharmacies, and the medication will be free through 2024 for Medicaid and Medicare patients. But in recent weeks, officials have handed distribution of the drug off to Pfizer, which has priced it at about $1,400 per course, though private insurers are expected to cover some portion of the price and Pfizer is offering co-payment assistance.

No study has looked at the effect of the handoff. The N.I.H. study period ended early last year. It found wide regional variation in Paxlovid use, with as many as 50 percent of eligible patients getting the medication in Utah and in the Northeast and Northwest regions of the United States. However, rates dipped close to zero in states in the Southeast and in parts of the lower Midwest.

Dr. Fessel, of the N.I.H., said he would be curious to see if concerns about so-called Paxlovid rebound contributed. The misgiving has been that the medication dampens symptoms initially and then leads to a second stage of illness.

In a recent review of studies, the Centers for Disease Control and Prevention found “no consistent association” with Paxlovid use and Covid rebound. Studies show rebound can also happen without treatment.

Denis Nash, a professor of epidemiology at the City University of New York, has also been studying Paxlovid use. In a far smaller study, his team also found uptake of the medication at nearly 14 percent, though lower among some, including 7 percent among people who are Black and nearly 11 percent among those with the lowest income levels.

He said his team worked on a nationally representative survey of 4,000 people to dig deeper (results have not yet been published or peer reviewed). One interesting finding, he said, was that awareness of Paxlovid was high — with about 80 percent of respondents saying they knew that it was available.

Yet respondents showed a lack of recognition about their own risk: Only about one-third of people older than 65 considered themselves to be at high risk for severe Covid, even though the C.D.C. considers all in that age group high risk. The finding was similar for patients with asthma or diabetes, though half of patients who were overweight or obese recognized their risk.

“People don’t necessarily perceive themselves to be at risk,” Dr. Nash said.

Another recent study found that starting Paxlovid very early, or on the first day of symptoms, improved odds of survival or avoiding hospitalization, compared with starting the drug a day or two later.

Studies have also looked at the use of another antiviral drug, molnupiravir, made by Merck, which was less effective and is used less frequently. Gilead, which makes the antiviral infusion remdesivir, is also studying a Covid antiviral pill called obeldesivir and plans to seek F.D.A. approval. The N.I.H. is studying yet another antiviral option, ensitrelvir, by the company Shinogi that also appears to reduce duration of the illness.

Researchers have also reported low Paxlovid use in nursing homes, given the risk patients face of serious illness or death. About one in four nursing home residents got an antiviral prescription to treat Covid by the end of 2022, a study found. The data showed that the rate rose to closer to one-third of nursing home residents by May 2023, said one study author, Brian McGarry, a University of Rochester assistant professor of medicine.

After that, federal officials stopped asking about Paxlovid use in their weekly nursing home Covid questionnaire.

“I think things are a little bit better,” Dr. McGarry said, “but at the same time, facilities are now dealing with Covid, plus R.S.V., plus flu.”

Understanding the Differences Between Nursing Homes and Assisted Living

No result found, try new keyword!Assisted living communities allow their residents more independence than nursing homes. Because assisted living residents don't have as many medical conditions, they will have more freedom to ...

Medical University of South Carolina

No result found, try new keyword!Medical University of South Carolina is a public school. The College of Nursing has an application fee of $50 for U.S. residents. The College of Nursing at Medical University of South Carolina has ...

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