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Winona State University
College of Nursing & Health Sciences
Department of Nursing
COURSE FACULTY:
Roberta M. Bumann, RN, MSN
Assistant Professor of Nursing
EA261 Rochester Campus
rbumann@winona.edu
Catherine M. Nosek, RN, PhD,
Associate Professor of Nursing
Stark 303H Winona Campus
cmnosek@winona.edu
COURSE NUMBER/TITLE: 498 Advanced Critical and Progressive Care Nursing
COURSE CREDITS/TIME ALLOTMENT: 2 Credits (30 Continuing Education Credits)
PREREQUISITE/CONCURRENT COURSES: Registered Nurse (RN) License. Consent of
instructor. Nursing experience in critical care or progressive/acute care is required.
COURSE DESCRIPTION
A. Catalog Description/Purpose
This course is specifically designed for Registered Nurses currently caring for adults in
critical or progressive/acute care nursing units. Course content is designed to meet
knowledge requirements for practice and/or certification in critical care or progressive care
nursing and as such, promotes continuing excellence in the nursing profession. Course
content will be based on the 2006 topic and certification blueprints established by the
American Association of Critical-Care Nurses (AACN) Certification Corporation. The
emphasis of learning activities will address clinical judgment in the eight major categories
including cardiovascular, pulmonary, endocrine, hematology/immunology, neurology,
gastrointestinal, renal, and multisystem, and explore concepts of professional caring and
ethical practice in nursing.
This course will have 3 section options for Registered Nurses:
Section 1: Designed for RNs desiring the CCRN content. This section is web-supplemented
(no reduced seat time, face-to-face instruction. Desire 2 Learn will be the platform for
instructional activities. RNs will be required to specify whether or not they plan on taking the
course for content exclusively or content and CCRN certification testing. Fee for
examination will vary depending on class size ($300.00 if < 20 RNs testing, or $250.00 if
20+ RNs test)
Section 2: Designed for RNs desiring the PCCN content. This section is web-supplemented
(no reduced seat time, face-to-face instruction). Desire 2 Learn will be the platform for
instructional activities. RNs will be required to specify whether or not they plan on taking the
course for content exclusively or content and PCCN certification testing. Fee for examination
will vary depending on class size ($250.00 if < 20 RNs testing, or $150.00 if 20+ RNs test)
Section 3: Designed for RNs desiring the CCRN or PCCN content. RNs will be required to
specify whether or not they plan on taking the course for content exclusively or content and
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certification testing. This section is INTERNET based meaning that all, or nearly all, of the
course activities will occur in an online environment. One or two activities (e.g. certification
testing) may occur face-to-face in the classroom.
B. Course Learning Outcomes
1. Identify signs and symptoms of various patient problems in the eight major categories
(cardiovascular, pulmonary, endocrine, hematology/immunology, neurology,
gastrointestinal, renal, and multisystem).
2. State normal ranges of lab values and identify anticipated abnormal lab values for various
critical and/or acute health conditions.
3. Describe anticipated medical therapies, procedures, and nursing interventions for various
critical and/or acute health conditions.
4. Discuss priority of care for the critical-care/acute illness phase of various health
problems.
5. Discuss appropriate assessments, monitoring parameters, and nursing interventions for
the patient’s status and expected outcomes.
6. Analyze own clinical judgment and decision-making ability.
7. Discuss nursing behaviors for Professional Caring and Ethical Practices.
8. Identify personal test-taking strategies.
LEARNING PLAN
A. Strategies
Lecture/discussion; Audiovisual materials; Web-based learning activities; Case
Studies/Clinical analysis; Practice tests; Study Groups; Assignments
B. Course Requirements
CCRN Section 1:
If taking AACN’s CCRN Certification exam, the Registered Nurse must meet AACN
eligibility criteria and sign the honor statement.
Eligibility criteria: “I have fulfilled the clinical practice hour requirements of 1,750 hours of
direct bedside care of acutely or critically ill adult patients within the previous 2-year period,
with 875 hours accrued in the most recent year preceding this application; or if renewing by
examination have fulfilled 432 hours of direct bedside care of acutely/critically ill patients
within the 3-year certification period, with 144 hours accrued in the most recent year
preceding renewal; and possess a current unrestricted U.S. license to practice as a registered
nurse.”
PCCN Section 2:
If taking AACN’s PCCN Certification exam, the Registered Nurse must meet AAACN
eligibility criteria and sign the honor statement.
Eligibility criteria: “I have fulfilled the clinical practice hour requirements of 1,750 hours of
direct bedside care of acutely ill adult patients within the previous 2-year period, with 875
hours accrued in the most recent year preceding this application; and possess a current
unencumbered U.S. license to practice as a registered nurse.
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Online Section 3:
If taking AACN’s CCRN or PCCN Certification exam, the Registered Nurse must meet
AACN’s eligibility criteria and sign the honor statements. (see statements 1 or 2 above).
C. Assignments for All Sections (assignments may vary each year depending on changing
health care, research, other variables)
a. Pre-test Assessment – (BKAT©)
All students must take the Basic Knowledge Assessment Test (BKAT ©). This is a
100-item test of basic knowledge. The purpose of this assignment is to assess a
baseline of students in the course and to give students test-taking experience. This is
a non-graded assignment.
b. Invasive Hemodynamic Monitoring Module
Hemodynamic assessment and monitoring are central to critical care nursing. Please
read, Headley, J.M. (2002). Invasive hemodynamic monitoring: Physiologic
principles and clinical applications. Edwards Life Sciences. After reading and
studying this monograph, students will take a 30-item post-test posted on D2L. This
is a graded assignment.
c. Case Studies
A series of case studies will be posted on D2L and that are designated for CCRN or
PCCN RNs. Students are encouraged to work together as they study the scenarios
and discuss the study questions. Students should share their knowledge and expertise.
Each student will be graded on a specified number of case studies. This is a graded
assignment.
d. Practice Quizzes/Tests
Practice tests allow students to evaluate knowledge and clinical decision-making
skills, as well as develop skill in test-taking. If you are able to communicate your
knowledge through the medium of a multiple-choice exam, you will more likely be
successful in passing the certification exam. Practice quizzes and tests will also
cover topics that are on the Test Blueprint, but will not be covered during the class
sessions. This is a non-graded assignment.
D. Evaluation of Learning. When registering for the course, student must select from 1 of 2
grading options.
Pass/No Credit Option - When the course is completed, either P (pass) or NC (no credit) is
entered in the student's permanent record. P is interpreted as equivalent to an A,B,C, or D
letter grade. If the student receives a "grade" of NC, the course can be repeated; however, it
must be repeated for a letter grade, and the grade will be included in the student's GPA.
Grade Option – The following grading scale is used for graded assignments and exams:
Grading Scale
A: 92 – 100 B: 83 – 91
C: 74 – 82
D: 65 – 73
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E. Resources
1. Faculty will be available for questions of course-related concerns via email or on-campus
during office hours.
2. Library Resources: Learning resources and some of the recommended texts will be on
reserve at WSU and hospital libraries.
3. Desire 2 Learn (D2L)
4. Textbooks and Readings
I. Students Registered for CCRN Sections
Required Text:
1. Donohoe Dennison, R. (2000). Pass CCRN! (2nd ed.) Mosby Elsavier.
Recommended Texts:
1. American Association of Critical-Care Nurses (2006). AACN Core curriculum for
critical care nursing (6th ed.). St. Louis, Missouri: Saunders Elsevier.
2. Ahrens, T., & Prentice, D. (1998). Critical care certification: Preparation, review
& practice exams (4th ed.). Appleton & Lange: Stamford. ISBN: 0-8353-1474-X.
3. American Association of Critical-Care Nurses (2004). Adult CCRN Practice
Exam,(5th ed.). Aliso Viejo, CA. AACN Certification Corporation. (www.aacn.org)
($14)
4. Davis, L. (2004) Cardiovascular Nursing Secrets. Mosby Elsevier: St. Louis,
MO. www.elsevierhealth.com ISBN: 0323031439
5. Hardin, S., & Kaplow, R. (2004). Synergy for clinical excellence: The AACN
synergy model for patient care. Sudbury, MA. Jones and Bartlett Publishers.
6. Urden, L. D., Stacy, K.M., & Lough, M.E. (2006). Thelan’s Critical Care
Nursing: Diagnosis and Management (5th edition). Mosby Elsevier.
www.elsevierhealth.com ISBN: 0-323-03248-6
7. Kuebler, K. K., Berry, P. H., & Heidrich, D. E. (2002). End of life care: Clinical
practice guidelines. Philadelphia, PA. Saunders.
8. Darovic, G. O. (2002). Hemodynamic Monitoring: Invasive and Noninvasive
Clinical Application. (3rd. ed.). Philadelphia, Pennsylvania. Saunders.
II. Students Registered for PCCN Sections:
Required Text and Readings:
1. Urden, L. D., Stacy, K.M., & Lough, M.E. (2006). Thelan’s Critical Care
Nursing:Diagnosis and Management (5th edition). Mosby Elsevier.
2. Society of Critical Care Medicine. (1998). Guidelines on Admission and discharge
for adult intermediate care units. [Electronic Version]. Critical Care Medicine,
26(3), 607-610.
3. American Association of Critical-Care Nurses. Progressive Care Fact Sheet.
Retrieved October 5, 2006, from
http://www.aacn.org/AACN/practice.nsf/vwdoc/TelemetryPage.
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4. American Association of Critical-Care Nurses (2004). AACN Delegation
Handbook, (2nd ed.). Retrieved October 5, 2006.
http://www.aacn.org/AACN/practice.nsf/vwdoc/TelemetryPage
Recommended References:
1. Ehrat, K. S. (2002). The Art of EKG Interpretation. (5th ed.). Dubuque, Iowa.
Kendall/Hunt Publishing Company.
2. American Heart Association. (2005). Guidelines 2005 for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. Available at
http://www.americanheart.org/presenter.jhtml?identifier=3011764
3. McCance, K. L. & Huether, S. E. (2006). Pathophysiology: The Biological Basis
for Disease in Adults and Children. (5th ed.). St. Louis, Missouri. Elsevier Mosby.
4. Darovic, G. O. (2002). Hemodynamic Monitoring: Invasive and Noninvasive
Clinical Application. (3rd. ed.). Philadelphia, Pennsylvania. Saunders.
5. Hardin, S., & Kaplow, R. (2004). Synergy for clinical excellence: The AACN
synergy model for patient care. Sudbury, MA. Jones and Bartlett Publishers.
TOPICAL OUTLINE
AACN’s Synergy Model and Exam Blueprints will be used to guide the topical outline. There
are blueprints for CCRN and PCCN. See Exam Blueprint (last page of syllabus) for specific
topics for each heading.
CCRN Section Blueprint
1. Clinical Judgment In Caring for Clients with Health Problems in These Areas (80%)
a. Cardiovascular (32%)
b. Pulmonary (17%)
c. Endocrine (4%)
d. Hematology/Immunology (3%)
e. Neurology (5%)
f. Gastrointestinal (6%)
g. Renal (5%)
h. Multisystem (8%)
2. Professional Caring and Ethical Practice (20%)
a. Advocacy/Moral Agency; b) Caring Practices; c) Collaboration; d) Systems
thinking; e) Response to diversity; f) Clinical Inquiry; g) Facilitation of learning
3. Exam preparation: Study tips & learning resources; Test taking tips; Dealing with test
anxiety; Strategies for successful testing
PCCN Section Blueprint
1. Clinical Judgment In Caring for Clients with Health Problems in These Areas (80%)
a. Cardiovascular (37%)
b. Pulmonary (13%)
c. Endocrine (4%)
d. Hematology/Immunology (5%)
e. Neurology (4%)
f. Gastrointestinal (5%)
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g. Renal (6%)
h. Multisystem (6%)
2. Professional Caring and Ethical Practice (20%)
a. Advocacy/Moral Agency; b) Caring Practices; c) Collaboration; d) Systems
thinking; e) Response to diversity; f) Clinical Inquiry; g) Facilitation of learning
3. Exam preparation: Study tips & learning resources; Test taking tips; Dealing with test
anxiety; Strategies for successful testing
EVALUATION TOOLS
1. Course Evaluation Tool
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CCRN EXAMINATION BLUEPRINT – ADULT
I. CLINICAL JUDGMENT (80%)
A. Cardiovascular (32%)
1. Acute coronary syndromes/unstable angina
2. Acute heart failure/pulmonary edema
3. Acute inflammatory disease (e.g.,myocarditis,
endocarditis, pericarditis)
4. Acute myocardial infarction/papillary
muscle rupture
5. Acute peripheral vascular insufficiency
(e.g., acute arterial occlusion, carotid artery stenosis,
endartarectomy, peripheral stents)
6. Cardiac surgery (e.g., valve replacement, CABG)
7. Cardiac tamponade
8. Cardiac trauma (blunt and penetrating)
9. Cardiogenic shock
10. Cardiomyopathies (e.g., hypertrophic, dilated,
restrictive, idiopathic)
11. Cardiovascular pharmacology
12. Conduction defects, blocks and pacemakers
13. Dysrhythmias/AICDs
14. Heart failure
15. Hemodynamic monitoring
16. Hypertensive crisis
17. Hypovolemic shock and volume deficit
18. Pulmonary hypertension(e.g., valvular
defects, aortic stenosis, mitral stenosis)
19. Ruptured or dissecting aneurysm (e.g., thoracic,
abdominal)
B. Pulmonary (17%)
1. Acute pulmonary embolus, fat embolus
2. Acute respiratory distress syndrome (ARDS)
3. Acute respiratory failure, hypoxemia
4. Acute respiratory infections
5. Air-leak syndromes (e.g., spontaneous pneumothorax,
pneumopericardium, pneumomediastinum, PIE)
6. Aspirations (e.g., aspiration pneumonia,
hospital acquired pneumonia, foreign-body aspiration)
7. Chronic lung disease
8. Pulmonary pharmacology
9. Pulmonary trauma (e.g., pulmonary hemorrhage,
tracheal perforation)
10. Respiratory distress (e.g., emphysema, bronchitis)
11. Status asthmaticus, exacerbation of COPD,
emphysema
12. Thoracic surgery (e.g., lung contusions, fractured ribs,
hemothorax, pulmonary hemorrhage, lung reduction,
pneumonectomy, lobectomy, tracheal surgery)
13. Thoracic trauma (e.g., lung contusions,
fractured ribs, hemothorax, pneumothorax from trauma,
pulmonary hemorrhage)
14. Ventilator management and ABG interpretation, mixed
venous gases, CPAP, volutrauma and barotraumas
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C. Endocrine (4%)
1. Acute hypoglycemia
2. Diabetes insipidus
3. Diabetic ketoacidosis
4. Hormones and endocrine anatomy and physiology
5. Hyperglycemic hyperosmolar nonketotic coma (HHNK)
D. Hematology/Immunology (3%)
1. Hematology, anatomy and physiology, blood products
and plasma
2. Immunosuppression-acquired (e.g., HIV, AIDS,
neoplasms)
3. Life-threatening coagulopathies (e.g., ITP, DIC,
hemophilia, HITTS, ReoProinduced) and non lifethreatening coagulopathies
4. Organ transplantation (e.g., liver, bone marrow, kidney,
heart, pancreas, lung)
5. Sickle cell crisis
E. Neurology (5%)
1. Aneurysm, AV malformation
2. Encephalopathy (e.g., hypoxic-ischemic, metabolic,
edema, infectious)
3. Head trauma (blunt, penetrating), skull fractures
4. Intracranial hemorrhage/intraventricular hemorrhage
(e.g., subarachnoid, epidural, subdural)
5. Neurologic infectious diseases (e.g., meningitis, GBS,
West Nile)
6. ICP monitoring
7. Neurosurgery (e.g., evacuation of hematoma, tumor
resection)
8. Seizure disorders
9. Stroke (e.g., embolic events, hemorrhagic)
F. Gastrointestinal (6%)
1. Acute abdominal trauma
2. Acute GI hemorrhage (e.g., esophageal, upper and
lower)
3. Bowel infarction, bowel obstruction, bowel perforation
4. GI surgeries (e.g., Whipple, esophagogastrectomy,
gastric bypass)
5. Hepatic failure/coma (e.g., portal hypertension, cirrhosis,
esophageal varicies, fulminant hepatitis)
6. Pancreatitis
7. Gastro-esophageal reflux
G. Renal (5%)
1. Acute renal failure (e.g., acute tubular necrosis, hypoxia,
dialysis)
2. Chronic renal failure and dialysis
3. Life-threatening electrolyte imbalances (e.g., potassium,
sodium, phosphorus, magnesium, calcium)
4. Fluid balance concepts and renal anatomy & physiology
5. Renal trauma
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CCRN EXAMINATION BLUEPRINT – ADULT
(CONTINUED)
H. Multisystem (8%)
1. Multisystem trauma
2. Septic shock/infectious diseases (e.g., viral,
bacterial, line sepsis, nosocomial infections,
immunosuppression)
3. Systemic inflammatory response syndrome
(SIRS)/sepsis/MODS
4. Toxic exposure (e.g., chemicals, radiation,
anaphylaxis)
5. Toxic ingestions and inhalations (e.g.,
drug/alcohol overdose, poisoning)
II. PROFESSIONAL CARING AND ETHICAL PRACTICE (20%)
A. Advocacy/Moral Agency (2%)
B. Caring Practices (4%)
C. Collaboration (4%)
D. Systems Thinking (2%)
E. Response to Diversity (2%)
F. Clinical Inquiry (2%)
G. Facilitation of Learning (4%)
CCRN
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PCCN CERTIFICATION EXAMINATION
BLUEPRINT
I. CLINICAL JUDGMENT (80%)
A. Cardiovascular (37%)
1. Acute coronary syndromes/unstable angina
2. Acute heart failure/pulmonary edema
3. Acute myocardial infarction/ischemia
4. Acute peripheral vascular insufficiency (e.g.,
acute arterial occlusion, carotid artery stenosis)
5. Cardiac surgery (e.g., valve replacement, CABG)
6. Cardiomyopathies (e.g., hypertrophic, dilated,
restrictive, idiopathic)
7. Dysrhythmias
8. Heart failure
9. Hypertensive crisis
10. Myocardial conduction system defects
11. Pulmonary hypertension (e.g., valvular defects,
aortic stenosis, mitral stenosis)
12. Ruptured or dissecting aneurysm
13. Shock states (e.g., cardiogenic, hypovolemic)
B. Pulmonary (13%)
1. Acute pulmonary embolus, fat embolus
2. Acute respiratory distress syndrome (ARDS)
3. Acute respiratory failure
4. Acute respiratory infections (e.g., pneumonia, strep
pneumonia, RSV)
5. Aspirations (e.g., aspiration pneumonia, foreign body
aspiration)
6. Chronic lung disease
7. Pulmonary hypertension
8. Respiratory distress (e.g., emphysema, bronchitis)
9. Status asthmaticus, exacerbation of COPD,
emphysema, bronchitis
10. Thoracic surgery (e.g., lung contusions, fractured ribs,
hemothorax, pulmonary hemorrhage, lung reduction,
pneumonectomy, lobectomy, tracheal surgery)
C. Endocrine (4%)
1. Acute hypoglycemia
2. Adrenal disorders (e.g., adrenal insufficiency)
3. Diabetes insipidus
4. Diabetic ketoacidosis
5. Hyperglycemic hyperosmolar nonketotic coma (HHNK)
D. Hematology/Immunology (5%)
1. Immunosuppression-acquired (e.g., HIV, AIDS,
neoplasms)
2. Life-threatening coagulopathies (e.g., ITP, DIC,
hemophilia, HITTS) and non life-threatening
coagulopathies
3. Organ transplantation (e.g., liver, bone marrow,
kidney, heart, pancreas, lung)
4. Sickle cell crisis
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E. Neurology (4%)
1. Intracranial hemorrhage/intraventricular
hemorrhage (e.g., subarachnoid, epidural,
subdural)
2. Seizure disorders
3. Stroke (embolic events, hemorrhagic)
F. Gastrointestinal (5%)
1. Acute GI hemorrhage (e.g., esophageal, upper
and lower)
2. Bowel infarction/obstruction/ perforation
3. Gastro-esophageal reflux
4. GI surgeries (e.g., Whipple, esophagogastrectomy,
gastric bypass)
5. Pancreatitis
G. Renal (6%)
1. Acute renal failure (e.g., acute tubular necrosis,
hypoxia, dialysis)
2. Chronic renal failure and dialysis
3. Life-threatening electrolyte imbalances (e.g.,
potassium, sodium, calcium, phosphorus, magnesium)
H. Multisystem (6%)
1. Multisystem trauma
2. Septic shock/infectious diseases (e.g.,
congenital viral, bacterial, line sepsis,
nosocomial infections, immunosuppression)
3. Systemic inflammatory response syndrome
(SIRS)/sepsis/MODS
4. Toxic ingestions and inhalations (e.g.,
drug/alcohol overdose, poisoning)
II. PROFESSIONAL CARING AND ETHICAL PRACTICE (20%)
A. Advocacy/Moral Agency (2%)
B. Caring Practices (4%)
C. Collaboration (4%)
D. Systems Thinking (2%)
E. Response to Diversity (2%)
F. Clinical Inquiry (2%)
G. Facilitation of Learning (4%)