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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.
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.
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.
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.
Septic Joint: Diagnosis and Treatment
Septic arthritis is caused by infection and inflammation in the joint and can result in significant damage to the joints. Early recognition and treatment are critical to the preservation of joint function. This course will discuss how to quickly identify and treat septic arthritis.
The goal of this course is to provide physicians, nursing professionals, and radiologic technologists with information about septic arthritis.
Recall how septic arthritis is acquired and its typical presentation.
Identify the laboratory and radiological tests used to make a diagnosis of a septic joint.
Recognize the principles of septic joint treatment.
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.
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.
Assessment and Treatment of Depressive Disorders in Children & Adolescents
In this course, you will learn to identify different depressive disorders, as well as the unique ways depression manifests in children and adolescents. Additionally, you will learn to recognize risk factors for both depression and suicidality in youth.
An integrated care model treats the whole child by combining primary care and mental healthcare in one setting. Within this model, treatment providers understand how to screen for depression and suicidality in order to coordinate care. You will learn about specific instruments useful for detecting depression and suicidality among youth. An understanding of the root causes of depression will highlight the rationale for various treatment approaches. Lastly, you will be able to describe the best practices available to help children and adolescents manage depression.
Identify three different types of depressive disorders and common symptoms of depression in children and adolescents.
Identify at least five causes and risk factors of clinical depression and how to screen for depressive disorders in children and adolescents.
Describe three interventions to treat child and adolescent depressive disorders.
Medical Management of Operative/Assisted Vaginal Delivery
This course discusses best practices in operative vaginal delivery techniques—forceps-assisted delivery and vacuum-assisted delivery (OAVD), as well as episiotomy.
The course is case-based, so you will have an opportunity to apply the principles covered to particular patient scenarios. The cases are branched, with different outcomes based on different choices.
Use of OAVD techniques vary from organization to organization. You may, for example, work in a hospital in which forceps techniques are no longer taught to residents. Each section has been organized so that you can move through it quickly or delve into it more deeply, depending on its relevance to your clinical practice.
Discuss the steps, indications, contraindications, and potential complications associated with vacuum-assisted vaginal delivery, forceps-assisted vaginal delivery, and episiotomies.
Describe the circumstances in which an episiotomy is and is not an appropriate intervention.
Explain the importance of the flexion point when placing a vacuum cup and how it is located. Identify the criteria for correct placement of the forceps during a non-rotational delivery, as well as guidelines regarding the number of pulls.
Anesthesia: Perioperative
The perioperative nurse plays a primary role in the anesthesia experience. Knowledge of techniques, patient assessment, and care management for the patient receiving or recovering from anesthesia positively impacts patient outcomes. This course discusses anesthetics and adjuvant medications used in the perioperative setting, anesthesia-related complications, and the nurse’s role in assisting with anesthesia management.
This course provides nursing professionals with information about the principles and practices of anesthesia care in the perioperative setting.
Identify the stages and types of anesthesia, and associated medications commonly used in the perioperative setting.
Recognize important assessment areas and nursing interventions for the perioperative patient receiving or recovering from anesthesia.
Describe complications of anesthesia and their treatments.
Perioperative Series: Emergencies in the OR
Perioperative providers can BEST prepare for emergencies in the operating room by knowing the responsibilities of each team member and rehearsing interventions ahead of time. When you are in the moment and your heart is racing, it’s easy to forget how to respond or even where supplies are located. Practicing your responsibilities and team interventions ahead of time will help to prepare you for the unexpected. This course provides you with an opportunity to participate in five emergency scenarios to test your knowledge. Time is of the essence when an emergency happens so you must think and act fast to save the patient!
The goal of this course is to equip nurses and STs with knowledge of the responsibilities of the team during a range of OR emergencies.
Recognize evidence-based strategies for treating and preventing a range of OR emergencies.
Describe the roles and responsibilities of members of the surgical team when emergencies occur.
Recall the best practices for improving patient outcomes during an emergency.