Anyone else studying for CCRN exam?

Specialties CCU

Published

  1. I have or would like to get my CCRN certification: (you may select more than one)

    • 851
      Yes
    • 17
      No
    • 365
      If yes: I get some kind of financial reward or incentive to achieve and maintain certification.
    • 331
      If yes: There is no financial reward or incentive at my institution for CCRN certification.
    • 360
      If yes: I have or can have CCRN on my name badge or there is other forms of acknowledgement.
    • 291
      If yes: I find the certification has empowered my practice and would encourage others to pursue it.
    • 13
      If yes: It really hasn't been worth the work and I would discourage others from pursuing it.
    • 5
      If no: I don't have the certification and feel no need or have had negative experiences.
    • 53
      If no: I would like to pursue it, but have had difficulty getting motivated.
    • 12
      I am undecided.

379 members have participated

Is there anyone else out there who is currently studying for the CCRN exam and would like to start a thread as perhaps a study and support group? I have just applied for the exam and have not yet set a date, but about in 3 months is when I will be taking it. I would love to be in communication with others in the same boat! I hope there is at least one other nurse out there! Thanks!

deeDawntee

Specializes in Travel Nursing, ICU, tele, etc.
I'm still following this thread!

I don't think I will be able to test this year though. I kinda fell out of the study habit for a few weeks.

I'll start studying again soon!

I am so glad that you are still here!!! I would love to keep this thread going, not only because it is fun, but it is very empowering.

I would love people to check in with cool patients or issues or anything, just to keep the communication alive. I can sometimes feel alone at work when I want to share or whatever but to know there are nurses around the country who are dealing with the same things and really want to empower their practices as well, is VERY supportive to me. That is my intention!! It doesn't matter when you will test for CCRN, that you have that commitment and intention is what is important to me. Some of us have described the 'ridicule' we have faced when we have told people we are interested in taking this exam, now those are the people I do NOT want to be involved with, know what I mean?

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Specializes in Travel Nursing, ICU, tele, etc.

what medications are contraindicated in hypertrophic cardiomyopathy?

no digoxin, dobutamine, dopamine, nipride, nitrates, tridil, isuprel, or morphine.

what medication is indicated?

need beta blocker (often inderal) to decrease contractility and slow down heart. (sometimes ca++ channel blocker, ie verapamil)

anybody want to respond to as why?

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Specializes in Travel Nursing, ICU, tele, etc.

Oh my gosh! Last night, I had a pt come in with DKA and an initial pH of 6.99. Unbelievable. Personally, that is the lowest pH I have encountered. It was really cool because the Doc who was managing him was not one of the Intensivists but one of the Hospitalists and he had started this guy on the standard ICU insulin gtt, which as we who have been studying this stuff know that it drops the sugar too fast and keeps them at too low of a blood sugar. Anyway, it was really cool to interact with him with some knowledge about DKA. He was reviewing the chart on the unit and I came out of the room and told him the pt's blood glucose was now 248, do want to switch him over to IVF with dextrose. He looked a bit bewildered, so I showed him the DKA protocol and the pt was switched to it. I needed to call him several times that night and I really felt that there was a respect there from him that felt really good!! Anyway, the guy was doing quite well by the morning, ABG's normalized, K and glucose wnl. Pretty cool.

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Specializes in MICU, CCRN.

Interesting that you posted about DKA! I had a DKA patient the past 2 days, and it was a mess.

We are in the process of getting our DKA Protocol finished. Can you imagine, we are a large teaching hospital, in the MICU, and we don't have DKA protocol!! Ugh!

First of all, pharmacy didn't understand the protocol (had never seen it before) and our secretary had never seen it either, so was entered into computer wrong. Therefore, I didn't get my insulin syringes until 1800 (pt admitted at 1030!!!!!!!) I wrote this up BIG TIME. (and had to steal syringes from other patients in the meantime).

Anyways, the protocol is flawed, and brings BG down too fast. Her sugars were not controlled, and then the next day our fellow switched her to q1h BG checks with q1h insulin replacement (if needed) with novolog insulin (!) before her ketones were cleared, and before her BG was under control with the gtt. Ahhh!! Our ICU CNS got involved as well as our Diabetes CNS.

Tell me about your protocol! And I have been studying poorly lately...but been MEANING to get crackin again!!!

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Specializes in Travel Nursing, ICU, tele, etc.

hi!! elizabethj!! i've been wondering how you've been doing! glad to see you back! hey, i copied and pasted the basics of our dka protocol. i hope this isn't more information than you want!!

nacl 0.9% iv infusion 1000 ml – duration based on

hours of administration

continuous, intravenous, rate: 500 -1000 ml/hr. for

treatment of diabetic ketoacidosis.

1. start infusion at 1000 ml/hr for 12 hours.

2. then decrease to 500 ml/hr for 24 hours.

insulin regular (novolin r) - initial iv bolus one time, intravenous, dose: 0.1 units/kg. for initial

treatment of dka.

maximum initial bolus not to exceed 10 units. administer

initial insulin iv bolus then begin insulin infusion.

continuous, intravenous, dose: 0.1 units/kg/hr. dka.

for phase i treatment of dka.

begin infusion at 0.1 units/kg/hr (maximum rate: 10

units/hour) and adjust as according to hourly blood glucose

level: do not bolus or increase infusion if

blood glucose decreases by more than 100

mg/dl; notify md.

discontinue phase i insulin infusion order when first blood

glucose is less than 250mg/dl and begin phase ii insulin

infusion.

follow until 1st blood glucose

blood glucose insulin adjustment

g 400 mg/dl 8 units iv bolus and increase rate by

1unit/hr.

251-399 mg/dl increase insulin infusion by 1 unit/hr.

1st bg

and change iv fluid to d5 in nacl

0.45 % (with kcl, if applicable) at

current rate.

insulin regular iv infusion – phase ii

conditional. route: intravenous, dose: 0.5-10 units/hr.

for phase ii treatment of dka. start after first blood glucose

is less than 250mg/dl.

follow after blood glucose

(call md if blood glucose rises above 250 after reaching 1st

blood glucose of less than 250).

blood glucose insulin adjustment

150-250mg/dl no change

100-149 mg/dl a. if current rate g 2 units/hr,

decrease rate by 1 unit/hr.

b. if current rate

continue at same rate and

change iv fluid to

d10 in nacl 0.45% (with

kcl, if applicable) at current rate.

if d10w in 0.45 nacl not immediately available, begin d10w

infusion until proper infusion is delivered from pharmacy.

60-99 mg/dl give 25 ml dextrose 50% and

recheck in 15 minutes.

a. if current rate g 2 units/hr,

decrease rate by 1 unit/hr.

b. if current rate

same rate and change iv fluid to

d10 in nacl 0.45% (with kcl, if

applicable) at current rate. if

d10 in nacl 0.45% already

infusing, give additional

25 ml dextrose 50% and

recheck in 15 minutes.

discontinue infusion, and notify md.

nursing - electrolytes

assess potassium replacement when blood

glucose less than 250 - dka

order next iv maintenance fluid to include potassium and

continue at same rate if:

serum k replace with

>5.5 no replacement.

4.5-5.5 20 of kcl / liter

3.5-4.4 40 of kcl / liter

protocol (if applicable) via 2nd line.

_________________________________

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Specializes in Travel Nursing, ICU, tele, etc.

Sorry about posting that whole dang protocol, practically!! It is too much information, but felt it was too complicated to try to explain adequately. You know it really doesn't surprise me, Eliz that you don't have a DKA protocol. I know the Doc I talked about in that last post, didn't know about our protocol. That is really odd! Presumably they have been managed without a protocol at least by some of the Docs in my hospital. I am too new in the ICU to know when the protocol first showed up. Sometimes it is a bit bewildering to me why the Hospitalists will manage a patient in the ICU versus the Intensivists/who know their protocols. I'm afraid that it may come down to insurance and the kind of reimbursement that can be expected. Totally unethical, but I have a feeling it does happen.....

Hey, I took a break from studying as well. Getting back into it. I take my ACLS recert on Friday and then have the whole weekend off. I need to finally set a date!!! I'm thinking of 8/23 so if there is room in that statistics class, I'll be able to start class with a 'clear' head!!

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Specializes in MICU, CCRN.

Our protocol is just worded really weird...it's 4 pages long, and the whole second page talks about IV fluids, and then on the 3rd page in small writing is the insulin gtt instructions. And it doesn't go into very much detail (the insulin gtt stuff). Plus, there is not detailed instructions about drawing follow up labs, aka ABGs and electrolytes. Ugh, it was just a mess and I'm glad I will be gone from the unit for a week!!!

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Specializes in Neuro ICU.

probably a silly question...does overtime count towards the 1750 hours required prior to taking the exam? I have been a RN since Feb this year, and working a lot of extra shifts. I would like to take the test the end of this year, if possible...just don't know if I'll be eligible. :)

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Specializes in Travel Nursing, ICU, tele, etc.
probably a silly question...does overtime count towards the 1750 hours required prior to taking the exam? I have been a RN since Feb this year, and working a lot of extra shifts. I would like to take the test the end of this year, if possible...just don't know if I'll be eligible. :)

HELLO!!! Great question! If I were you I would call the folks at the AACN office (very nice folks) and ask them.

http://www.aacn.org/AACN/Memship.nsf/vwdoc/YOURNATIONALOFFICE--@YourService

AACN Information: (800) 899-2226

I would bet that you will qualify, but you had better get it from the "horse's mouth"!

Let us know what you find out!!! ;)

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Specializes in Travel Nursing, ICU, tele, etc.

OK everybody!! I finally did it!! I scheduled my exam for August 20th (It is a Monday at 1:30 PM)!! It looks as if I will be able to get into that Stats class, so I wanted to take the exam before that class starts!! I'm actually relieved that it is finally set. I just got back from my ACLS recert, anyone had ACLS since the BLS changes? It has changed the way we do ACLS as well, not in a major way, but we are supposed to do A LOT more compressions now!!

I actually feel pretty confident about all of the areas, now I'm going to jump back into cardiac full throttle. There are things I am still not real strong in... like the cardiac enzymes and when they peak...and all the different clicks and rubs and murmurs, split S2's, holosystolic etc...maybe we don't have to know much about these for CCRN, but I really want to know about them for my practice. I REALLY love Dr Laura's impressions of the murmurs from the valve disorders!!! They sound JUST like it!!!

So, it will be a lot of cardiac this weekend for me. How is everybody doing? I'm really not going to take any time off, I have this whole weekend and the next and may take one night off, we'll see how it is going.

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Specializes in Cardiac.

We don't have a DKA protocol either. I go up and down on the drip as I see fit, and we change the IVF to d5 when the sugars get below 250. That's it!

A doctor got mad at me the other day for turning the gtt off. He said I need to follow the protocol. I say, 'we have no protocol, and his BS was 90. Did you want me to keep the gtt on?"

He wanted the gtt on regardless of the BS....

Weird!

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Specializes in Travel Nursing, ICU, tele, etc.
We don't have a DKA protocol either. I go up and down on the drip as I see fit, and we change the IVF to d5 when the sugers get below 250. That's it!

A doctor got mad at me the other day for turning the gtt off. He said I need to follow the protocol. I say, 'we have no protocol, and his BS was 90. Did you want me to keep the gtt on?"

He wanted the gtt on regardless of the BS....

Weird!

Yeah Doc, whatya want, send him into insulin shock, seizures and a coma???!!! duh!! Hehehe!!! aren't they something sometimes???

:smackingf

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