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CRRN test Format | CRRN Course Contents | CRRN Course Outline | CRRN test Syllabus | CRRN test Objectives

1. Rehabilitation nursing models and theories (6%)
2. Functional health patterns (theories, physiology, assessment, standards of care, and interventions in individuals with injury, chronic illness, and disability across the lifespan) (58%)
3. The function of the rehabilitation team and community reintegration (13%)
4. Legislative, economic, ethical, and legal issues (23%).

The CRRN test Content Outline lists each domain with related tasks, knowledge, and skill statements. It is the best source of information for test content.

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Domain I: Rehabilitation Nursing Models and Theories (6%)
Task 1: Incorporate evidence-based practice, models, and theories into patient-centered care.
Knowledge of:
a. Evidence-based practice
b. Nursing theories and models significant to rehabilitation (e.g., King, Rogers, Neuman, Orem)
c. Nursing process (i.e., assessment, diagnosis, outcomes identification, planning, implementation, evaluation)
d. Rehabilitation standards and scope of practice
e. Related theories and models (e.g., developmental, behavioral, cognitive, moral, personality, caregiver development and function)
f. Patient-centered care Skill in:
a. Applying nursing models and theories
b. Applying rehabilitation scope of practice
c. Applying the nursing process
d. Incorporating evidence-based practice
Domain II: Functional Health Patterns (theories, physiology, assessment, standards of care, and interventions in individuals with injury, chronic illness, and disability across the lifespan) (58%)
Task 1: Apply the nursing process to optimize the restoration and preservation of the individual's health and wellbeing.
Knowledge of:
a. Physiology and management of health, injury, acute and chronic illness, and adaptability
b. Pharmacology
c. Rehabilitation standards and scope of practice
d. Technology (e.g., smart devices, internet sources, personal response devices, and telehealth)
e. Alterations in sexual function and reproduction
Skill in:
a. Assessing health status and health practices
b. Teaching interventions to manage health and wellness
c. Using rehabilitation standards and scope of practice
d. Using technology
e. Assessing goals related to sexuality and reproduction
f. Teaching interventions and technology related to sexuality and reproduction (e.g., body positioning, mirrors, adaptive equipment, medication)
Task 2: Apply the nursing process to promote optimal nutrition.
Knowledge of:
a. Adaptive equipment and feeding techniques (e.g., modified utensils, scoop plates, positioning)
b. Anatomy and physiology related to nutritional and metabolic patterns (e.g., endocrine, obesity, swallowing)
c. Diagnostic testing
d. Diet types (e.g., cardiac, diabetic, renal, dysphagia)
e. Fluid and electrolyte balance
f. Nutritional requirements
g. Skin integrity (e.g., Braden scale, pressure ulcer staging)
h. Pharmacology (e.g., anticholinergics, opioids, antidepressants)
i. Safety concerns and interventions (e.g., swallowing, positioning, food textures, fluid consistency)
Skill in:
a. Assessing nutritional and metabolic patterns (e.g., nutritional intake, fluid volume deficits, skin integrity, metabolic functions, feeding and swallowing)
b. Implementing and evaluating interventions for nutrition
c. Implementing and evaluating interventions for skin integrity (e.g., skin assessment, pressure relief, moisture reduction, nutrition and hydration)
d. Teaching interventions for swallowing deficits
e. Using adaptive equipment
Task 3: Apply the nursing process to optimize the individual's elimination patterns.
Knowledge of:
a. Anatomy and physiology of altered bowel and bladder function
b. Bladder and bowel adaptive equipment and technology (e.g., bladder scan, types of catheters, suppository inserter)
c. Bladder and bowel training (e.g., scheduled self -catheterization, timed voiding, elimination programs)
d. Pharmacologic and non-pharmacological interventions
Skill in:
a. Assessing elimination patterns (e.g., elimination diary, patients history)
b. Implementing and evaluating interventions for bladder and bowel management (e.g., nutrition, exercise, pharmacological, adaptive equipment)
c. Teaching interventions to prevent complications (e.g., constipation, urinary tract infections, autonomic dysreflexia)
d. Providing patient and caregiver education related to bowel and bladder management
e. Using adaptive equipment and technology
Task 4: Apply the nursing process to optimize the individuals highest level of functional ability.
Knowledge of:
a. Anatomy, physiology, and interventions related to musculoskeletal, respiratory, cardiovascular, and neurological function
b. Assistive devices and technology (e.g., mobility aids, orthostatic devices, orthotic devices)
c. Clinical signs of sensorimotor deficits
d. Activity tolerance and energy conservation
e. Pharmacology (e.g., antispasmodics, vasopressors, analgesics)
f. Safety concerns (e.g., falls, burns, skin integrity, infection prevention)
g. Self-care activities (e.g., activities of daily living, instrumental activities of daily living)
Skill in:
a. Assessing and implementing interventions to prevent musculoskeletal, respiratory, cardiovascular, and neurological complications (e.g., motor and sensory impairments, contractures, heterotrophic ossification, aspiration, pain)
b. Assessing, implementing, and evaluating interventions for self-care ability and mobility
c. Implementing safety interventions (e.g., sitters, reorientation, environment, redirection, nonbehavioral restraints)
d. Using technology (e.g., mobility aids, pressure relief devices, informatics, assistive software)
e. Teaching interventions to prevent complications of immobility (e.g., skin integrity, DVT prevention)
Task 5: Apply the nursing process to optimize the individual's sleep and rest patterns.
Knowledge in:
a. Factors affecting sleep and rest (e.g., diet, sleep habits, alcohol, pain, environment)
b. Pharmacology
c. Physiology of sleep and rest cycles
d. Technology
Skill in:
a. Assessing sleep and rest patterns
b. Evaluating effectiveness of sleep and rest interventions
c. Teaching interventions and strategies to promote sleep and rest (e.g., energy conversation, environmental modifications)
d. Using technology (e.g., sleep study, CPAP, BiPAP, relaxation technology)
Task 6: Apply the nursing process to optimize the individual's neurological function.
Knowledge of:
a. Measurement tools (e.g., Rancho Los Amigos, Glasgow, Mini Mental State Examination, ASIA, pain analog scales)
b. Neuroanatomy and physiology (e.g., cognition, judgment, sensation, perception)
c. Pain (e.g., receptors, acute, chronic, theories)
d. Pharmacology
e. Safety concerns (e.g., seizure precautions, fall precautions, impaired judgment)
f. Technology
Skill in:
a. Assessing cognition, perception, sensation, apraxia, perseveration, and pain
b. Implementing and evaluating strategies for safety (e.g., personal response devices, alarms, helmets, padding)
c. Teaching strategies for neurological deficits
d. Teaching strategies for pain and comfort management (e.g., pharmacological, non-pharmacological)
e. Using technology (e.g., TENS unit, baclofen pump)
f. Implementing behavioral management strategies (e.g., contracts, positive reinforcement, rule setting)
Task 7: Apply the nursing process to promote the individuals optimal psychosocial patterns and holistic wellbeing.
Knowledge of:
a. Individual roles and relationships (e.g., cultural, environmental, societal, familial, gender, age)
b. Role alterations
c. Psychosocial disorders (e.g., substance abuse, anxiety, depression, bipolar, PTSD, psychosis)
d. Theories (e.g., self-concept, role, relationship, interaction, developmental, human behaviors)
e. Traditional and alternative modalities (e.g., medications, healing touch, botanicals)
f. Cultural competence
Skill in:
a. Assessing and promoting self-efficacy, self-care, and self-concept
b. Accessing supportive team resources and services (e.g., psychologist, clergy, peer support, community support)
c. Promoting strategies to cope with role and relationship changes (e.g., individual and caregiver counseling, peer support, education)
d. Including the individual and caregiver in the plan of care
e. Incorporating cultural and spiritual values
f. Promoting positive interaction among individual and caregivers
g. Evaluating the effects of values, belief systems, and spirituality of the individual
Task 8: Apply the nursing process to optimize coping and stress management skills of the individual and
Knowledge of:
a. Community resources (e.g., face-to-face support groups, internet, respite care, clergy)
b. Coping and stress management strategies for individuals and support systems
c. Cultural competence
d. Physiology of the stress response
e. Safety concerns regarding harm to self and others
f. Technology for self-management
g. Theories (e.g., developmental, coping, stress, grief and loss, self-esteem, self-concept)
h. Types of stress and stressors
i. Stages of grief and loss
Skill in:
a. Assessing potential for harm to self and others
b. Assessing the ability to cope and manage stress
c. Facilitating appropriate referrals
d. Implementing and evaluating strategies to reduce stress and Boost coping (e.g., biofeedback, cognitive behavioral therapy, complementary alternative medicine, pharmacology)
e. Using therapeutic communication
Task 9: Apply the nursing process to optimize the individual's ability to communicate effectively.
Knowledge of:
a. Anatomy and physiology (e.g., cognition, comprehension, sensory deficits)
b. Communication techniques (e.g., active listening, anger management, reflection)
c. Cultural competence
d. Developmental factors
e. Linguistic deficits (e.g., aphasia, dysarthria, language barriers)
f. Assistive technology and adaptive equipment
Skill in:
a. Assessing comprehension and communication (e.g., oral, written, auditory, visual)
b. Implementing and evaluating communication interventions
c. Involving and educating support systems
d. Using assistive technology and adaptive equipment
e. Using communication techniques
Domain III: The Function of the Rehabilitation Team and Community Reintegration (13%)
Task 1: Collaborate with the interdisciplinary/interprofessional team to achieve patient-
centered goals. Knowledge of:
a. Goal setting and expected outcomes (e.g., SMART goals, functional independence measures [FIM], WeeFIM)
b. Types of healthcare teams (e.g., interdisciplinary/ interprofessional, multidisciplinary, transdisciplinary)
c. Rehabilitation philosophy and definition
d. Roles and responsibilities of team members
e. Theory (e.g., change, leadership, communication, team function, organizational)
Skill in:
a. Advocating for inclusion of appropriate team members
b. Applying appropriate theories (e.g., change, leadership, communication, team function, organizational)
c. Communicating and collaborating with the interdisciplinary/ interprofessional team
d. Developing and documenting plans of care to attain patient-centered goals
Task 2: Apply the nursing process to promote the individual's community reintegration.
Knowledge of:
a. Technology and adaptive equipment (e.g., electronic hand-held devices, electrical simulation, service animals, equipment to support activities of daily living)
b. Community resources (e.g., housing, transportation, community support systems, social services, recreation, CPS, APS)
c. Personal resources (e.g., financial, caregiver support systems, caregivers, spiritual, cultural)
d. Professional resources (e.g., psychologist, neurologist, clergy, teacher, case manager, vocational rehabilitation counselor, home health, outpatient therapy)
e. Teaching and learning strategies for self-advocacy
Skill in:
a. Accessing community resources
b. Assessing readiness for discharge
c. Assessing barriers to community reintegration
d. Evaluating outcomes and adjusting goals (e.g., interdisciplinary/interprofessional team and patientcentered)
e. Identifying financial barriers and providing appropriate resources
f. Initiating referrals
g. Participating in team and patient caregiver conferences
h. Planning discharge (e.g., home visits, caregiver teaching)
i. Teaching health and wellness maintenance
j. Teaching life skills
k. Using adaptive equipment and technology (e.g., voice activated call systems, computer supported prosthetics)
Domain IV: Legislative, Economic, Ethical, and Legal Issues (23%)
Task 1: Integrate legislation and regulations to guide management of care.
Knowledge of:
a. Agencies related to regulatory, disability, and rehabilitation (e.g., CARF, The Joint Commission, APS, CPS, CMS, SSA, OSHA)
b. Specific legislation related to disability and rehabilitation (e.g., Medicare, Medicaid, ADA, rehabilitation acts, HIPAA, Affordable Care Act, workers compensation, IDEA, Vocational, IMPACT Act)
Skill in:
a. Accessing, interpreting, and applying legal, regulatory, and accreditation information
b. Using assessment, measurement, and reporting tools (e.g., functional independence measures [FIM], patient satisfaction, IRF-PAI)
Task 2: Use the nursing process to deliver cost effective patient-centered care.
Knowledge of:
a. Clinical practice guidelines
b. Community and public resources
c. Insurance and reimbursement (e.g., PPS, workers compensation)
d. Regulatory agency audit process
e. Staffing patterns and policies
f. Utilization review processes
Skill in:
a. Analyzing quality and utilization data
b. Collaborating with private, community, and public resources
c. Incorporating clinical practice guidelines
d. Managing current and projected resources in a cost effective manner
Task 3: Integrate ethical considerations and legal obligations that affect nursing practice.
Knowledge of:
a. Ethical theories and resources (e.g., deontology, ombudsperson, ethics committee)
b. Legal implications of healthcare related policies and documents (e.g., HIPAA, advance directives, powers of attorney, POLST/MOLST, informed consent)
Skill in:
a. Advocating for the individual
b. Documenting services provided
c. Identifying appropriate resources to assist with legal documents
d. Implementing strategies to resolve ethical dilemmas
e. Applying ethics in the delivery of care
Task 4: Integrate quality and safety in patient-centered care.
Knowledge of:
a. Quality measurement and performance improvement processes (e.g., Agency for Healthcare Research and Quality; Institute of Medicine; National Database of Nursing Quality Indicators)
b. Models and tools used in process improvement (e.g., Plan, Do, Check, Act; Six Sigma; Lean approach)
c. Federal quality measurement efforts
d. Reporting requirements (e.g., infection rates, healthcare acquired pressure injury, sentinel events, discharge to community, readmission rates)
Skill in:
a. Assessing safety risks
b. Minimizing safety risk factors
c. Implementing safety prevention measures
d. Utilizing assessment, measurement, and reporting tools (e.g., functional independence measurement; patient satisfaction)
e. Incorporating standards of professional performance

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Medical Rehabilitation Practice Test

Consensus on analysis, management of Acute Flaccid Myelitis | CRRN VCE test and Questions and Answers

a huge community of researchers has reviewed the literature related to acute flaccid myelitis (AFM) and has summarized present competencies of this disorder in a brand new consensus document.

In it, researchers describe the epidemiology and competencies reasons of AFM, the disorder's medical presentation, the methods required to diagnose it, beneficial thoughts for acute management, and concerns for long-term rehabilitation.

Dr Carlos Pardo

The authors meant "to obtain a consensus for analysis and administration of AFM to facilitate more desirable and more constructive care of patients plagued by this ailment," Carlos A. Pardo, MD, professor of neurology and pathology at Johns Hopkins institution college of medication, Baltimore, Maryland, told Medscape clinical information. "The remaining intention is that any healthcare provider around the globe be aware about AFM, the diagnostic criteria, and acute management and care of the long-term penalties of AFM."

The incidence of AFM has increased because 2012, and the disease should be considered as a major global public health challenge, the authors write. The probability of future AFM outbreaks makes it vital to enhance focus of the disease and clinicians about prognosis and medication, they notice.

Questions that remain unanswered include how typical exposures corresponding to enterovirus infections trigger severe neurologic ailment, what the surest therapeutic approach is, and whether prevention is critical.

The review become posted online January 23 within the Lancet.

Pleocytosis common

AFM is a disabling disorder that resembles polio and primarily affects toddlers. It has been diagnosed around the globe and often happens in geographical clusters. Researchers suspect that the D68 enterovirus causes the seasonal, biennial outbreaks that have been observed.

other enteroviruses, similar to A71 and coxsackievirus traces, additionally can cause AFM. Defining the disorder by using its linked organism may now not be acceptable for scientific practice, youngsters, inasmuch as D68 can be detectable best at an early stage of the disease, the authors write.

The median age of patients with AFM is 6.3 years. Most journey a prodrome marked by means of fever and respiratory symptoms, equivalent to cough, rhinorrhea, or pharyngitis, they be aware. Neurologic signs commonly begin 1 to 10 days after the onset of the prodrome.

patients develop flaccid weak point and hyporeflexia or areflexia in a single or greater limbs. Onset customarily is uneven and favors the higher limbs and proximal muscle tissues. patients additionally might also have weakness of the neck, trunk, diaphragm, or different respiratory muscle tissues. Most patients require hospitalization, and a few need intubation.

the most valuable diagnostic test, the researchers suggest, is MRI of the spinal wire. The attribute discovering in AFM is T2 hyperintensity of the spinal wire gray count number. Spinal wire gray matter lesions are usually longitudinally wide. The cervical wire is probably the most commonly affected.

For almost all sufferers, lumbar puncture reveals cerebrospinal fluid (CSF) pleocytosis, the authors word. The white blood mobilephone count number is mildly to moderately extended; tiers get to the bottom of over a number of weeks. within the acute section, CSF evaluation helps distinguish AFM from different motives of flaccid paralysis which are much less more likely to cause pleocytosis.

picking the reasons of AFM or its mimics requires investigation backyard the valuable fearful equipment or CSF, they note. Respiratory samples might also indicate enterovirus D68, and stool samples can also point out enterovirus A71. Electromyography or nerve conduction reports regularly don't seem to be required for analysis.

Early management of AFM centers on supportive treatment. This comprises securing the airway, treating autonomic dysfunction, managing ache, preventing the issues of acute immobility, and beginning early rehabilitation. The pathophysiology of AFM is incompletely understood, and no scientific treatments were studied in potential, managed trials. Intravenous immunoglobulin often is run since the simple cause of AFM is believed to be viral an infection.

Residual Impairment

After remission, many patients with AFM Boost residual impairment. records suggest that fewer than 10% of patients achieve full recovery. Electromyography, nerve conduction reports, and MRI may assist predict patients' results.

restoration within the limbs seems to growth from distal to proximal areas. The worst-affected muscle businesses are the least more likely to get better. Deaths from AFM are infrequent. youngsters rehabilitation can cause carrying on with functional recovery, patients may have neurologic, musculoskeletal, or psychological sequelae.

"Prognosis and influence biomarkers of AFM are not very smartly based," said Pardo. "despite the fact, the magnitude of MRI abnormalities in the spinal wire right through the extreme stage and the want for critical care administration and mechanical ventilation are perhaps probably the most recognized components that determine terrible effects."

essentially the most pressing focus of research is the mechanism of AFM pathogenesis, referred to Pardo. Investigators are also searching for authentic tools for the swift laboratory prognosis of AFM. These equipment may additionally identify viruses or diagnostic biomarkers. another precedence of research is the identification and development of remedy methods for limiting the quick development of neurologic damage after symptom onset, spoke of Pardo.

comprehensive evaluation

"here is essentially the most finished overview [of AFM] posted so far," Marc C. Patterson, MD, professor of neurology, pediatrics, and scientific genetics at Mayo sanatorium infants's middle, Rochester, Minnesota, told Medscape scientific information. "The evaluate emphasizes the magnitude of on account that this prognosis in any newborn with weak point, notably uneven weak spot, and gives constructive information in differentiating alternative diagnoses."

Dr Marc Patterson

cognizance of AFM has greater enormously in contemporary years, even though it is still a challenge, Patterson delivered. "entry to the acceptable diagnostic tests represents a endured unmet want, chiefly in aid-terrible areas," he spoke of.

A majority of sufferers who're exposed to the virus could be mildly affected, and the largest unanswered query may be which host components predispose a affected person to Boost extreme sickness.

"These aren't new questions; within the age of polio pandemics, only a minority of inclined people developed severe neurologic disorder," observed Patterson. "If they understood the host elements (presumably regarding genetically decided adaptations in particular person immune programs), it can be viable to appreciate highly inclined individuals and to tailor certain remedies for them."

The evaluate became supported with the aid of the Siegel infrequent Neuroimmune affiliation and the Bart McLean Fund for Neuroimmunology analysis. Pardo is an unpaid consultant to the AFM assignment force of the facilities for disorder control and Prevention. He receives support from the national Institutes of fitness and the Bart McLean Fund for Neuroimmunology research. Patterson has disclosed no important fiscal relationships.

Lancet. posted online January 23, 2021. abstract

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CRRN Reviews

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