AACN CCRN-Pediatric - CCRN (Pediatric) - Direct Care Eligibility Pathway Exam

Initial management ofsevere pediatric sepsis and MODSfocuses onearly goal-directed therapy, includingfluid resuscitation,vasopressors for perfusion, andventilator support for respiratory failure. This aligns with Pediatric Advanced Life Support (PALS) andAACNsepsis management protocols.

“In children with sepsis-induced MODS, the priority is to restore tissue perfusion through fluid resuscitation and initiate vasopressors if shock persists. Ventilator support is implemented for respiratory compromise. These interventions are considered initial and lifesaving.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem Dysfunction and Sepsis Guidelines)

Pediatric ICU delirium is a common but underdiagnosed condition in critically ill children, especially those on prolonged ventilation. Hallmarks includedisorientation, sleep disturbance, agitation, and altered attention.

“Delirium should be suspected in pediatric ICU patients showing new or worsening behavioral symptoms, altered sleep-wake cycles, and fluctuating mental status. Prolonged sedation and critical illness are risk factors.”

(Referenced from CCRN Pediatric – Direct Care: Neurologic Dysfunction and ICU Delirium)

The first step in any evidence-based practice (EBP) or quality improvement (QI) process is toclearly define the clinical problem or question. Before outcomes or interventions are addressed, the council mustdetermine the exact issue to be studied.

“In quality improvement and evidence-based practice, step one is always problem identification. A well-defined problem leads to targeted and effective research.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Evidence-Based Practice and QI Models)

Negative-pressure wound therapy (NPWT), also known as wound VAC, accelerates wound healing byremoving exudate, reducing bacterial burden, andstimulating angiogenesis and granulation tissue formationthroughmechanical microstrain. This is essential in deep, complex wounds such as post-sternal infections.

“Negative pressure wound therapy promotes wound healing through the removal of infectious material and exudate and by increasing local blood flow and granulation tissue.”

(Referenced from CCRN Pediatric – Direct Care: Integumentary, Advanced Wound Management)

Ashunt infectionis a common complication, especially within thefirst few months after placement. Symptoms includefever, irritability, bulging fontanel, and vomiting. Negative blood and urine cultures suggest acentral nervous system source, supporting the likelihood of a shunt infection.

“Shunt infections typically present with fever, bulging fontanel, and neurologic irritability. They can occur without systemic bacteremia and require prompt neurosurgical consultation.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, VP Shunt Complications)