ACCNS-N case studies
ACCNS-N · Put your knowledge to work in context.
The ACCNS-N is AACN's certification credential for clinical nurse specialists practicing in neonatal care. It is intended for advanced practice nurses who have completed graduate-level CNS preparation with a neonatal focus and who want independent validation of their ability to lead evidence-based care for high-risk newborns, their families, and the units that serve them. The ACCNS-N case studies are 5 cases and about 3,207 words.
1Persistent Hypoglycemia in a Late Preterm Infant After Feeding Protocol Change
A 35 2/7-week infant (birth weight 2,480 g) is now 30 hours old in your level II nursery. A unit-wide feeding protocol was revised last month: breastfeeding mothers are now encouraged to feed on demand with a minimum of every 4 hours rather than the prior every 3 hours, and formula supplementation is offered only if the pre-feed glucose is below 40 mg/dL.
580 words, about 3 min2Alarm Fatigue and a Near-Miss After a Monitor Default Change
Your 40-bed level III/IV NICU migrated to a new physiologic monitoring platform six weeks ago. Default alarm limits were set centrally by the vendor configuration team: SpO2 low 85%, high 100%; heart rate low 80, high 200; respiratory rate low 10, high 80.
707 words, about 4 min3Deciding Whether to Adopt a New Feeding Protocol: Appraising the Evidence
Your NICU is considering a change from scheduled bolus feeding to a more rapid-advance feeding protocol for infants 1,000–1,500 g, intended to shorten time to full enteral feeds. The proposal cites a single-center randomized trial (n=180) showing a 2.1-day reduction in time to full feeds (95% CI 0.4–3.8 days) and no difference in necrotizing enterocolitis (NEC).
655 words, about 3 min4Scope-of-Practice Conflict Over a CNS-Led Follow-Up Clinic
You are a neonatal CNS in a health system that has just opened a neonatal follow-up clinic for graduates of your level III NICU. You developed the clinic model, and you will see infants at 2 weeks and at 1, 4, 8, and 12 months corrected age, coordinating developmental screening, feeding/growth, and referral to early intervention.
601 words, about 3 min5A Family Declines a Recommended Transfer, and the Team Disagrees
A 1,900 g infant born at 33 weeks is now 10 days old in your level II nursery, stable on room air and full feeds. The infant has had two apnea events in the last 48 hours, both self-resolving with stimulation, and a new murmur is heard.
664 words, about 3 min