ACCNS-N flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Apgar scoring components

Five components scored 0-2 each: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (effort), assigned at 1 and 5 minutes of life.

Therapeutic hypothermia eligibility window

Cooling for hypoxic-ischemic encephalopathy should begin within 6 hours of birth at 33.5-34.5 degrees C for 72 hours in infants at least 36 weeks gestation who meet clinical and/or EEG criteria.

Bilious emesis in a neonate

Green-tinged vomiting in a newborn is a surgical emergency until malrotation with volvulus is excluded, because bowel ischemia can progress rapidly with a deceptively benign abdominal exam.

CNS spheres of impact

The three foundational CNS practice domains: direct care of patients and families, nurses and nursing practice, and organizations and systems, all guided by the CNS's clinical expertise.

NRP initial steps indications

For a newborn who is term, breathing, and has good tone, initial steps occur skin-to-skin; positive pressure ventilation is indicated for apnea or a heart rate below 100 per minute.

Neonatal hypotension screening heuristic

A mean arterial pressure in mmHg numerically below the gestational age in weeks is a common screening threshold for hypotension, though evidence for this rule is debated.

Gestational-age-adjusted dosing

Neonatal medication doses and monitoring parameters are indexed to postmenstrual age and weight in kilograms because hepatic and renal clearance are immature and change rapidly after birth.

CNS independent clinical reasoning

Documentation should show assessment, differential diagnosis, plan, and the guideline or evidence supporting the plan, demonstrating autonomous CNS judgment rather than delegated tasks.

AWHONN staffing guidelines

Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines provide acuity-based recommendations for perinatal and neonatal nurse staffing rather than fixed ratios alone.

Levels of neonatal care

Level I (well newborn) through Level IV (subspecialty regional NICU) describe service capability; transfer decisions are based on required capability, not bed availability.

PDSA cycle

Plan-Do-Study-Act is an iterative improvement method the CNS uses to test small changes, evaluate results, and spread effective interventions across the unit.

Iowa Model of evidence translation

A framework guiding the CNS from identification of a clinical question through evidence review, pilot implementation, evaluation, and integration into organizational practice.

Structured handoff format

Situation-Background-Assessment-Recommendation (SBAR) standardizes interprofessional communication during rounds and handoffs, reducing omissions and improving team situational awareness.

Shared governance councils

Unit-based decision-making structures where bedside nurses participate in practice, quality, and education decisions; CNS-led councils are associated with improved retention and empowerment.

NIDCAP developmental care

Newborn Individualized Developmental Care and Assessment Program is an organizational standard requiring environmental modification, clustering of care, and staffing alignment to support neurodevelopment.

Cost-of-care analysis

CNS business cases should include direct, indirect, and opportunity costs, and demonstrate return on investment such as reduced central line infections or length of stay.

Care coordination in the NICU

CNS-led coordination begins discharge planning at admission and includes structured family education, which reduces length of stay and readmissions.

Evidence hierarchy

Systematic reviews and meta-analyses of randomized trials rank above single trials, cohort studies, case reports, and expert opinion when appraising strength of evidence.

Melnyk levels of evidence

A seven-level framework where Level I is a systematic review or meta-analysis of randomized trials and Level VII is expert opinion or committee report.

Kirkpatrick evaluation levels

Four levels of educational outcome evaluation: reaction, learning, behavior, and results, used to measure whether neonatal education changed practice and outcomes.

Return demonstration competency

Psychomotor competency validation requires observed skill performance in addition to written knowledge testing; return demonstration is the accepted standard for neonatal procedures.

Simulation with deliberate practice

Simulation-based neonatal resuscitation education using deliberate practice and structured debriefing improves team performance and is preferred over lecture alone.

EBP versus research utilization

Evidence-based practice integrates best evidence, clinical expertise, and patient preference; research utilization applies findings from a single study without that full integration.

IRB approval for QI

Institutional Review Board review is required before human-subjects data collection, including quality improvement projects that test new interventions or seek generalizable knowledge.

Critical appraisal elements

Appraisal addresses validity, reliability, clinical significance, and applicability to the local neonatal population; statistical significance alone does not establish clinical importance.

Two patient identifiers

A National Patient Safety Goal requiring two identifiers before care or medication; for neonates these typically include the identification band number and name or date of birth.

FMEA risk scoring

Failure mode and effects analysis is a proactive tool that scores severity times occurrence times detection to prioritize neonatal safety risks before harm occurs.

Root cause analysis

A retrospective, structured method used after a sentinel event to identify contributing system factors and design corrective actions rather than assign individual blame.

CLABSI prevention bundle

Central line-associated bloodstream infection prevention includes hand hygiene, maximal sterile barrier precautions, appropriate skin antisepsis, and daily review of line necessity.

High-alert medication double-check

Independent double-checks by two clinicians are required for high-alert neonatal medications such as insulin, opioids, and concentrated electrolytes before administration.

Just culture reporting

A nonpunitive reporting framework that distinguishes human error from at-risk and reckless behavior, encouraging neonatal medication error reporting without fear of blame.

Mandatory reporting obligations

State statutes and institutional policy require reporting suspected child abuse or neglect and impaired practice by a colleague; the CNS must know the required pathway.