CCRN (Adult) — Tele-critical Care Eligibility Pathway Study Guide

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After a cardiac procedure, a patient becomes hypotensive and tachycardic while venous pressure rises and perfusion worsens. Escalate promptly, report the trends, and prepare for urgent assessment and possible treatment.

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A patient with a slow rhythm becomes confused and hypotensive. Confirm rhythm and instability, summon help, establish monitoring and pacing readiness, and follow the adult bradycardia algorithm.

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A patient with a rapid rhythm becomes hypotensive and confused while a pulse remains present. Alert the team and prepare for synchronized cardioversion under the current algorithm and local protocol.

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A falling arterial pressure accompanies cool extremities, new confusion, and decreasing urine output. Verify the waveform and transducer, compare trends, and report the combined evidence of worsening perfusion.

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The monitor shows pacing spikes followed by complexes, but the patient remains hypotensive and no pulse is palpable. Assess mechanical capture immediately, alert the team, and troubleshoot rather than accepting the ECG appearance as success.

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A patient with known systolic dysfunction develops worsening orthopnea, crackles, and edema. Trend oxygenation and perfusion, review fluid and medication history, and report the clinical picture for evaluation.

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After vascular surgery, a patient reports sudden back pain, becomes hypotensive, and has weaker pedal pulses. Notify the surgical team immediately, reassess perfusion and hemodynamics, and prepare for urgent evaluation.

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A monitor alarms for ventricular tachycardia while an awake patient speaks normally. Assess pulse and perfusion while checking leads and obtaining a better tracing; escalate if the patient or tracing confirms an emergency.

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An intubated patient with ARDS has elevated plateau pressure. Verify predicted body weight and measurements, alert the respiratory and critical-care team, and assess the effect of an ordered protective adjustment.

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A severely hypoxemic patient remains poorly oxygenated despite optimized initial ventilation. Coordinate trained staff, secure the airway and devices, protect pressure points, and reassess oxygenation and hemodynamics afterward.

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A ventilated patient develops a high-pressure alarm, hypoxemia, hypotension, and unilateral absent breath sounds. Assess the patient, call for immediate assistance, check airway and circuit, and urgently escalate possible tension pneumothorax.

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A recently immobilized patient develops sudden dyspnea, tachycardia, and falling oxygen saturation. Assess hemodynamic stability, alert the team, support oxygenation as indicated, and anticipate urgent evaluation.

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A ventilated patient abruptly becomes hypotensive with worsening oxygenation and markedly reduced breath sounds on one side. Call for immediate assistance, support the patient, and prepare for emergency pleural decompression as directed.

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A patient treated for severe asthma becomes drowsy and has less audible wheezing while chest movement diminishes. Treat this as deterioration, summon urgent assistance, and reassess ventilation.

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A patient with a chest tube develops sudden dyspnea and the drainage system is found disconnected. Call for assistance, assess oxygenation and the patient, and restore system integrity according to local emergency procedure.

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A patient with DKA has potassium of 3.2 mmol/L. Escalate the result, anticipate replacement and monitoring, and delay insulin until potassium rises above 3.5 mmol/L according to protocol.

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A patient taking an SGLT2 inhibitor has nausea, abdominal discomfort, and rapid breathing with only modest glucose elevation. Request assessment for ketones and acidosis and communicate the risk promptly.

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After several days of heparin exposure, a patient has a substantial platelet fall and new thrombosis. Raise concern for HIT, notify the team, and anticipate heparin cessation and therapeutic-intensity non-heparin anticoagulation while evaluation proceeds, subject to contraindications and clinical judgment.

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During transfusion, a patient develops acute hypoxemia and bilateral pulmonary opacities. Stop the product, follow the reaction process, assess hemodynamics and volume status, and escalate for evaluation.

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A patient’s baseline creatinine is 1.0 mg/dL and rises to 1.4 within 48 hours. Recognize that the change meets a creatinine criterion for AKI, report it, and assess urine output and possible causes.

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A patient with AKI has low urine output but no signs of volume overload. Review perfusion and possible causes with the team rather than requesting a diuretic solely to increase urine output.

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A patient with cirrhosis becomes confused after a gastrointestinal bleed. Assess for bleeding and infectious precipitants, review medications and hydration, and notify the team rather than basing the diagnosis on ammonia alone.

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A patient with melena becomes tachycardic, hypotensive, and increasingly confused before a repeat hemoglobin returns. Activate urgent evaluation and report impaired perfusion rather than waiting for laboratory confirmation.

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After pituitary surgery, a patient develops marked dilute polyuria and rising serum sodium and osmolality. Recognize a pattern concerning for DI, report it, and trend fluid balance, neurologic status, and relevant laboratory results.

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A sedated patient on vasopressors has prolonged immobility and an oxygen device pressing on the face. Inspect pressure points, reposition safely under local policy, and coordinate an individualized prevention plan.

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A chemotherapy patient with known neutropenia develops fever and new confusion. Escalate immediately, initiate the local febrile-neutropenia process, and facilitate prompt ordered evaluation and treatment.

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A patient with a forearm fracture reports escalating pain despite analgesia; passive finger extension worsens it and the forearm feels tense. Notify the surgical team urgently and reassess without waiting for pulse loss.

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A patient’s MAP is 80 mm Hg and ICP is 25 mm Hg; calculated CPP is 55 mm Hg. Communicate the calculation and trend promptly, then follow the neurocritical-care plan.

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An adult has continuous generalized convulsions lasting several minutes. Protect the patient, call the emergency response, support ventilation, note duration, and prepare ordered initial treatment without restraining the limbs.

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An ICU patient becomes inattentive and alternates between agitation and somnolence. Use the unit’s validated tool, review possible causes and medications, and implement appropriate orientation, sleep, mobility, and sensory supports.

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A patient with new facial asymmetry and dysarthria asks for water. Follow the required swallow-screening process before oral intake, escalate the neurologic changes, and document onset and findings.

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Following cervical trauma, a patient is hypotensive with a slow heart rate and warm skin. Maintain spinal alignment, assess for hemorrhage and other shock causes, and urgently notify the trauma team.

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A recently extubated patient pulls at lines and cannot sustain attention. Secure immediate safety, assess oxygenation, pain, and delirium, speak calmly, and call for assistance before considering restrictive interventions.

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A patient initially alert after a head injury becomes harder to arouse and develops unequal pupils. Escalate immediately, protect oxygenation and blood pressure, and prepare for urgent neuroimaging and specialist evaluation.

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A patient with suspected Guillain-Barré syndrome has ascending weakness, a weak cough, and difficulty swallowing. Escalate early for airway and respiratory assessment, maintain aspiration precautions, and communicate progression.

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A survivor of prolonged ventilation reports nightmares, poor concentration, and reduced ability to walk. Acknowledge the concerns, assess safety and function, and coordinate appropriate rehabilitation and follow-up planning.

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With bicarbonate 12 mmol/L, expected PaCO2 is about 26 mm Hg, plus or minus 2. If measured PaCO2 is 40, report likely additional respiratory acidosis and promptly reassess ventilation.

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A septic patient remains hypotensive after initial fluid and develops crackles. Report perfusion and possible congestion, request reassessment using appropriate dynamic measures, and avoid repeating fluid without evaluating response.

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A patient with suspected septic shock needs urgent antimicrobial therapy, and cultures have not been collected. Obtain them rapidly if this will not delay treatment; communicate any barrier immediately.

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A patient treated for sepsis has a falling lactate but remains confused, cool, and hypotensive. Report persistent clinical hypoperfusion and request reassessment rather than relying on the improved laboratory trend.

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A patient with AKI has markedly elevated potassium and new QRS widening. Escalate immediately, ensure continuous cardiac monitoring, and prepare for urgent ordered treatment and reassessment.

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A patient with pneumonia develops worsening oxygenation, oliguria, and confusion over several hours. Communicate multisystem deterioration, reassess perfusion and infection management, and coordinate urgent team review.

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A patient with a central line develops fever without an obvious source. Assess the patient and line, follow local culture and escalation procedures, and review ongoing line necessity with the team.

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A critically ill patient with uncertain recovery has uncontrolled breathlessness and family questions about outcomes. Address symptoms, clarify what matters to the patient, and facilitate a timely interdisciplinary discussion.

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A patient arrives after an unknown household chemical exposure and is coughing. Protect responders, follow decontamination and airway-assessment procedures, gather product information, and contact the designated toxicology resource.

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A patient on a temperature-control device develops shivering and a new skin change beneath a pad. Assess temperature and skin, notify the team, and follow the ordered response while maintaining monitoring.

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A patient is unstable, unable to communicate, and has limited family support. Prioritize vigilant clinical judgment, advocacy, and coordination of available resources, then reassess as the condition changes.

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You report a deteriorating patient’s falling pressure, but the concern is dismissed. Restate the specific trend and risk, then escalate through the chain of command if the issue remains unresolved.

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Before discharge, ask a patient to describe how they will follow the medication plan. If the response is incorrect, explain the steps more simply and ask the patient to teach them back again.

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A team wants to improve line-care reliability. Identify the gap, trial a feasible change on a limited scale, track adherence and outcomes, and refine the process before wider adoption.

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A remote nurse detects a sustained rhythm change with falling pressure. Contact the bedside clinician through the escalation process, communicate the trend and risk, confirm the response, and reassess the patient’s status.

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A patient’s family offers to interpret a complex treatment discussion. Ask the patient’s preference and arrange appropriate language assistance so the patient can participate directly and confidentially.

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A medication delay recurs across shifts despite reminders. Map handoff and pharmacy workflow with frontline staff, identify process barriers, test a targeted change, and review data for improvement.

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A patient with decision-making capacity declines a proposed intervention after stating a clear goal. Confirm understanding, communicate the preference to the team, and support discussion of alternatives and consequences.

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A patient’s oxygenation worsens while ventilator changes, transport, and imaging are discussed. Coordinate the bedside nurse, respiratory therapist, and provider around immediate stability, assigned actions, and reassessment.

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A ventilated patient appears distressed during a procedure. Pause when clinically safe, assess pain and communication needs, explain the next step, and coordinate symptom relief while maintaining procedural safety.

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A tele-critical care team notices its escalation process often misses early deterioration. Define the problem, review evidence and local data, involve bedside staff, and test a monitored process change.

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A remote nurse needs to discuss a patient’s status with a consultant. Verify identity and authorization, use the approved secure channel, share relevant information, and document communication according to policy.

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A recovering patient is fatigued during medication teaching. Prioritize urgent information, pause and return when the patient is alert, and use teach-back to confirm understanding of a key safety step.

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The care team’s plan appears inconsistent with a capable patient’s stated goals. Clarify the decision and understanding, speak with involved clinicians, and seek appropriate ethics or leadership support if disagreement continues.