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NURSING Continuing Education
Elite Learning
This book satisfies all continuing education requirements for your license renewal
ELITELEARNING.COM/BOOK Complete this book online with book code: ANCCUS2423 24-hour Continuing Education Package $38.95
WHAT’S INSIDE
ALL COURSES SATISFY GENERAL HOURS REQUIREMENT Asthma Management in Special Populations
1
[3 contact hours] This course focuses on asthma management for the adult with asthma. Asthma guidelines from the Global Initiative for Asthma (GINA) and the National Heart, Lung, and Blood Institute (NHLBI) will be presented. Types of asthma commonly seen in adults are discussed. Comorbid conditions that worsen asthma outcomes are also reviewed. The relationship of obesity and asthma throughout the life span is also examined. Implications for the older adult patient with asthma are also addressed. Basic Psychiatric Concepts 16 [6 contact hours] This course is designed for registered nurses, licensed practical/vocational nurses, and newly licensed registered nurses who desire a greater understanding of basic mental health concepts. A fundamental understanding of medical terminology, abbreviations, and nursing care is assumed. Crisis Resource Management for Healthcare Professionals 40 [3 contact hours] Understanding Crisis Resource Management (CRM) and utilization of the concepts within team emergent responses can improve patient outcomes. The course will outline CRM concepts and demonstrate the application within emergent situations in healthcare. CRM concepts discussed will include leadership and followership, role identity and clarity; effective communication strategies; situational awareness; resource allocation; and dynamic decision making. Physicians, advanced practice providers, nurses, respiratory therapists, pharmacists, and other health team members should understand CRM to improve their performance in emergent team responses and ultimately improve patient outcomes. CRM framework is also applicable in medical and environmental emergent situations where teams work together to ensure patient safety. Diabetes Prevention and Management for Healthcare Professionals 54 [5 contact hours] Diabetes is a significant health problem in the United States and throughout the world. It is imperative that the healthcare community take aggressive steps to reduce the number of Americans who have the disease and to promote more effective treatment so that persons with diabetes can enjoy their maximum quality of life. This education program presents information on both the impact of the disease and how to provide effective healthcare professional interventions to those affected. Ethical and Legal Issues in Nursing Practice 77 [7 contact hours] Nursing practice is guided by three major pillars: ethical concepts, professional standards, and laws/regulation to ensure safe and professional nursing practice. A nurse must know and understand all three of these guiding pillars. A nurse will be held to these guiding pillars and lack of knowledge or understanding will not be an excuse if something happens to a patient. This course will first describe ethical concepts that influence nursing practice, then examine professional standards, most of which are based on specific ethical concepts. Finally, laws and regulations will be discussed. By the end of the course the nurse will have a better understanding of the three pillars that guide nursing practice. Course Participant Sheet 111
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
i
NURSING CONTINUING EDUCATION
Book Code: ANCCUS2423
What are the requirements for license renewal? Contact Hours Required FREQUENTLY ASKED QUESTIONS
Review our chart on the following pages, find your state and your required contact hours.
How much will it cost? If you are only completing individual courses in this book, enter the code that corresponds to the course below online.
CONTACT HOURS
COURSE TITLE
PRICE
COURSE CODE
Asthma Management in Special Populations
3 6 3 5 7
$23.95 $35.95 $23.95 $29.95 $35.95 $38.95
ANCCUS03AS ANCCUS06PC ANCCUS03CR ANCCUS05DM ANCCUS07EL ANCCUS2423
Basic Psychiatric Concepts
Crisis Resource Management for Healthcare Professionals Diabetes Prevention and Management for Healthcare Professionals
Ethical and Legal Issues in Nursing Practice Best Value - Save $110.80 - All 24 Hours
24
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you approved by ANCC? Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Are my contact hours reported to my state board? We report your hours to the following boards: Arkansas, District of Columbia, Florida, Georgia, Kentucky, Michigan, Mississippi, New Mexico, North Dakota, South Carolina, and West Virginia. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Nursing you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-866-344-0971, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
ii
Book Code: ANCCUS2423
NURSING CONTINUING EDUCATION
HOW TO COMPLETE THIS BOOK FOR CREDIT
Please read these instructions before proceeding. IF YOU’RE COMPLETING ALL COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code ANCCUS2423 in the book code box, then click GO . • If you already have an account created, sign in with your username and password. If you don’t have an account, you’ll be able to create one now.
• Follow the online instructions to complete your final exam. Once you finish your purchase, you’ll receive access to your completion certificate. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code that corresponds to the course below, then click GO . Each course will need completed individually.
COURSES YOU’VE COMPLETED
CODE TO ENTER
All 24 hours in this correspondence book
ANCCUS2423
ANCCUS03AS
Asthma Management in Special Populations
ANCCUS06PC
Basic Psychiatric Concepts
ANCCUS03CR
Crisis Resource Management for Healthcare Professionals
ANCCUS05DM
Diabetes Prevention and Management for Healthcare Professionals
ANCCUS07EL
Ethical and Legal Issues in Nursing Practice
By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
iii
NURSING CONTINUING EDUCATION
Book Code: ANCCUS2423
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
24
Alabama
24 LPNs, RNs, and APRNs - CRNPs are required to complete 24 contact hours of CE every 2-year renewal period. Contact hours must include: ● Board Functions, the Nurse Practice Act, Regulations, Professional Conduct, and Accountability – 4 contact hours at 1st renewal period. For more information visit the Alabama Board of Nursing website. 30 LPNs, RNs, and APRNs - ANPs are required to complete 2 of the following every 2-year renewal period: ● 30 contact hours of CE. ● 30 contact hours of professional nursing activity. ● 320 hours of nursing employment. For more information visit the Alaska Board of Nursing website.
30
Alaska
0
Arizona
0 LPNs and RNs – No CE requirements at this time. 4-year renewal period. For more information visit the Arizona Board of Nursing website.
15
Arkansas
15 LPNs, RNs, and APRNs are required to complete 1 of the following every 2-year renewal period: ● 15 contact hours of accredited practice-focused activities. ● Hold a current nationally recognized certification/recertification. ● Completed a minimum of 1 college credit hour nursing course with a C grade or better. For more information visit the Arkansas Board of Nursing website. 30 LPNs, RNs, and APRNs are required to complete 30 contact hours of CE every 2-year renewal pe- riod. For more information visit the California Board of Nursing website. 0 LPNs, RNs, and APRNs – No CE requirements at this time. 2-year renewal period. For more information visit the Colorado Board of Nursing website. 0 LPNs and RNs – No CE requirements at this time. Annual renewal period. For more information visit the Connecticut Board of Nursing website. 30/24 LPNs are required to complete 24 contact hours every 2-year renewal period. RNs and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. Contact hours must include: 24/18 LPNs are required to complete 18 contact hours of CE every 2-year renewal period. RNs and APRNs are required to complete 24 contact hours of CE every 2-year renewal period. LPN, RN, and APRN CE contact hours must include: ● HIV and AIDS – 3 contact hours every 2-year renewal period. For more information visit the Washington DC Board of Nursing website. 24 LPNs and RNs are required to complete 24 contact hours of CE every 2-year renewal period. LPNs, RNs, and APRNs CE contact hours must include: ● Prevention of Medical Errors – 2 contact hours every 2-year renewal period. ● Florida Laws and Rules – 2 contact hours every 2-year renewal period. ● NEW Human Trafficking – 2 contact hours every 2-year renewal period. ● HIV/AIDS – 1 contact hour; 1-time requirement. ● Recognizing Impairment in the Workplace: ○ LPNs and RNs - 2 contact hours every 4th renewal (the license will include 27 contact hours during the renewal period when taken). ○ APRNs - 2 contact hours every 4th renewal (the license will include 30 contact hours during the renewal period when taken). ● Domestic Violence: ○ LPNs and RNs: 2 contact hours every 3rd renewal (the license will include 26 contact hours during the renewal period when taken). ○ APRNs: 2 contact hours every 3rd renewal (the license will include 29 contact hours during the renewal period when taken). For more information visit the Florida Board of Nursing website. 30/20 LPNs are required to complete 20 contact hours of CE every 2-year renewal period. RNs and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the Georgia Board of Nursing website. 30 LPNs and RNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the Hawaii Board of Nursing website. 15 LPNs and RNs are required to complete 15 contact hours of CE every 2-year renewal period. For more information visit the Idaho Board of Nursing website. 20 LPNs and RNs are required to complete 20 contact hours of CE every 2-year renewal period. For more information visit the Illinois Board of Nursing website. ● Substance Abuse – 3 contact hours every 2-year renewal period. For more information visit the Delaware Board of Nursing website.
30
California
0
Colorado
0
Connecticut
RNs-30 / LPNs-24
Delaware
RNs-24 / LPNs-18
District of Colum- bia
24
Florida
RNs-30 / LPN-20
Georgia
30
Hawaii
15
Idaho
20
Illinois
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
iv
Book code: ANCCUS2423
NURSING CONTINUING EDUCATION
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
0
Indiana
0 LPNs and RNs – For active licenses at the time of renewal, no CE is required. 2-year renewal period. IF license has lapsed 3+ years and not currently licensed in another jurisdiction, requirements for renewal include: ● Refresher course including a clinical component and; ● 24 contact hours of CE. For more information visit the Indiana Board of Nursing website. 36 LPNs and RNs are required to complete 36 contact hours of CE every 3-year renewal period. ● Every 5 years the renewal requires 2 contact hours of CE for Identification and Reporting of Child/Dependent Adult Abuse (must be a state-approved course). For more information visit the Iowa Board of Nursing website. 30 LPNs, RNs, and APRNs are required to complete 30 contact hours of CE every 2-year renewal pe- riod. For more information visit the Kansas Board of Nursing website. 14 LPNs, RNs, and APRNs are required to complete 14 contact hours of CE annually. Contact hours must include: ● Domestic Violence – 3 contact hours; 1-time requirement. ● Pediatric Abusive Head Trauma – 1.5 contact hours; 1-time requirement. For more information visit the Kentucky Board of Nursing website.
30
Iowa
30
Kansas
14
Kentucky
Up to 15
Louisiana
5/10/ or 15
LPNs - No CE requirements at this time. Annual renewal period. RNs and APRNs are required to complete CE contact hours every annual renewal period based on employment: ● Full-time employment - 5 contact hours every annual renewal period. ● Part-time employment - 10 contact hours every annual renewal period.
● Unemployed - 15 contact hours every annual renewal period. For more information visit the Louisiana Board of Nursing website. 0 LPNs and RNs - No CE requirements at this time. 2-year renewal period. For more information visit the Maine Board of Nursing website. 0 LPNs and RNs - No CE requirements at this time. 2-year renewal period. For more information visit the Maryland Board of Nursing website.
0
Maine
0
Maryland
15
Massachusetts
15 LPNs and RNs are required to complete 15 contact hours of CE every 2-year renewal period. CE contact hours are not required for 1st renewal period. For more information visit the Massachusetts Board of Nursing website. 25 LPNs, RNs, and APRNs are required to complete 25 contact hours of CE every 2-year renewal period. Contact hours must include: ● Pain and Symptom Management – 2 contact hours every 2-year renewal period. Per the State Board of Nursing, the following is a 1-time REQUIRED COURSE, but CAN NOT count toward total required CE contact hours: ● Human Trafficking. For more information visit the Michigan Board of Nursing website. 24/12 LPNs are required to complete 12 contact hours of CE every 2-year renewal period. RNs are required to complete 24 contact hours of CE every 2-year renewal period. For more information visit the Minnesota Board of Nursing website. 0/10 ● LPNs - Beginning January 1, 2018 and every two years thereafter, LPNs must complete 20 con - tact hours. (30 Mississippi Administrative Code, Part 2815, Chapter 1.4). ● RNs - Beginning January 1, 2018 and every two years thereafter, RNs must complete 20 contact
25
Michigan
RNs-24 / LPNs-12
Minnesota
RNs-0 / LPNs-10
Mississippi
hours. (30 Mississippi Administrative Code, Part 2815, Chapter 1.5). For more information visit the Mississippi Board of Nursing website. 0 LPNs and RNs - No CE requirements at this time. 2-year renewal period. For more information visit the Missouri Board of Nursing website.
0
Missouri
24
Montana
24 LPNs, RNs, and APRNs are required to complete 24 contact hours of CE every 2-year renewal pe- riod. For more information visit the Montana Board of Nursing website. 20 LPNs are required to complete 20 contact hours of CE every 2-year renewal period. Contact hours must include: ● IV Therapy (didactic only) – 8 contact hours every renewal period. RNs are required to complete 20 contact hours of CE every 2-year renewal period. For more information visit the Nebraska Board of Nursing website. 30 LPNs and RNs are required to complete 30 contact hours of CE every 2-year renewal period. Licenses issued within 2 years are not required to complete CE contact hours for 1st time renewal. Contact hours must include: ● Bioterrorism: Responding to Acts of Terrorism – 4 contact hours; 1-time requirement. For more information visit the Nevada Board of Nursing website. 30 LPNs and RNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the New Hampshire Board of Nursing website.
20
Nebraska
30
Nevada
30
New Hampshire
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
v
NURSING CONTINUING EDUCATION
Book code: ANCCUS2423
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
30
New Jersey
30 LPNs and RNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the New Jersey Board of Nursing website. 30 LPNs and RNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the New Mexico Board of Nursing website.
30
New Mexico
4
New York
4
RNs are required to complete: ● Infection Control - state approved course every 4-year renewal period. * ● Child Abuse – 2 hour one time requirement for initial renewal. Since September 1, 1990, programs registered by NYS that lead to nursing licensure have been required to include a 2-hour training in the identification and reporting of child abuse. Students graduating from such programs on or after September 1, 1990 are not required to take additional training. Individu- als who did not graduate from a licensure-qualifying NYS nursing program must provide proof they’ve completed this training when initially applying for licensure. LPNs are required to complete: ● Infection Control - state approved course every 4-year renewal period. * The Child Abuse course requirements does not apply to LPNs. * Elite has a NY state approved course. For more information visit the New York Board of Nursing website.
15 / 30
North Carolina
15/30 LPNs are required to complete 15 contact hours of CE every 2-year renewal period. RNs are required to complete 30 contact hours of CE every 2-year renewal period. For both LPNs and RNs, additional contact hours to fulfill CE requirements must include 1 of the following: ● 640 hours of active practice within last 2 years or; ● National certification/re-certification or; ● Completion of Board-approved refresher course or; ● Completion of a minimum of 2-semester hours of post-licensure academic education related to nursing practice or; ● Authoring a nursing article, paper, book or book chapter or; ● Nursing project as principal investigator or co-investigator or; ● Developing and conducting continuing education presentation (Accounts for 5 contact hours). For more information visit the North Carolina Board of Nursing website. 12 LPNs and RNs are required to complete 12 contact hours of CE every 2-year renewal period. For more information visit the North Dakota Board of Nursing website. 24 LPNs and RNs are required to complete 24 contact hours of CE every 2-year renewal period. Con- tact hours must include: 24 LPNs and RNs are required to complete 1 or more of the following every 2-year renewal period: ● 24 contact hours or; ● 520 hours of employment a year or; ● Certification in a nursing specialty area or; ● Complete a Board-approved refresher course or; ● 6 academic semester credit hours. For more information visit the Oklahoma Board of Nursing website. 7 LPNs and RNs are required to complete CE contact hours every 2-year renewal period. Contact hours must include: ● Pain Management – 7 contact hours (includes 1 contact hour for Oregon Pain Management Commission course plus 6 contact hours of any other pain management course); 1-time requirement. For more information visit the Oregon Board of Nursing website. 2/30 LPNs are only required to complete 3 contact hours (initially) and 2 contact hours thereafter on Child Abuse Recognition and Reporting every 2-year renewal period. RNs and APRNs - CRNPs are required to complete 30 contact hours every 2-year renewal period. Contact hours must include: ● Child Abuse Recognition and Reporting - 3 contact hours (initially) and 2 contact hours thereafter every 2-year renewal period. For more information visit the Pennsylvania Board of Nursing website. 10 LPNs, RNs, and APRNs are required to complete 10 contact hours of CE every 2-year renewal pe- riod. Contact hours must include: ● The Nurse Practice Act – 2 contact hours for 1st renewal period. ● Ohio Laws and Rules – 1 contact hour every renewal period. For more information visit the Ohio Board of Nursing website.
12
North Dakota
24
Ohio
24
Oklahoma
6
Oregon
LPNs*-2/RNs-30 (*LPNs - 3 initially 2 thereafter)
Pennsylvania
10
Rhode Island
● Substance Abuse - 2 contact hours every 2-year renewal period. For more information visit the Rhode Island Board of Nursing website.
30
South Carolina
30 LPNs, RNs and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the South Carolina Board of Nursing website.
0
South Dakota
0 LPNs, RNs and APRNs - No CE requirements at this time. 2-year renewal period. For more information visit the South Dakota Board of Nursing website.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
vi
Book code: ANCCUS2423
NURSING CONTINUING EDUCATION
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
5
Tennessee
5 LPNs and RNs are required to complete 5 contact hours of CE every 2-year renewal period. For more information visit the Tennessee Board of Nursing website. 20 LVNs, RNs and APRNs are required to either maintain/renew national certification or complete 20 contact hours of CE every 2-year renewal period. Contact hours must include: ● Texas Nursing Jurisprudence and Ethics – 2 contact hours every third renewal period. ● Older Adult/Geriatric Care - 2 contact hours every renewal period. Additional requirement for APRNs with prescriptive authority (for a total of 28 contact hours): ● Pharmacotherapeutics – 5 contact hours every 2-year renewal period. ● Prescribing Controlled Substances – 3 contact hours every 2-year renewal period. Recommended: ● Tick-borne diseases, diagnosis and treatment (hours unspecified). Additional requirement for emergency department nurses (LVNs, RNs and APRNs): ● Forensic Evidence Collection – 2 contact hours; 1-time requirement. For more information visit the Texas Board of Nursing website. 30 LPNs and RNs are required to complete 1 of the following every 2-year renewal period: ● 30 contact hours or; ● 15 contact hours and 200 practice hours of employment a year or; ● 400 practice hours. For more information visit the Utah Board of Nursing website.
20
Texas
30
Utah
0
Vermont
0 LPNs and RNs - No CE requirements at this time. For more information visit the Vermont Board of Nursing website.
Up to 30
Virginia
15 / 30
LPNs and RNs are required to complete 1 of the following every 2-year renewal period: ● Current specialty certification by a national credentialing body recognized by the Board or; ● Completion of a Board-approved refresher course or; ● Completion of a minimum of 3 credit hours of post-licensure academic education related to nursing practice offered by a regionally accredited college or university or; ● Completion of a nursing-related, evidence-based practice project or research study or; ● Completion of a publication as the author or co-author during a renewal cycle or; ● Teaching or developing a nursing-related course resulting in no less than 3 semester hours of college credit, a 15-week course, or specialty certification or; ● Teaching or developing nursing-related continuing education courses (Accounts for up to 30 contact hours) or; ● 15 contact hours of workshops, seminars, conferences, or COURSES relevant to the practice of nursing and 640 hours of active practice as a nurse or; ● 30 contact hours of workshops, seminars, conferences, or COURSES relevant to the practice of nursing. For more information visit the Virginia Board of Nursing website.
45
Washington
45 LPNs and RNs are required to complete 45 contact hours of CE and 531 hours of clinical practice every 3-year audit period. License renewals are annual. LPNs, RNs, and APRNs contact hours must include: ● Suicide Prevention - 6 contact hours; 1-time requirement. ● HIV/AIDS – 7 contact hours; 1-time requirement. For more information visit the Washington Board of Nursing website. 12/24 LPNs are required to complete 24 contact hours of CE and 400 practice hours every 2-year renewal period. Contact hours must include: ● Mental Health Conditions Common to Veterans and Their Family Members – 2 contact hours every 2-year renewal period. ● Substance Abuse – 3 contact hour every 2-year renewal period. ● End-of-Life Care – 2 contact hours; 1-time requirement. RNs are required to complete 12 contact hours of CE every 1-year renewal period. Contact hours must include: ● Mental Health Conditions Common to Veterans and Their Family – 2 contact hours every 1-year renewal period. ● Chemical Dependence/Substance Abuse Disorders – 3 contact hours every 1-year renewal period. ● For RNs prescribing, administering, or dispensing controlled substances: Drug Diversion and Safe Prescribing Practices – 3 contact hours initially and 1 contact hour thereafter every 1-year renewal period. For more information visit the West Virginia Board of Nursing website.
RNs-12 / LPNs-24
West Virginia
0
Wisconsin
0 LPNs and RNs - No CE requirements at this time. 2-year renewal period. For more information visit the Wisconsin Board of Nursing website.
20
Wyoming
20 LPNs and RNs are required to complete 20 contact hours of CE every 2-year renewal period. CE is not required if worked more than 500 hours in the past 2 years or 1,600 hours in the past 5 years. For more information visit the Wyoming Board of Nursing website.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
vii
NURSING CONTINUING EDUCATION
Book code: ANCCUS2423
Asthma Management in Special Populations 3 Contact Hours
Release Date: October 21, 2021
Expiration Date: October 21, 2024
Faculty Judith Quaranta, PhD, RN, CPN, AE-C, FNAP , is an Associate Professor in the Decker College of Nursing and Health Sciences, Binghamton University. She received her PhD from the Decker School of Nursing, with her dissertation focusing on asthma management of school nurses. Dr. Quaranta’s research focus is on barriers and facilitators for asthma management as well as factors that impact asthma and asthma development. As a Train the Trainer for the American Lung Association’s Open Airways for Schools curriculum, she has worked collaboratively with the Broome County Health Department, the Asthma Coalition of the Southern Tier, United Health Services Hospital, and the local American Lung Association to implement this program in local schools. She has presented at multiple national conferences on the topic of asthma and self-management. Dr. Quaranta has also authored manuscripts for numerous journals including the Public Health Nursing, Journal of School Nursing, Journal of Asthma and Allergy Educators, Online Journal of Rural Nursing, Journal of Family Social Work, Journal of Interprofessional Care , as well authored chapters in textbooks on research and community and public health.. Judith Quaranta has disclosed that she has no significant financial or other conflicts of interest pertaining to this course. Course overview This course focuses on asthma management for the adult with asthma. Asthma guidelines from the Global Initiative for Asthma (GINA) and the National Heart, Lung, and Blood Institute (NHLBI) will be presented. Types of asthma commonly seen in Learning objectives After completing this course, the learner will be able to: Apply the National Asthma Education and Prevention Program and the Global Initiative for Asthma guidelines for asthma management. Differentiate the types of asthma seen in adults. How to receive credit ● Read the entire course online or in print which requires a 3-hour commitment of time. ● Complete the self-assessment quiz questions which are at the end of the course or integrated throughout the course. These questions are NOT GRADED. The correct answer is shown after you answer the question. If the incorrect answer is selected, the rationale for the correct answer is provided. These questions help to affirm what you have learned from the course. ● Depending on your state requirements you will be asked to complete either: CE Broker reporting Colibri Healthcare, LLC, provider # 50-4007, reports course completion results within 1 business day to CE Broker. If you are licensed in Arkansas, District of Columbia, Florida, Georgia, Accreditations and approvals Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Reviewer: Karen Meyerson, MSN, RN, FNP-C, AE-C , is Director of Commercial Care Management for Priority Health, the second largest health plan in the state of Michigan. Karen previously served as Manager of the Asthma Network of West Michigan (ANWM), a nationally recognized asthma coalition serving western Michigan. She has served as a national speaker/ consultant and has lectured extensively on asthma for professional and lay audiences. Karen graduated with her Bachelor of Science degree in nursing from the University of Wisconsin-Madison and her Master of Science degree in Nursing from Grand Valley State University in Grand Rapids, Michigan. A board-certified family nurse practitioner, Karen specialized in asthma and allergies in private practice for 9 years. At the national level, Karen was elected to the National Asthma Educator Certification Board (NAECB), where she now serves as an Emeritus member, and has presented on asthma-related issues at Congressional Briefings on Capitol Hill in Washington, DC. Karen Meyerson has disclosed that she has no significant financial or other conflicts of interest pertaining to this course. adults are discussed. Comorbid conditions that worsen asthma outcomes are also reviewed. The relationship of obesity and asthma throughout the life span is also examined. Implications for the older adult patient with asthma are also addressed. Distinguish antecedent, comorbid, and exacerbating conditions that can affect asthma care in the adult. Examine the relationship between obesity and asthma. Examine the adverse effect on asthma of certain medications. Examine the unique considerations for providing care to the older adult with asthma. ○ An affirmation that you have completed the educational activity. ○ A mandatory test (a passing score of 70 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. ● If requested, provide required personal information and payment information. ● Complete the MANDATORY Course Evaluation. ● Print your Certificate of Completion.
Kentucky, Michigan, Mississippi, New Mexico, North Dakota, South Carolina, or West Virginia, your successful completion results will be automatically reported for you.
Page 1
Book Code: ANCCUS2423
EliteLearning.com/Nursing
Individual state nursing approvals Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. In addition to states that accept courses offered by ANCC accredited Providers, Colibri Healthcare, LLC is an approved Provider of continuing education in nursing by: Alabama Board of Nursing, Provider #ABNP1418 (valid through February 5, 2025); Arkansas State Board of Nursing, Provider #50-4007; California Board of Registered Nursing, Provider #CEP17480 (valid through January 31, 2024); California Board of Vocational Nursing and Psychiatric Technicians (LVN Provider # V15058, PT Provider #V15020; valid through December 31, 2023); District of Columbia Board of
Nursing, Provider #50-4007; Florida Board of Nursing, Provider #50-4007; Georgia Board of Nursing, Provider #50-4007; Kentucky Board of Nursing, Provider #7-0076 (valid through December 31, 2023; CE Broker provider #50-4007). Michigan Board of Nursing, Provider #50-4007; Mississippi Board of Nursing, Provider #50- 4007; New Mexico Board of Nursing, Provider #50-4007; North Dakota Board of Nursing, Provider #50-4007; South Carolina Board of Nursing, Provider #50-4007; and West Virginia Board of Registered Nurses, Provider #50-4007. This CE program satisfies the Massachusetts States Board’s regulatory requirements as defined in 244 CMR5.00: Continuing Education.
Activity director Shirley Aycock, DNP, RN, Executive Director of Quality and Accreditation Disclosures Resolution of conflict of interest In accordance with the ANCC Standards for Commercial Support for continuing education, Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity.
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Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative
to diagnostic and treatment options of a specific patient’s medical condition.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Course verification All individuals involved have disclosed that they have no No. 241, every reasonable effort has been made to ensure that the content in this course is balanced and unbiased. significant financial or other conflicts of interest pertaining to this course. Likewise, and in compliance with California Assembly Bill
ASTHMA MANAGEMENT PRINCIPLES AND GUIDELINES
Asthma is a chronic disease characterized by airway inflammation that can be controlled with appropriate interventions, including medications, trigger avoidance, identification of signs and symptoms of worsening asthma, and/or peak flow monitoring (if appropriate). Asthma is a chronic disease. Symptoms of asthma may include wheezing, shortness of breath, chest tightness, and cough. Expiratory airflow limitation may also be experienced by the person with asthma. Airway hyperresponsiveness (AHR), which occurs in response to asthma triggers, is also associated with asthma. Asthma symptoms are not usually persistent; they are intermittent and vary in intensity, which poses challenges to treatment. It needs to be emphasized that AHR and chronic airway inflammation are present even when the person with asthma is not experiencing any asthma symptoms. Although there are several different underlying disease processes of asthma with distinct demographic, clinical, and/or pathophysiological characteristics (referred to as phenotypes), treatment goals remain the same (GINA, 2021). However, accurate diagnosis needs to occur before appropriate asthma interventions can be implemented. Treating asthma before carrying out objective tests decreases their sensitivity and can make confirmation of the diagnosis difficult. Unfortunately, there is no agreed-upon gold standard to diagnose asthma. Asthma may present with common respiratory symptoms, and physical
examination may be unrevealing. Additionally, the most widely available tests (peak flow and spirometry) can be normal unless the patient is experiencing an exacerbation. This may result in underdiagnosis or overdiagnosis of asthma. Overdiagnosis leads to unnecessary treatment and a delay in making an alternative diagnosis. Underdiagnosis risks the continuation of daily symptoms, potentially serious exacerbations, and long- term structural changes in the airway (Kavanagh et al., 2019). A diagnosis is typically made by reviewing clinical features and objective measures and by assessing response to therapy. It needs to be emphasized that asthma management is not a one-size-fits-all endeavor. Interventions need to be individualized at each interaction with the healthcare system according to the level of severity and asthma control. It is crucial that healthcare providers use an evidence-based approach to managing asthma within the population. Treatment decisions need to consider the patient’s likely response to treatment, patient preferences, and practical issues. It is crucial for the healthcare provider to discuss barriers to adherence to the asthma management plan, which may include medication access and cost to the patient (GINA, 2021).
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Healthcare Professional Consideration : There are numerous issues when a patient is either undiagnosed or overdiagnosed with asthma. For the person with undiagnosed asthma, symptoms go unaddressed and untreated, impacting their quality of life. Time is lost from work or school because of difficulty breathing or poor sleep from nocturnal asthma. This poses economic hardship from lost wages from work, because of the person’s own illness or that of their child. Permanent pathological changes can occur within the respiratory system, leading to disability. Emergency room visits and hospitalizations are more likely to occur from untreated asthma, greatly impacting quality of life and resulting in economic burden. For the person misdiagnosed with asthma, the excess expense of unneeded medications and healthcare visits can impose a heavy burden. It is essential that objective testing be conducted to confirm the diagnosis of asthma; the healthcare provider should not rely on patient symptom history alone for treatment decisions. Appropriate follow-up care is needed to confirm or reject the diagnosis and to ascertain the best treatment intervention to alleviate the symptoms presented by the person Asthma guidelines The National Asthma Education and Prevention Program (NAEPP) of the NHLBI, which developed the Expert Panel Report 3 (EPR3); the subsequent 2020 Focused Updates to the Asthma Management Guidelines (also developed by the NHLBI); and the GINA are three of the most commonly cited guidelines used by healthcare providers and researchers to achieve best practices. The GINA Scientific Committee prepares updates to their guidelines each year, which are available on the GINA website Asthma management goals The goals for asthma management for both NAEPP and GINA are to achieve good symptom control and reduce impairment and risk (GINA, 2021; NHLBI, 2007). Specific recommendations are based on age groups that vary slightly depending upon the two guidelines. GINA (2021) differentiates treatment for adults/adolescents, children ages 6 to 11 years, and children 5 years and younger; the latest updates to the EPR3 (NHLBI, 2021) delineate the age groups as 12 years and older, 5 to 11 years, and 0 to 4 years. Impairment refers to the intensity and frequency of asthma symptoms and the limitations imposed by these symptoms. Risk encompasses the adverse outcomes associated with asthma and its treatments. Specific goals for reducing impairment include freedom from asthma symptoms Asthma assessment Frequency of asthma assessment depends upon the patient’s initial level of asthma control, their response to treatment, and their level of engagement with self-management. Patients should be seen 1 to 3 months after the start of treatment and every 3 to 12 months thereafter. If an exacerbation occurs, a review visit with the healthcare provider should be scheduled within 1 week (GINA, 2021). Asthma assessment should also be conducted with each encounter with the healthcare system, even if asthma is not the focus of the visit. Spirometry should be done in the office, if available. Peak flow monitoring should be done if spirometry is not available. The person with asthma should monitor peak flows at home, if appropriate. GINA (2021) emphasizes a continuous cycle of assessment (diagnosis, symptom control, risk factors, comorbidities, inhaler technique and adherence, patient preference and goals), adjusting treatment (asthma medications, nonpharmacologic strategies, treatment of modifiable risk factors), and reviewing response (symptoms, exacerbations, side effects, patient satisfaction, lung function) to achieve asthma control. The following questions should be asked (Fanta, 2020): 1. How often has your asthma awakened you at night or in the early morning? 2. How often have you needed to use rescue (quick-relief) medication for cough, shortness of breath, or chest tightness?
as they are completed. The Committee reviews the world’s literature with regard to asthma management and updates the GINA documents to reflect any new evidence-based information (GINA, 2021). NHLBI, based on systematic reviews conducted by the Agency for Healthcare Research and Quality, with input from NAEPP participant organizations, medical experts, and the public, released updates to the EPR3 in 2020 (NHLBI, 2021). (cough, chest tightness, wheezing, shortness of breath), use of rescue medication no more than 2 days per week, no more than two nighttime awakenings per month, optimization of lung function, no activity limitations, and satisfaction with asthma care provided. Specific goals for reducing risk include prevention of recurrent exacerbations and the need for emergency department or hospital care, prevention of lung function loss, and optimization of pharmacotherapy with minimal or no adverse effects (Fanta, 2020). Again, it is essential that the patient’s goals for treatment be considered and incorporated into the management plan, and also a personalized plan addressing modifiable risk factors that have the potential to reduce the occurrence of asthma exacerbations (GINA, 2021). 3. Have you needed any unscheduled care for your asthma, including calling in to the healthcare provider, an office visit, or emergency room visit? 4. Have you been able to participate in school/work and recreational activities as desired? 5. If peak flow measurements are done, have your peak flow readings been lower than your personal best? 6. Have you taken oral steroids for your asthma within the past year? 7. Have you been hospitalized for your asthma? How many times in the past year? 8. Have you been admitted to the intensive care unit or intubated because of your asthma within the past 5 years? 9. Do you or anyone in your household currently vape or smoke cigarettes? If yes, how many each day? 10. Have you noticed an increase in asthma symptoms after taking aspirin or a nonsteroidal anti-inflammatory agent (NSAID)? Asthma management Both the EPR3 (NHLBI, 2007) and GINA (2021) recommendations include a “step-up” or “step-down” methodology, increasing or decreasing medications and/or dosages, based on the needs of the person with asthma. Initial treatment plans are based on an assessment of asthma severity with adjustments made to the plan based on assessing the level of control. Both look at
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impairment and risk to determine the best interventions. Asthma severity classification is determined by the number of days/ nights with asthma symptoms, frequency of short-acting beta agonist use, activity limitations because of asthma, pulmonary function tests, and frequency of exacerbations requiring oral steroids. It should be noted that the levels of classification differ slightly between the EPR3 and GINA. The EPR3 (NHLBI, 2007) identifies four categories of severity: intermittent, mild persistent, moderate persistent, and severe persistent. GINA (2021) has incorporated intermittent asthma into the mild persistent category. Intermittent asthma historically was not treated with inhaled corticosteroids; however, the use of inhaled corticosteroids has been shown to reduce the severity of asthma exacerbations in those with intermittent asthma. GINA is currently reviewing its definition of mild asthma (GINA, 2021). For both guidelines, severity is classified by the category in which the most severe feature occurs. A step down should be considered for asthma that has been well controlled for at least 3 months. If a step up is needed because of poor asthma control, the health professional should first assess medication adherence, inhaler technique, environmental control, and comorbid conditions. Asthma management education Education for asthma self-management, and the skills needed to perform the needed management, is a critical component of asthma intervention. This should be done through a partnership between the healthcare provider and the person with asthma, with goals for treatment mutually agreed upon. The person with asthma needs clear training on using medication administration devices correctly. Adherence with medications and follow-up appointments needs to be encouraged through an agreed-upon strategy. Information about asthma needs to be provided so the person with asthma has an understanding and appreciation of what is happening to their body. The healthcare provider also needs to provide information on guided self-management, including self-monitoring of symptoms and/or peak flow measurements. A written asthma action plan that provides information on recognizing and responding to worsening asthma should be developed for each person with asthma and reviewed
as the level of asthma control or severity changes (GINA, 2021; NHLBI, 2007). The healthcare professional needs to evaluate the readiness of the person with asthma to undertake the necessary self-management interventions and should also assess for any barriers that may preclude this from happening. If barriers are present, the healthcare professional needs to work with the person with asthma to assist in eliminating these barriers. Self-Assessment Quiz Question #1 Which of the following is accurate regarding the asthma management guidelines discussed in this course? a. Both the Expert Panel Report 3 and the Global Initiative for Asthma are updated yearly. b. The Global Initiative for Asthma classifies asthma severity in three categories, whereas the Expert Panel Report 3 uses four categories. c. In terms of the goal for asthma treatment, GINA focuses on asthma risk, whereas the EPR3 focuses on asthma control. d. The age group delineation for asthma treatment is the same for both GINA and the EPR3. Self-Assessment Quiz Question #2 A patient who experienced shortness of breath was previously prescribed a rescue inhaler. At the time of the visit, the patient is not experiencing any symptoms but is concerned about having asthma. Which of the following statements is true? a. The healthcare provider should prescribe spirometry testing for a definitive diagnosis of asthma. b. An asthma diagnosis should be based on the patient’s symptoms that are specific to having asthma. c. Treating symptoms before testing increases the ability to achieve an accurate diagnosis. d. Spirometry testing may be normal if the patient is not experiencing any asthma symptoms.
TYPES OF ASTHMA IN ADULTS
Work-related asthma Work-related asthma is caused by an occupational environment, characterized by variable airflow limitation and/or AHR attributable to stimuli encountered in the workplace (Quirce & Sastre, 2020). An estimated 11 million workers are exposed to at least one of the numerous agents known to be associated with occupational asthma. Approximately 17% of all adult- onset asthma cases are related to the work environment. Persons with work-related asthma are more likely to experience asthma attacks, emergency room visits, and worsening asthma symptoms than other adults with asthma. Workers who are African American, American Indian/Alaska Native, multiracial, or of Puerto Rican ethnicity have a higher prevalence of work- related asthma. No gender differences have been noted (National Institute for Occupational Safety and Health [NIOSH], 2017; Occupational Safety & Health Administration, n.d.). Workers at greatest risk for occupational asthma include bakers, detergent manufacturers, drug manufacturers, farmers, grain elevator workers, laboratory workers (especially those working with laboratory animals), metal workers, millers, plastics workers, and woodworkers (MedlinePlus, 2021). The pathophysiology of work-related asthma is the same as that for non-work-related asthma: inflammation, edema, bronchoconstriction, and buildup of mucus in the airways lead to coughing, wheezing, chest tightness, and shortness of breath. Triggers include environmental sensitizers, irritants, or physical conditions. Sensitizers initiate an allergic response. Typically, there is a latency period of at least a few months between initial exposure and the development of symptoms. Sensitizers are categorized as either high or low molecular weight. Irritants in the workplace create a nonallergic response. Physical conditions, such as exposure to cold air and physical exertion, may lead to bronchoconstriction (NIOSH, 2017; Quirce & Sastre, 2020).
The diagnosis of work-related asthma includes an exposure history. Work-related asthma should be considered in individuals with new-onset asthma or worsening asthma after previously being controlled. Known exposures from all workplaces, past and present, should be assessed. Symptoms may develop at work or may be delayed, occurring after leaving the workplace (NIOSH, 2017; Quirce & Sastre, 2020). The key to managing occupational asthma is to remove the worker from exposure as quickly as possible after the onset of symptoms. In some cases, occupational asthma may resolve if removal from exposure occurs soon after onset of symptoms. The use of respiratory protective equipment decreases worker exposure levels and reduces the incidence of occupational asthma, but does not completely protect against development of work-related asthma. Exposure monitoring, combined with medical surveillance of exposed workers, enables early identification of sensitization and removal from exposure to these agents for those who develop occupational asthma. Unfortunately, very low concentrations of antigen may be undetectable but still provoke bronchospasm in sensitized workers. Smoking cessation should be advised, as this may decrease the risk of antigenic sensitization in the workplace (Lemiere & Bernstein, 2019).
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