CEN

CEN Retinal Detachment

Retinal detachment is a disorder of the eye in which the retina detaches from the retinal pigment epithelium. Retinal detachments can be caused by fluid leaking behind the retina through tears, by traction on the retina, or by fluid exuding from the retina. The visual prognosis of a retinal detachment is dependent on the duration of the detachment, whether the macula was detached, and the underlying health of both the retina and circulatory system of the eye. The retina is a thin layer of light sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film or sensor in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.

Signs and Symptoms

A rhegmatogenous retinal detachment is commonly preceded by a posterior vitreous detachment which gives rise to these symptoms:

• flashes of light (photopsia) – very brief in the extreme peripheral (outside of center) part of vision
• a sudden dramatic increase in the number of floaters
• a ring of floaters or hairs just to the temporal (skull) side of the central vision

Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:

• a dense shadow that starts in the peripheral vision and slowly progresses towards the central vision
• the impression that a veil or curtain was drawn over the field of vision
• straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsler grid test)
• central visual loss

In the event of an appearance of sudden flashes of light or floaters, an eye doctor needs to be consulted immediately.  A shower of floaters or any loss of vision, too, is a medical emergency.

Risk Factors

The following factors increase your risk of retinal detachment:

• Aging — retinal detachment is more common in people over age 50
• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury
• Previous other eye disease or inflammation

Diagnosis

• Retinal examination - The doctor may use an instrument with a bright light and a special lens (ophthalmoscope) to examine the back of your eye, including the retina. The ophthalmoscope provides a highly detailed view, allowing the doctor to see any retinal holes, tears or detachments.

• Ultrasound imaging - this test if bleeding has occurred in the eye, making it difficult to see your retina.

CEN Retinal Detachment - Types

• Rhegmatogenous retinal detachment – A rhegmatogenous retinal detachment occurs due to a break in the retina (called a retinal tear) that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. Retinal breaks are divided into three types – holes, tears and dialyses. Holes form due to retinal atrophy especially within an area of lattice degeneration. Tears are due to vitreoretinal traction. Dialyses are very peripheral and circumferential, and may be either tractional or atrophic. The atrophic form most often occurs as idiopathic dialysis of the young.

• Exudative, serous, or secondary retinal detachment – An exudative retinal detachment occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break. In evaluation of retinal detachment it is critical to exclude exudative detachment as surgery will make the situation worse, not better. Although rare, exudative detachment can be caused by the growth of a tumor on the layers of tissue beneath the retina, namely the choroid. This cancer is called a choroidal melanoma.

• Tractional retinal detachment – A tractional retinal detachment occurs when fibrous or fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.

Treatment

• Cryopexy and laser photocoagulation
• Scleral buckle surgery
• Pneumatic retinopexy
• Vitrectomy

 

CEN Pulmonary Embolism

Pulmonary Embolism Overview & Pathophysiology

PE is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body through the bloodstream.  PE usually results from a blood clot in the leg that travels to the lung.  The risk of blood clots is increased by cancer, prolonged be rest, smoking, stroke, certain genetic conditions, pregnancy, obesity, and after some types of surgery.  A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.  Pulmonary embolisms affects about 300,000 and 600,000 people a year in the U.S, which results in about 50,000 to 200,000 deaths.  Rates are similar in males and females.  They become more common as people get older.

Because pulmonary embolism almost always occurs in conjunction with deep vein thrombosis, most doctors refer to the two conditions together as venous thromboembolism.  Although anyone can develop a DVT and PE, factors such as immobility, cancer and surgery increases your risk.  A PE can be life threatening, but prompt treatment can greatly reduce the risk of death.  Taking measures to prevent blood clots in your legs will help protect you against a pulmonary embolism.

Signs and Symptoms 

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clots and your overall health - especially the presence or absence of underlying lung disease or heart disease.

• Common signs and symptoms include
• Shortness of breath
• Chest pain
• Cough
• Leg pain or swelling or both usually in the calf
• Clammy or discolored skin
• Fever
• Excessive sweating
• Rapid or irregular heartbeat
• Lightheadedness or dizziness

Causes 

Pulmonary embolism occurs when a clump of material, most often a blood clot, gets wedged into an artery in your lungs.  These blood clots most commonly originate in the deep veins of your legs, but they can also come from other parts of your body.

Risk Factors 

Certain medical conditions places you at high risk for PE

• Hear disease
• Cancer

Prolonged immobility such as

• Bed rest
• Long journeys

Surgery is one of the leading causes of blood clots, especially seen after joint replacements of the hip and knee. Other risk factors are

• Smoking
• Being overweight
• Supplemental estrogen
• Pregnancy

Complications 

Pulmonary embolism can be life threatening.  About 1/3 of people with undiagnosed and untreated pulmonary embolism don't survive.  PE can also lead to pulmonary hypertension.

Tests and Diagnosis

PE can be difficult to diagnose, especially in people who have underlying heart or lung disease.  For that reason, your physician may order a series of tests to diagnose the presence of a PE

• D-dimer - high levels may indicate the likelihood of blood clots
• Chest X-ray - used to rule out other conditions that may mimic a PE
• Noninvasive Ultrasound
• CT scan of the chest
• Pulmonary angiogram
• MRI

Treatment

Treatment is aimed at keeping the blood clot from getting bigger and preventing new clots from forming.  Prompt treatment is essential to prevent serious complications or death.

• Blood thinners (anticoagulants)
• Clot dissolvers  (thrombolytics)
• Clot removal
• Vein filter

Prevention

• Anticoagulants
• Compression stockings
• Pneumatic compression
• Physical activity
• Leg elevation

 

 

CEN Exam Course - Preparing For Success!!

CEN Exam Overview

The CEN is for nurses working in the emergency department.  Flight nurses may also take this certification as well.  The CEN Exam covers the following topics; gastrointestinal emergencies; genitourinary, gynecology, and obstetrical emergencies; maxillofacial and ocular emergencies; neurological emergencies; psycho/social emergencies; respiratory emergencies; environment and toxicology emergencies; shock; medical emergencies and communicable diseases; and professional issues.  The CEN Exam is divided up based on the following; assessment 26%, Analysis 23%, intervention 30% and evaluation 20%.  There is a total of 175 questions on the exam; 150 are scored and 25 unscored pretest items.  You will be allowed 180 minutes to complete the exam.  After the exam is complete, you will receive a score report indicating whether you passed or failed the exam.  If you do not pass the exam, there is a 90 day waiting period for retesting.

CEN Preparation Strategies For Success

Taking and passing the CEN Exam on the first attempt can be a tough ordeal.  Some nurses are successful and some are not.  I have seen in times past where really smart nurses fail the CEN exam, and nurses that are not so bright, pass the exam on the first attempt.  That backwards scenario has nothing to do with luck or lack of preparation on either of the nurses part.  It has everything to do with fatigue.  If you are studying for the CEN exam and plan to be successful, you have to prepare for that 150 question exam the same way you would prepare for a marathon.  We call it, "The Marathon Effect."  "The Marathon Effect" is all about mental and physical preparation.  I have never seen a runner go run a marathon and finish it or win it, without adequate preparation.  When preparing for the CEN Exam, it is always best to train yourself to take and complete the 150 question exam.  Start by taking 25 questions a day for 7 days, then 50 questions per day for 7 days, then 75 questions per day for 7 days, until you reach 150 questions.  If you prepare this way, you will know doubt pass the CEN exam on the first attempt.

CEN Practice Questions

Undoubtedly the toughest past of the CEN exam has to be the questions.  The primary key to answering the questions correctly has to do with content.  You will not be successful at answering the questions appropriately without a firm content base.  There is no replacement for content.  If you have a firm content base, you can answer any question that is thrown your way.  Make sure you have a firm grasp on the content then practice well over 3000 practice questions scoring an average of 80% or better and you should be fine.  Be sure to practice taking 175 questions in one setting without taking a break.  On test day, you will have to just that.  Most people fail the exam due to fatigue, not because of lack of knowledge.  If you develop a good content base and practice over 3000 questions, you should be able to master the CEN exam without having to retake the exam.  

CEN Exam Questions

CEN Certification Overview

The CEN certification is primarily for registered nurses providing direct care to patients in the emergency room setting, and flight nursing.  In order to be successful on the CEN Exam, you must dedicate some time to studying on a daily basis.  In times past, the most beneficial has been to find a really good review course that offers at least 1500 to 2000 CEN Exam Practice Questions and detailed overview of content.

CEN Questions

The CEN Exam is a 3 hour test that contains 175 test items.  150 items are scored and 25 are used to gather statistical data on item performance for future exams (BCENCertifications.org).  Listed below is a detailed breakdown of the exam content outline and percentages assigned to each section.  In order to be successful on your first attempt, you must score greater than a 70% on the exam.  If you want to be successful on your first attempt, you must answer at least 2000+ CEN style exam questions prior to test day with an 85% or greater.  We have designed several courses that we feel will aid in your studies.  Some of the courses that we have to offer are listed below… 

CEN Test Plan

The content of the CEN Exams is described in the test plans on BCENCertifications.org.  Candidates are tested on a variety of patient care problems that are organized under major categories.  Listed below is a detailed list of the content areas. Cardiovascular Emergencies (13%) Gastrointestinal Emergencies (7%) GU, Gynecology and OB Emergencies (7%) Maxillofacial and Ocular Emergencies (6%) Neurological Emergencies (10%) Orthopedic and Wound Emergencies (9%) Respiratory Emergencies (12%) Environment and Toxicology Emergencies (7%) Shock (6%) Medical Emergencies and Communicable Diseases (11%) Professional Issues (7%)

CEN Sample Questions

1)  A 63 y/o patient complains of dizziness, weakness over the past week, and syncopal episode this am. Initial VS are BP 170/98 mmHg, HR 32 bpm, RR 18 bpm, and T 98.3. What is the priority intervention for this patient? A)  Administer O2 via non-rebreather mask B)  Prepare pt for a STAT CT scan C)  Activate the rapid response team D)  Initiate IV access with a saline lock Answer:  (A) Administer O2 via a non-rebreather mask Rationale:  The pt is at risk for falling d/t the chief complaint of dizziness and is also at risk for cardiovascular collapse related to bradycardia. Providing O2 is indicated given the patient's HR and the need to maintain adequate oxygenation.   2)  Which assessment technique could contribute to making a diagnosis in a patient with a sudden onset of "tearing" chest pain? A)  Perform a right sided ECG B)  Assess for pedal edema C)  Auscultate heart sounds for a friction rub D)  Obtain BP readings in both arms Answer:  (D) Obtain BP readings in both arms Rationale:  Sudden onset of tearing chest pain could indicate an aortic dissection. Patients with aortic dissection frequently have unequal upper extremity BP readings, with a difference of 20 mmHg or more systolic. This occurs because of turbulent blood flow thru the disrupted aorta during systole, resulting in higher readings in the left arm compared to the right arm.  

CEN Transient Ischemic Attack

A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. A TIA usually lasts only a few minutes and doesn't cause permanent damage. Often called a ministroke, a transient ischemic attack may be a warning. About 1 in 3 people who has a transient ischemic attack will eventually have a stroke, with about half occurring within a year after the transient ischemic attack. A transient ischemic attack can serve as both a warning of a future stroke and an opportunity to prevent it.

Signs and Symptoms

Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour, though rarely symptoms may last up to 24 hours. The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of:

• Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
• Slurred or garbled speech or difficulty understanding others
• Blindness in one or both eyes or double vision
• Vertigo or loss of balance or coordination

Causes

A transient ischemic attack has the same origins as that of an ischemic stroke, the most common type of stroke. In an ischemic stroke, a clot blocks the blood supply to part of your brain. In a transient ischemic attack, unlike a stroke, the blockage is brief, and there is no permanent damage. The underlying cause of a TIA often is a buildup of cholesterol-containing fatty deposits called plaques (atherosclerosis) in an artery or one of its branches that supplies oxygen and nutrients to your brain. Plaques can decrease the blood flow through an artery or lead to the development of a clot. A blood clot moving to an artery that supplies your brain from another part of your body, most commonly from your heart, also may cause a TIA.

Prevention

• Don't smoke
• Limit cholesterol and fat
• Eat plenty of fruits and vegetables
• Limit sodium
• Exercise regularly
• Limit alcohol intake
• Maintain a healthy weight
• Don't use illicit drugs
• Control diabetes

Diagnosis

• Physical exam and tests
• Carotid ultrasonography
• Computerized tomography (CT) or computerized tomography angiography (CTA) scanning
• Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA)
• Echocardiography
• Arteriography

Treatment

• Anti-platelet drugs
• Anti-coagulants
• Surgery