I will be adding to this as I gather my thoughts, but this should be a good beginning.
Several strong suggestions:
Pay the $12 for the flash cards - EVERYTHING is on them
Buy the Mosby's. Carpenito is going away.
Beg, borrow or steal to get to the workshop.
Identify your stengths and weaknesses. For example, I KNOW that I need to palpate every pulse and auscultate every blood pressure I can before the exam.
And remember, they really want you to pass.
The workshop began at 0900. We were all there by 0830 and came from all over the country. We had a couple of people who were physicians in China, about 4 paramedic/firefighters, and lots of LPN’s. We numbered 19, far more than I anticipated. It was excellent to be on an actual campus. Excelsior has three buildings right off of Washington Street, bordering I-90 and near SUNY Albany and the state government buildings.
We spent the first hours introducing ourselves and discussing our fears and weaknesses. Everyone was freaked about the documentation.
The afternoon was spent doing simulation exercises – the four stations on which you will be tested during the CPNE.
We also did PLANNING PHASE care plans.
Day 2 we went over care planning again and more skills. We then spent the rest of the day working with the Patient Care Situation (PCS) Recording Form and a LOT of discussion of organization and mnemonics. More care planning. Every area of care one could be assigned was covered.
Day three was EVALUATION PHASE care planning and a review of pediatrics and tube feeding/med administration. The afternoon was spent practicing skills if you wanted to stay. I beat feet home – I was exhausted.
THE KARDEX IS YOUR CARE PLAN. Don’t get creative. You need two nursing diagnoses, one actual and one can be a risk for, with two interventions. They need to be measurable within the PCS. So you will always be assigned mobility. It is marked to get the patient who had a left hip replacement OOB to the chair with 1 assist. Your diagnosis is “
Impaired mobility related to
limited weight bearing on left leg as evidenced by
need for 1 assist to move from bed to chair.” CHOOSE FROM THE KARDEX. The Kardex IS your care plan in sensible terms we all understand. Your nursing diagnoses must be supported by the evidence and you will NOT need any of, as one of my older intructors called them, the “high-falutin’ ones that I don’t know how they came up with them.”
K keep
I it
S simple,
S safe, and
S specific!
On the first day of the CPNE you will arrive at the hospital to begin at 1630. Wear business casual clothing – basically, Dockers day. You will be oriented to the hospital and floor, and given the Kardex for your first patient care situation. You will then do the simulation labs. There are four, and you can re-test on every one on Sunday should you fail.
ID YOUR PATIENT FROM THE MAR AND BRACELET IMMEDIATELY BEFORE ADMINISTERING ANY DRUG OR PERFORMING WOUND CARE.
IV gravity flow
You will be given a piggyback IV to flow via gravity. You must determine the drops per minute and then manipulate the stopper and bags to set it correctly. You have a leeway of 5 drops for minute.
IM of SQ Injection
You will be given one or the other. You WILL be mixing meds.
If it is SQ it will more than likely be insulin and know what to draw up first and what to rill. Know to pinch an inch and not aspirate and not massage.
If it is IM choose the vastus lateralis and know the proper landmark, to aspirate, the needle to choose, and to aspirate and massage gently.
Wound Care
You will have a really nasty wound with a sterile wet-to-dry dressing change to be done.
IV Push
You will have an IV push med to give. You are better to go too slowly – although not by say 50% - than too quickly.
Remember that the instructors WANT you to pass.
Overriding Areas of Care
Physical Jeopardy (Safety) – bed rails up, bed down, slippers on feet, common sense stuff that you know. KEEP YOUR PATIENT SAFE AND FREE FROM INJURY.
Aspesis – Wash your hands, duh! As soon as you enter the room and before you introduce yourself. Glove before touching anything that might have secretions – IV site, oral thermometer, giving an injection, changing a diaper, etc. Carry lots of pens and if you drop one kick it away. You CAN do this in pencil since none of it is documented into the patient’s actual chart and it is being draded on the spot.
Caring – Be nice, don’t be demeaning by calling people sweetie, etc, if the patient wants to talk talk and find a way around your time limitations
Emotional Jeopardy – see caring
Mobility – You will ALWAYS have mobility to perform. If there are transfers or amulation, etc. that WILL be part of your PCS.
Required Areas of Care
You will ALWAYS have vital signs and fluid management. Do not do VS you were not assigned – e.g. not O2 sat of not checked. FM is checking the IV if there is one. It is NOT I/O. It is also skin turgor - tenting/non-tenting, or mucous membranes, or fontanel for infant.
Selected Areas of Care
Abdominal Assessment – All 4 quadrants. CHART all 4 quadrant. Not “bowel sounds.” “Bowel sounds present all 4 quadrants.”
D daylight Distention
S savings Sounds
T time Tenderness, rigidity
L look
L listen
F feel
Neurological Assessment -
COPSMN cops make nice for adults, CAMP for kids.
C consciousness
O orientation
P pupils
S strength/sensation
M movement
N noxious stimuli – response, if necessary
C consciousness
A anterior fontanel (under 1)
M movement
P Pupils
Peripheral Vascular Assessment –
P lease Pulse (most distal, at same time)
M ake Motion
S ure Sensation
T o Temp
C hart Color/Capillary Refill
Respiratory Assessment – 4 lobes. Upper 2, at soft spot between clavicle and scapula, and bottom two, below scapula + 3 finger lengths. CHART ON ALL 4 QUADRANTS. Chart pattern.
Skin Assessment –
I Integrity
C Color
T Temperature
E Edema
M Moistness
And x 2 – two separate sites!
Comfort Management – change sheets, reposition, wash hands and face, yada yada yada. DO NOT USE ALTERATION IN COMFORT – it is only in the old Carpenitio’s and if it isn’t in the book you are using you will not be permitted that nursing diagnosis.
Musculoskeletal Management -
B balance
E extraneous movements
A assistive devices
M moved where?
R response
M movement
A abnormalities
P pain
This included ROM and PROM
Oxygen Management – O2 on or off, responses, etc
S kin (around nose, behind ears, under cannula)
O xygen/ check flow rate, O2 sat
A ctivity level/response
P atterns, respiratory
Pain Management – medicate, reposition, distract, etc
Respiratory Management – This is NOT respiratory assessment. It’s percussion, incentive spirometry, etc. CHART REPONSE and evaluate resp status before and after treatment.
Wound Management
L location
T type
A appearance
D drainage
Drainage and Specimen Collection
Enteral Feeding
Irrigation
Medications
P prepare
I ID and introduce
G give
S sign
Patient Teaching
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Re: I took the Excelsior CPNE Workshop
