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snowiebella 2,485 Views

Joined Sep 6, '10. Posts: 19 (32% Liked) Likes: 6

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  • Sep 9 '10

    Hey Guys and Gals, I just got off of the phone with Human Resources and I got the job, I start on the 27th of this month!!
    Steve

  • Sep 8 '10

    Hello,

    Yes, you should know where to locate and palpate the pulses for the carotid, brachial, radial, femoral, popliteal, posterior tibial pulse, and the dorsalis pedis pulse, but you may learn this in skills lab...I learned the locations in fundamentals. You should measure the apical pulse with a stethoscope and the radial pulse with two or three fingers. Usually when you are palpating the other pulses with your fingers (or with a doppler for hard to find pulses), you are measuring the quality and strength of each pulse bilaterally except for the carotid pulse, this you do separately otherwise the patient can lose consciousness from reduced circulation to the brain. The strength measurement is as follows: +4 bounding, +3 full, +2 normal, +1 weak, 0 absent. Hope this helps!

  • Sep 8 '10

    the pedal pulse has been my enemy. Finally got it with help from my FF hubs. Make a "c" with your fingers and your thumb on the hand opposite the foot you want to check the pulse on (left hand right foot, right hand left foot), and cup the "c" around the foot with your thumb around the ball of the big toe. Slide your fingers from the outer edge of the foot to the inner edge. Don't be afraid to press firmly. You should be able to find the pedal pulse this way.
    HTH!

  • Sep 8 '10

    i update this thread ever so often as things happen....i just got accepted to the texas tech rn to bsn program and i am very excited....ec made all of this possible......

  • Sep 8 '10

    I'm so glad to see so many EC/RC success stories. I passed the CPNE in 3/94 and got my ADN in 5/04 (back when it was called Regents College) and RN in 7/04. Since then I graduated with my BSN via ISU's distance ed program and will graduate from USI's distance ed MSN/FNP program next May. I'm slated to start USI's DNP program next Fall. I think I might be one of the first in the US to do ADN/BSN/MSN/DNP all through distance ed.

    Currently I own a vocational educational college that I started back in 1995, and am the CEO of a nurse registry I started back in 2000. I also serve in the California State Military Reserve as a captain in the nursing corps and as adjunct facult for public health nursing.

    Go EC!

  • Sep 8 '10

    both posts above explain it very well, ec only requires you to register and qualify for the nursing program before you can take nc3, therefor you are able to take nc1-2 without paying the 1000$ enrollment fee. this is important because ec charges you a "yearly" fee of 500$, so if you can complete nc3-7 and the cpne within a year you can save yourself some money.

    ec dosent require you to buy any materials, all you must do is pay for the exams nc1-7 are 220$ and they give you free content guides (also you can download all of the content guides free online from ec website and creating a online account "my ec").

    https://www.excelsior.edu

    what i have done is buy a couple of the basic books
    1. fundamentals of nursing practice by: kozier publisher: prentice hall
    isbn: 0536263442___ ed: 2007

    2. wong's essentials of pediatric nursing by: hockenberry publisher: elsevier
    isbn: 0323025935___ ed: 7th
    used in course(s): exam 461

    then i bought lisa arend's cd's (a former grad of ec with great notes), off of e-bay ( [color=#8a8a8a]http://search.ebay.com/_w0qqsasszlarendsqqhtz-1 ).
    [color=#8a8a8a]
    along with with ec practice tests (which are 60$ for two 100 question test), which give you ratonale for the correct and incorrect answers.

    with the above i have passed nc1 this passed weekend and plan on taking nc2-7 over the next 4 months.

    last but not least join up @ http://groups.yahoo.com/group/freehe...lsiorstudents/

    this is a great supportive group with study files and links, it is a bunch of ec students help each other out.

    imo with the above you dont need to spend alot of money on publishing companies like rue/tcn or even excelsiors guided study packages

    with ec if you dont have another degree and need to do other general ed credits you can do them thru ec or a local college you must have them done before you graduate.

    lastly to pass ec you must pass a clinical weekend at a hospital what we ec students call the cpne. it is the final requirment to pass and it cost a hefty 2k. there is plenty of resources out there such as this workshop:

    http://www.cpnesolutions.com/

    to help you pass this last class. ec and other hold more workshops also but they cost more.

    your final cost is a graduation fee which is used to pay for all the processing used to get you ready to take the nclex and get your diploma.

    the only fees you will ever have to pay (other than for your study materials) is your test fees (220 for all the nc tests), enrollment fee (895), yearly re-enrollement fee (450), and graduation fee (495), cpne (1725) and any general education credits you need (150-250).

    hope it helps

    chris.

  • Sep 7 '10

    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.

    Overview

    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!
    Skills

    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

  • Sep 7 '10

    Quote from zimsaint
    Hey All,

    I aM floored. I just received notice from GA Board of Nursing that they denied the endorsement of my MN RN license because I did not meet clinical practice requirements . When I called the board, they transferred me to a their Legal Nurse Consultant who stated that effective July 1, 2008 GA would no longer endorse RN license from Excelsior College students with no previous RN experience. She suggested that I go to my licensed state and work for a while then try again, but she could not give me a time frame.

    Has anyone else experienced this. I thought we should at least have gotten some sort of notice/warning before this type of rule be adopted by the board. I am going to file a motion for reconsideration using an Attorney. Before I entered Excelsiors program I called GA Board to verify acceptance. I had been accepted to a traditional LPN to RN bridge program; I could have been almost finished their too. I am so sad right now. I have been crying for two days. I think I will need to see my doctor for Zoloft.

    I have been an LPN for over 13 years doing Med/Surg for at least 10. I work on a hospital unit right now. THIS IS SO UNFAIR!!!
    Others suggested working in another state. That's a plan, but another possibility is working for the VA system. The VA -- being governed by federal regs -- allows nurses to be licensed in any state, and this is an option.

    A word of encouragement: I was the first Excelsior grad licensed in NC. I had to fight. You've been crying for 2 days? Fine. Now stop crying, and figure out what you're going to do. You've graduated from Excelsior's tough program, and you've passed boards. You're obviously a smart, resilient nurse, and you'll get through this hassle, too.


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