I took the Excelsior CPNE Workshop

[SuesquatchRN, BSN, RN]

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

[FocusRN]

Wow. You have me thinking about going to EC's worshop. Thanks Sue.

[akanini, MSN, RN]

Best of luck to you Suesquatch! Thanks for your info.

[gradyrn2b08]

This info is wonderful, thanks for sharing!!!:bowingpur

[SuesquatchRN, BSN, RN]

You're all welcome.

Okay. You have 30 minutes for the planning phase. In that time you will be given your Kardex and take report from the nurse. You will develop your planning phase care plan.

Upon entering the room, you have a total of 1 1/2 hours to complete everything. Your clinical examiner (CE) will have gathered everything you need.

WASH YOUR HANDS and then introduce yourself to your patient. Identify him by HOLDING THE KARDEX TO THE PATIENT'S BRACELET and asking them their name and DOB.

GLOVE and check the IV site if present and the IV flow rate and solution. THIS MUST BE DONE IN THE FIRST 20 minute. Have your papers folded in half and in your pocket. If you must use the pt's personal space - bedside table or tray table - ask permission and clean it before and after use, and replace their stuff.

GLOVE before touching anything that has the chance of getting bodily fluids on you.

You will be asked to provide 4 (I think - I'll verify later) areas of care from the ones I listed.

WASH YOUR HANDS EVERY TIME YOU ENTER OR LEAVE THE ROOM AND BEFORE YOU TOUCH ANYTHING IN THE ROOM. The alcohol cleansers are okay.

If you screw up the PCS will end immediately.

The last 40 minutes are for you to document your EVALUATION CARE PLAN.

---------------------------

Depending upon where you test you may not have peds. Since I'm testing at Albany Med I will.

On Sunday, if you failed any PCS you get the chance to do another. So you can repeat ONE adult PCS and one child.

------------------------

Organization will be key to passing. When you take report and see the Kardex make a grid and write down your mnemonics or whatever it is you use to keep track of what you need to do. Highlight the assigned and overriding areas of care THAT YOU NEED TO DO.

You will be expected to invoke clinical decision making at any point in the PCS that you think things have changed or need immediate attention. Say you're doing a PVA and the patient has been stable and their left leg is cold with a rigid, distended vein and a cyanotic foot. At that point, you say, "I am invoking clinical decision making and getting the RN to inform her that the patient has a condition she should be aware of immediately."

If the doctor or family shows up and your time is interrupted in a way that you can't work around the CE will give you that time back.

---------------------------------

I'm sure that I will pass. I am sure that had I not taken the workshop I would not.

[SuesquatchRN, BSN, RN]

When you enter the room, think

WIGS

W wash hands

I ID and introduce

G Greet and Glove

S Start

And meds -

PIGS

P prepare

I IDENTIFY

G give and glove if injection or IV site

S SIGN

[caliotter3]

Thanks a lot Sue. I think this is the first positive description of the EC workshops that I've seen. Very helpful.

[TIN65RN]

WOW,Thank you,This is great stuff!!!!:bowingpur

[Lunah, MSN, RN]

Pay the $12 for the flash cards - EVERYTHING is on them

I totally agree! I love my flashcards!!! Also, there is an audio version of the flashcards -- a CD you can play in the car or at home. The recording quality is a bit ... well, let's just say the letter "P" is a bit strong, I thought she might blow my speakers with it at one point! LOL!! But it's great. I listen to it while driving to/from work, or whenever I'm in the car, really. It's on my iPod, too! :)

Anyway, both are available on the EC website. Great stuff!

Sue, it sounds like the workshop was great! You summarized the careplanning very well -- USE THE KARDEX!! It's the outline.

[EricJRN, MSN, RN]

Good luck as you continue to prepare, Sue. I found the Excelsior workshop to be helpful, too!

[txspadequeenRN, BSN, RN]

thanks sue!!!!!!! this is great review

[BetterMeRN]

Thanks for the great information, can't wait to be there soon.