Care plans

I made these notes from another forum on this board and it has helped me more than anything.......hope it helps you.

Work backwards.

What is the problem as I see it? Example: Patient buttocks is getting red and I'm worried about skin.

What can I do? I can turn q 2 hr, use pillows and bed position changes. (Here is your implementation) I will know if it worked by decreased redness and no further breakdown. ( here is your goal)

Why is this happening? Bed bound? Lack of mobility? (this is your R/T)

Then comes your NANDA DX Impaired Skin Integrity

So, now you have the following:

Impaired Skin Integrity R/T decreased mobility AEB moist, warm reddened areas on bilateral buttocks.

Implementation: Turn pt q 2 hrs, use of pillows to float area as much as possible. Monitor skin q shift and alert wound care PRN. Discuss use of air mattress with MD

Eval and Goals. Patient will have lessening of redness on bilateral buttocks and keep intact skin.

Once I saw this to work backwards, it helped me so much.. Priority is always ABC's and Pain. Airway, Breathing, Circulation, Pain.

I go and read the transcripts of the CPNE chats. Every faculty member that hosts the chat says that nerves is what will fail you. So, you have prepared as well as anyone could. You go out there and show that you KNOW you are a good nurse. You know how to do these skills. You know how to evaluate if there is a problem and you CAN DO THIS!!!!!!!!!!!! Concentrate on the patient. Forget the Excelsior person is there. Show the patient that you are a great nurse. Write a 1000 times.......I am a great nurse. Believe in yourself. Show the patient that he/she is in good hands.

Great post above mudwoman! Nicely done. That is a solid set of advise and it works. Good luck and breathe counting backwards from 10 too! Nerves are tough.

You can also send practice careplans to EC and they will critique them for you. I found that very helpful, the more I did the easier it got.

Thanks for the replies! I send them to EC all the time and I think that is the problem, I overthink things. Will I know that the patient has abnormal breath sounds before start of PCS? I would hate to use Ineffective breathing pattern and fail before starting PCS because the patient does not have those defining characteristics present. Maybe I am just a ball of nerves!!!!!!!!! I have studied for six months for this cpne and utizilized all on-line resources through EC and the workshop. The best thing I could probably do for myself is put everything away for the next 10 days and just DO IT!!! The more I look over things, the more I start to doubt myself in an area where I was confident. I need HELP!!!!!!!!!!

You'll be able to access the patient's charts before sitting down to write your careplans. Stop freaking yourself out! Relax!

I do know how you feel though. I am sure you are completely prepared for this exam. Take control of your stress and relax!!