CPNE-ERS, please critique

BeachieRN84 · Aug 14, 2011

hey girlie, my answers are in green

sorry to throw this here, not much response on epn right now.
pcs#1. osteo arthritis & rt total knee, 1 day post op
1) acute pain r/t surgery aeb verbalizing pain 4-6 on a 0-10 verbal pain scale you cannot use a procedure or person for your related to, because it's considered blaming, to rewrite this you would use acute pain r/t tissue trauma (always tissue trauma!!) as evidenced by verbalizing pain level of 4 out of 10 on a 0-10 verbal pain scale
*the patient will report pain of 3 or less the patient will report a pain level of 3 or less on a 0-10 verbal pain scale during my pcs
*the nurse will apply ice pack to right knee for 20 minutes during pcs
*the nurse will suggest relaxation techniques i like to put specifics on my interventions, if for nothng else for me, so that way i can specfically evaluate, so i might use something like offer patient distraction of watching television or offer patient a back rub, and for pain i usually try to kill two birds w/one stone by throwing in a reposition on the care plan if i am assigned repositioning for mobility
*assessment to be performed validating the dx label: pain assessment tool 0-10 verbal scale
2) risk for injury:altered mobility this is my fave careplan lol i plan to use this for all of my pcs's (thanks lunah!!!)
*the patient will remain free from injury during pcs
*the nurse will maintain 2 upper side rails while in bed i would not use "the nurse" on here, i would just put "maintain 2 upper side rails while in bed" bc remember, u are not functioning as a lpn, you are going to be a student.
*the nurse will assist patient in ambulating with walker you could go even easier on this one, and use maintain call bell within reach, or ensure bed is locked and in low position
assessment to be performed to validate- musculoskeletal assessment and pva
(is this what they are looking for here?) you are on the right track--def base your care plans off what u are assigned on your kardex to keep it simple!

hope this is helpful loops :-)

LoopsRN2 · Aug 14, 2011

Huge help Beachie! Thank you :) I am going too simple, taking KISS too far, lol! I did my first mock with my son, and my IV supplies are too old or something. I can't get my mini bag tubing disconnected & all stoppers/valves open& no drip, yay! I ran soooo over 2o minutes, not funny! But I can see where practice will help. On my kardex for PCS1 the DOB has pt age if 62, no actual birthdate? I verbalized every single thing I do, and I can't shake the habit.

When you write your grid, do you do one generic format or do you personalize each one? (does that make sense?) I still have to watch robs DVDs, they will prob clarify things too. Thanks again, sure wish we lived closer!

BeachieRN84 · Aug 15, 2011

Huge help Beachie! Thank you :) I am going too simple, taking KISS too far, lol! I did my first mock with my son, and my IV supplies are too old or something. I can't get my mini bag tubing disconnected & all stoppers/valves open& no drip, yay! I ran soooo over 2o minutes, not funny! But I can see where practice will help. On my kardex for PCS1 the DOB has pt age if 62, no actual birthdate? I verbalized every single thing I do, and I can't shake the habit.
When you write your grid, do you do one generic format or do you personalize each one? (does that make sense?) I still have to watch robs DVDs, they will prob clarify things too. Thanks again, sure wish we lived closer!

Yeah after a while the labs are no biggie, I have all mine between 7-8 mins except the wound is around 8-10. You have to have 2 out of 3 patient identifiers so if no DOB you could do name and medical record number.

I write the mneumonics for the intro and 20 mins check and also mobility on the grid, leave a space for 2 sets of vitals and any notes, then make it specific to each PCS.... no sense in wasting time writing mneumonics u are not going to use! I love Rob, he makes it super simple.

25 days left for me... *breeeathe* LOL

Editorial Team / Moderator · Aug 15, 2011

I heard that in the 18th edition, they've mandated that students must come up with two actual nursing dx in the planning phase ... no more "risk for" anything in planning. I think maybe they've seen risk for injury one time too many? LOL

Just remember, the Kardex is like a road map ... use your assigned AOCs to determine your nursing dx.

LoopsRN2 · Aug 15, 2011

I heard that in the 18th edition, they've mandated that students must come up with two actual nursing dx in the planning phase ... no more "risk for" anything in planning. I think maybe they've seen risk for injury one time too many? LOL
--
Just remember, the Kardex is like a road map ... use your assigned AOCs to determine your nursing dx.

Thank you Lunah

I read through the 18th Edition and I found it very confusing, and I am waiting for clarification from EC about this use of @ Risk Dx...From what I understand, the 18th Edition suggests using @ Risk Dx in the evaluation phase of the the care plan, but the wording is a little odd. The most wonderful thing I read, which I am also waiting clarification on is that the 18th Edition will start on November 7th and my PCS will be over Nov 6th (if I don't get a cancel)

A few more questions, when I submit my careplans to EC, can I submit the entire care plan through the evaluation phase?

*For those that have done Sheri's online, do you need to do a lot with online videos? I have next to NO bandwidth here at home, and a couple you tube videos and I am done--my internet speed is slowed to a crawl, I have had to post on allnurses with my iphone for last month thanks to a microsoft office download my son did.

*I want to order IV bag, mini bag & tubing--I jimmy rigged what I have from my set but I doubt what I am getting for a drip rate is a true rate since this tubbing seems odd. Anyone have a suggested site? I really can't get anything from work, all our stuff gets used unless pt cx surgery.

*Robs video suggests digital watch....really?! What are you/did you guys use? 20 years ago I was trained with the old fashioned sweep hand, and if my chances are better as far getting that exact number as the CE then I will get digital (Need to buy either one, have no watch) then I will.

Thanks again guys! As mentioned, not much response on EPN or replies yet from EC and I am anxious to keep moving

dslpninla · Aug 15, 2011

see below please, thanks

thank you lunah
i read through the 18th edition and i found it very confusing, and i am waiting for clarification from ec about this use of @ risk dx...from what i understand, the 18th edition suggests using @ risk dx in the evaluation phase of the the care plan, but the wording is a little odd. the most wonderful thing i read, which i am also waiting clarification on is that the 18th edition will start on november 7th and my pcs will be over nov 6th (if i don't get a cancel)
a few more questions, when i submit my careplans to ec, can i submit the entire care plan through the evaluation phase? yes
*for those that have done sheri's online, do you need to do a lot with online videos? i have next to no bandwidth here at home, and a couple you tube videos and i am done--my internet speed is slowed to a crawl, i have had to post on allnurses with my iphone for last month thanks to a microsoft office download my son did. sheris does have a video showing each lab station, several for ncp help and a few for showing how to do aocs. there are also a few "mock" videos. they are a good reference. if you are like me with the iphone as you say, the videos may not play. i downloaded an app called "skyfire".... it's the same as safari but it will automatically convert the video to a playable file so you can watch it. i had to do the same for my ipad. let me know if you need help in the setup, took me a while to get it but once you do its no biggie.
*i want to order iv bag, mini bag & tubing--i jimmy rigged what i have from my set but i doubt what i am getting for a drip rate is a true rate since this tubbing seems odd. anyone have a suggested site? i really can't get anything from work, all our stuff gets used unless pt cx surgery. ec recommends a site you can order theitems from as a package, the site is listed on the ec cpne page or check ec once you login. i have also heard a lot of ppl saying to order supplies cheap from ebay, i heard an iv pole was like $10 somewhere on ebay!
*robs video suggests digital watch....really?! what are you/did you guys use? 20 years ago i was trained with the old fashioned sweep hand, and if my chances are better as far getting that exact number as the ce then i will get digital (need to buy either one, have no watch) then i will. per the ec study guide you may not have a digital, it must have a sweeping second hand.
thanks again guys! as mentioned, not much response on epn or replies yet from ec and i am anxious to keep moving

LoopsRN2 · Aug 15, 2011

See below please, thanks

HUGE Thank you!! Ugh!! I missed the watch info in the study guide! I just posted something on EPN about bumping into info that seemed foreign to me after reading through that guide. Now I seem to remember something early on about uniforms etc.

I am going to need much more than 6 pcs to send into EC for care plans, but every single person that I know of that took their care plan conference didn't feel it was worth the $$, but that the documentation was.

Thanks so much for your help guys! Hoping things will smooth out after a hard core week of practice

LoopsRN2 · Aug 15, 2011

i heard that in the 18th edition, they've mandated that students must come up with two actual nursing dx in the planning phase ... no more "risk for" anything in planning. i think maybe they've seen risk for injury one time too many? lol
just remember, the kardex is like a road map ... use your assigned aocs to determine your nursing dx.

nona has replied, 18th edition goes into effect my weekend of nov 4...ugh!

once the 18th edtion starts, at risk may only be used in care plan revision. i just sent yet another email back to ec with more clarification details on this.

t-lo · Aug 15, 2011

If the 18th edition of the manual is out where is the link for it?

t-lo · Aug 15, 2011

PS- beachnurse84- nice job on that critique:yeah:

LoopsRN2 · Aug 15, 2011

If the 18th edition of the manual is out where is the link for it?

I apologize, I read through the 18th Edition revisions which came in a message and are also posted on MY EC. I talked to 2 advisers, MPAC as well as an instructor at MPAC. Everything I do from here out will be with the 18th Edition revisions and I can implement those changes even if I get a Sept/Oct cancel So, no more at risk diagnostic labels for me, boo! After reading so many journals, I can see where this really imposes some challenges as students stated that they had a hard time when their patients had no (obvious?) problems or complaints, ugh...