Cpne Experience Amarillo 2008

[ougreene]

it has been a few weeks now, since i have passed the cpne and i thought i would put in my 2 cents worth :twocents:.....

cpne experience amarillo tx 2008

"i can do it"

my history:

i am an lpn, certified clinical research coordinator and certified asthma educator. i have been in health care for almost 9 years. i felt that excelsior has given me the opportunity to advance my career to the next level. along with my personal endeavor to become an rn, i believe excelsior has prepared me well to be an entry level rn. currently i work as a pulmonary function technician.

cpne site:

amarillo tx - wonderful site! coming here was a very long, 8 hour plane trip, from were i live.

cpne preparation:

cpne study guide

cpne skills bag - very useful, comes with great instruction work book.

cpne video- very useful

cpne workshop 6 months ago - very useful and gave me a jump start for the cpne

flash cards with mnemonics for critical elements

grid - blank format for my mnemonics

allnurses.com - excellent web site!

youtube.com - great for visuals of wound skill, abd. andrespitoryassessment.

friends and co-workers who helped.

cpne preparation time:

about 9 months, combined with working and having family life also....

items i brought with me on the plane for cpne (i am a little ocd)

cpne study guide

cpne skills bag - i turned my hotel room into a practice station, i didn't let the maid in either for several days!

cpne video - i watched this also on my dvd player fri. and sat. when not at cpne.

flash cards with my mnemonics -practiced, practiced.

grid format (blank) for my mnemonics - practiced, practice filling out by memory

nursing dx book - highlighted, tabbed with general nsg dx -

2008 drug book - never looked at it during cpne

sharpie colored pens red and blue

highlighter - yellow

pencils - cheap kind....

calculator - my favorite one.

extra big wrist watch - put on other's available online

grid - blank format for my mnemonics

cpne preparation time:

about 9 months, combined with working 40 hours a week and amily life also....

items i brought with me on the plane for cpne (i am a little ocd)

cpne study guide

cpne skills bag - i turned my hotel room into a practice station, i didn't let the maid in either for several days!

cpne video - i watched this also on friday and saturday when not at cpne.

flash cards with my mnemonics -practiced, practiced.

grid format (blank) for my mnemonics - practiced, practice filling out by memory

nursing dx book - highlighted and tabbed with general nsg dx

2008 drug book - never looked at it during cpne

sharpie colored pens red and blue

highlighter - yellow

pencils - cheap kind....

calculator - my favorite one.

extra big wrist watch - put on left hand to be sure to see the time for vs etc.

my regular watch - on my right hand.

timer - for timing myself during skills lab practice back at the hotel.

pair of reading glasses, one's stronger than i normally wear.

benadryl - still not sure if it helped me sleep or not...

accommodation:

la quinta hotel. a little distance from hospital, however a good walk. i asked for a quite room, which they gave me on the 3rd floor. the waffle house restaurant was next door and that worked out great for hot meals.

thursday day before the cpne:

i arrived early for the cpne - got to amarillo on wed. pm. so i had plenty of time to study and practice. i walked up to the hospital, to see how far it was and located the lobby were we will first meet for cpne on friday pm 4:15.

day 1 (friday):

i my skills lab in my hotel room prior to walking up there at 4:15pm. our ca, "linda", a wonderful rn, came out to the lobby and introduced herself. there were 5 others students beside myself waiting for the unknown and not really talking to each other!

linda took us downstairs to the "tunnel" were the skills lab was all set up, just like in the video. after going over paper work and getting our pcs teams in order such as peds vs. adult, we had the 15 minutes to get familiar with our materials we were going to be tested on for the skills lab. this is your time to try on gloves, open syringes up, look at the wound etc....make sure you get to know your right size of sterile gloves at this time. when time was up, all of the ce's came out and introduced themselves to us. at that point, students are all sent outside of the room, while the ce's and ca set up for the test.

i brought my big faced watch and placed it were i could see it clearly as well as the ce for every skill lab evaluation. when the time was for instance 5:23 - i would change the second hand to show 5:30. this makes it easier to keep track of your time. i also wrote down my starting time on my test form, for me to know how much time i have.

first skills lab was the wound. i finished it with much time to spear, but my hands were shaking a lot towards the end... passed.

second was the iv medication station. passed with time to spare.

third was sc/im. i got the insulin subc mixing one, i was hoping for this one.......lets see r is for roll the nph between my palms......i used the abd. as my site......passed with plenty of time to spear also.

last: iv med. push. i did pass but it took me 14 minutes to complete this station, which they only give you 15 minutes to do this one. for the first saline push syringe (the one you aspirate with), i wrote on the paper wrapper "sa" for saline aspirate, where as the other saline syringe i wrote "s", for medication syringe i wrote "med". i circled the amount that i was going to push for each 15 seconds (since i was assigned a one minute push). ensuring that i went slow!

the skills here are all very basic nursing skills, however all my practice with the cpne skills bag really paid off - no repeats!

after skills lab friday pm

your specific ce will then take you up to the floor you will be working on for your first pcs. i had an older adult male, located in the med surg. unit. you get 20 minutes to look at patients chart then you go back to the hotel room to write up the care plan. this booklet consists of the care plan, revised care plan, assignment kardex, evaluation page, record sheet, progress note area and 1 blank page at the back. the blank page is for when you write your grid. you can only write your care plan in it - not your grid or anything else.

now, you will be able to see which area's the ce has assigned/selected for you, that you will carry out with the assigned patient. i had 2 selected area's of care, comfort assessment and abdominal assessment as well as fluid management, mobility, safety etc....

it would appear only 2 are assigned with your first patient, however with pcs's #2 and #3, we all seem to have 4 areas of selected areas of care assigned.

it is around 8pm and now you can go back to the hotel room to write the care plan: your nsg dx, pt goal and 2 interventions for each nsg dx, which you will carry out in the pcs #1.

i think i stayed up until 11:30 trying to figure out what nsg dx i would use and the care plan specifics. i choose 2 nsg dx, but did not really like my second one i choose so i woke up at 5 am to rewrite my second one. boy was i tired already!

**important: one nsg dx has to be actual, and one can be @ risk.

ultimate care planning goal: find a suitable nsg dx, patient goal, "r/t____" (etiology), along with identifying "a.e. b.___" (symptoms) your patient currently has or potential will display. you will be incorporating intervention #1 and intervention #2 as part of your selected areas of care and or assigned selected areas of care. this is when you will use the nursing dx book extensively!

day 2 cpne (starting saturday 0715)

you all meet up together in the meeting room where the ca "linda" will review and flip through every page of your nsg dx book as well as any drug book you have brought with you. then your specific ce will take you to your specific unit.

before each pcs the ce will give you a tour of the unit, medication dispenser, show you how various equipment work, - that you might use, location of laundry etc...then you get to start. at this point the ce will let you write your grid, which i did right away - literarily pulling out what has been stored in my brain for months, in an organized fashion.

psc #1

required areas of care mnemonics (critical elements):

20 minute check - new chick i o u money (mnemonic noted below)

fluids - fluid (mnemonic noted below)

safety - be safer (mnemonic noted below)

mobility - trained (mnemonic noted below)

20 minute check

new chick i o u money

nock

enter

wash or use hand sanitizes a lot!

carry out only tasks assigned

have glove on or in pocket (don't get too carried away with gloves!)

intro self/ce

check id x2 - verbalize this out loud!

keep always explaining what you are doing to the patient!

ifest iv- parental- enteral

flow rate/gtt rate, po fluids measure

enteral fluids also?

site examines - edema? warm/cool to touch, note location

tubing check and turgor check or check mucus membranes

ofest o2 = __flow rate/lpm?

fowlers/semi fowlers best

examine ears, nail color, cap. refill

spo2 record *if assigned

tubing check, flow adj. *if assigned

ufest urine?

foley check

empty urinal etc

save urine in hat! tell patient to do this

the diaper weight?

mobility- notice it! is patient none ambulating?

observe for pain? ask patient 0-10 scale record

need comfort? ask patient what you could do to make them more comfortable

extract answers!

you record all w/first 20 minutes! ce will want all your fluid info at this time!

safety

be safer

bed down position when leaving - say this out loud

evaluate bedside area - table and floor. it is safe?

slippers on and near by - say out loud

ambulation - devices - transfers - notice it and write it down

f (p) hone/call light by bed - touch and say out loud

explain why and what you are doing

rails up when leaving - as ordered x 2 etc....say this out loud

mobility

trained

transfers? check chart

rx? ok or + pain = notify rn implement cdm

assess mobility level - abn, atrophy, contractures, walk independently, assists

increase support to injury, weak body part

note abnormal gait/movement - normal gait & station, no contractures seen.

education needed?

devices? note if present

fluid management

fluid (this is also to be done w/i your first 20 minutes in pt room)

fontanel - palpate if

look/inspect mucus membranes or skin turgor

ufest - urine

foley check

empty urinal etc

save in hat!

the diaper wt?

ifest iv- parental- enteral (your record all intake fluids)

flow rate/gtt rate: write it , po fluids

enteral fluids also? write it down check rate, name

site examines - edema? warm/cool to touch, note, say and record.

tubing check, turgor check or check mucus membranes record

document data on mar-type, assessment, implementation, response

selected areas of care memnumonics (critical elements):

confort management: 3/7 acdc 4 square (mnemonic noted below)

abdominal assessment: and spuds (mnemonic noted below)

comfort management (ce designated which ones i was to do)

3/7 acdc 4 square

3/7 choose 3 of the following:

ask pt what they prefer

clean body - washing areas can't reach

dentures/teeth care assist

change linens

4 square is as follows: i draw a square and divide it into 4 sections writing rub, relation/distraction, reposition, hot/cold pack (if assigned) , in each square.

abdominal assessment

and spuds

always pee prior- and measure!

need body flat or with knee's bent

distention -shape, contour of abd. observe symmetry @ foot of bed vs. asymmetric

sound bowels in all 4 quads - if + in one quad go to next. no bs listen x 60 sec.

palpate lightly - rigid vs. (you ask) tender vs. non tender/rigid, hand parallel to

umbilicus measure for girth*if assigned

do assessment in correct order!

suction off then back on when done, if pt on suctioning

additional organization items i did during planning phase:

i highlighted the record page for vs, and fluids.

i had drawn little check off boxes for my grid items and so that i could check them off as i went.

i also placed a star with my red or blue sharpie by my interventions, to bring attention to them. ce does not grade this area, but they can look at it and at the end this can be the difference between passing or failling.

regarding vital signs: i wrote down pts most recent ones on my grid. clueing me in if when i am taking vs they are apprx. in the typical range for patient...

total planning phase time for pcs #1:

about 40 minutes - this is not what i had intended on! because i already had my care plan formed from night before. i was just really nerves and took too long writing out my grid and noting pt. info. in their chart.

when you are ready, you will hand the ce your care plan you made up the night before, then she will take it away from you and evaluate it. my ce went away and came back with some kind of issue with one of my interventions, although i had pulled it direct from the nsg dx book, there was some kind of issue, but it was acceptable. the ca had to come and talk with me regarding this, but all worked out.

during the implementation phase:

the ce will be with you just about every moment. i can tell you i kept using the hand sanitize on the walls incorrectly, by pushing on them, when i should have been pulling on it with my hand....this kept making a bit of a mess on the wall and the ce would clean this up for me! now i look back and how could i be such a goof ball!

i got in and did all what i was assigned to do, without any difficulty.

i passed meds to patient and took manual bp here.

as we (patient and i) thought it would be a good thing to straighten the bedding up for a comfort management critical element, i found a used very bloody needle, which right then and there i gloved up and i said out loud "i have found a biohazard item on the bed and will dispose of this item in the sharps receptical" ce was listening and watching my every move in disbelief of what i found at the bottom of patient bed, on the top side of the covers which had been all wrinkled up.

total time i was with the patient must have been about 1 hour or so.

evaluation phase:

here you documented all assessments etc in the progress note area. you must document all your assessments you did or you will fail! if it is not documentented in the progress note area, it was not done!

i really can not tell you what i used for my final "priority nsg dx", i was pretty nerves about the whole thing. however.....i passed pcs #1.

break time:

it was now around 12:00pm and i get my 20 minute break between pcs#1 and pcs #2, this seems way too short. however in that time i rushed downstairs to cafeteria grab a sandwich and a pepsi, shove it in my mouth and get back upstairs for pcs#2.

**********during pcs, there may be times you cannot be with your patient because, doctor is with them, they just got there breakfast or lunch tray or pt is with them. typically your ce will be giving you additional time, to make up for the time you can not be with your patient. this is why your pcs could take much longer than the said amount of time 2.5 hours. *********************

pcs #2.

a wonderful ce by the name of jane came out and took me to different med. surg. adult unit. she gave me the tour and set me on my way to start the planning phase. it was about 1:00pm

planning phase:

you do not have the additional planning time as you had for pcs #1 regarding care planning. however you kind now understand what to do. my plan was to keep my planning phase to 20-30 minutes, however in reality it took about 45 - 50 minutes which was really too long!

upon reviewing patients chart, i noticed previous vs and med hx of falling.

i completed my care plan, including my nsg. dx

i noted information about my pt was older female with ms admitted for abrasion to head r/t falling.

my grid routine remained the same as in psc#1.

my assigned areas of required care mnemonics (critical elements) were as follows:

20 minute check - new chick i o u money (mnemonic noted above)

fluids - fluid (mnemonic noted above)

safety - be safer (mnemonic noted above)

mobility - trained (mnemonic noted above)

my assigned selected areas of care mnemonics (critical elements):

**area's of selected care had increased to 4 this time (remember first pcs only had 2!)! i knew i had to get in and do what was assigned with good time!

comfort assessment: 3/7 acdc 4 square (mnemonic noted above in pcs #1)

neurological assessment

logical

level of consciousness , 1-3 yr old, visual, hear, touch or recog. familiar things.

noxious stimulus - only when unresponsive - press nail bed

go ahead squeeze my finger w/both hands & dorsi or plantar flex

infant

communicate always!

assess - pupils reaction to light, equal in size -

log documentation - assessment, implementation, response of pt

skin assessment (ce assigned my areas of care)

2/5 staphs cmite

2/5 areas: sacral/coccyx, (ce assigned sacral/coccyx)

trochanter (i chose also trochanter, my pt had many bruises on hips.)

anal

peri

heels

skin folds

color changes - pink, purple etc no discoloration noted.

moisture - sweat, pee, diarrhea, drainage, skin fold, anal, peri, pruritus?

integrity - lesions, rash, pressure effect, skin tears, skin intact, no lesions

temp of skin -warm - hot-cold to touch warm & dry

edema - pitting scale 1 (slight=2cm to deep=8cm) vs. no signs of edema

peripheral assessment

pretty

palpate pulse's of most distant extremity - present or absent, compare l to r pulses refill cap

extremity have pt move or note movement say "please wiggle toes etc..."

tactile touch test, excite response applied to distal extremity, use paper towel

temperature of extremity "not excessively warm or cold?"

you record; assessment, implementation, response o/pt

during implementation phase we had many delays during this pcs, finally by the time i was all done with pcs #2 implementation, it was nearing 3:45m.

evaluation phase:

during care planning i had already chosen my priority nsg dx: @ risk for impaired skin integrity. remember for @ risk nsg dx you do not need to list "a.e. b.". i used for interventions #1) nurse will assess site - sacral/coccyx area (done during skin assessment) #2) nurse will reposition patient (selected by ce during comfort assessment). documented all assessments etc in the progress note area. you must document all your assessments there. i double checked all my things and done! handed it to jane.

it does take some time for the ce to evaluate your evaluation phase of your care plan, so it must have been about 4:30pm and then my ce "jane" came out and congratulated me for passing pcs #2!

i was exhausted! however i walked back to the hotel, ate a big meal at the waffle house, watched the cpne video (there i am mary marsh!) - the peds portion only, knowing tomorrow i have my peds patient pcs. chances were very good that i would indeed have a peds patient. this hospital has a 33 bed ped. unit, with a very cute ronald mcdonald house for hospitalized children inside.

day 3 - sunday psc #3 time 0715

i slept better this night and woke up feeling somewhat refreshed...

once again we all met with the ca, who faithfully inspected our nsg dx book and drug book. then we were off with our ce's. my new ce (you get a new one for each pcs) took me to the peds unit and gave me the tour.

my patient was a sweet 7 yr old female, whose mother did not speak english. mother had been staying with girl in pt. room. dx: pneumonia, diarrhea and now constipation.

my assigned areas of required care mnemonics (critical elements) were as follows:

20 minute check - new chick i o u money (mnemonic already noted)

fluids - fluid (mnemonic noted above)

safety - be safer (mnemonic noted above)

mobility - trained (mnemonic noted above)

my assigned selected areas of care mnemonics (critical elements):

abdominal assessment (mnemonic noted above in pcs #1)

comfort assessment (mnemonic noted above pcs#1 and pcs#2)

skin assessment, ce selected anal /peri area for my assessment (mnemonic noted above psc#2)

respitory assessment

what first

watch breathing pattern - shallow vs. deep vs. normal

have gloves and tissues near by and ready to use

auscultate left to right, upper and lower systematically side to side x 8 locations

teach pt to breathe in/out deep as possible, while auscultation with stethoscope

fowlers/semi/side lying/anterior chest ok if pt not able to sit up or side lie.

id posterior landmarks - have pt. fold arms & you feel ribs, shoulder blade.

rule out abn vs. normal. doc: no dyspnea, no labored no nasal flaring etc

spo2 if required * it was for me!

tell rn re: any labored breathing.

my grid routine remained the same as in psc#1 and #2.

once again, i feel i took too long with planning phase, must have been about 50 minutes! i choose for my nsg dx #1: @ risk for impaired fluid, intervention #1 assess mucosa membrane, tongue, skin turgar for signs of dehydration #2 encourage fluids. i also had for my nsg dx #2 impaired gas exchange, since she had pneumonia; however i knew i was going to use the @ risk for my primary nsg dx. easier for me - less writing!

during implementation phase:

this became a little challenging due to the language barrier with the mother. the mother did ask for an interpreted, however being the week end there was none available and so the ce discussed this with the mother and decided that the little girl would translate what i said to her and her mother - english to spanish, and vise a versa for her mother.

however checked off all critical elements as i went - got in and got it all done!

evaluation phase

35 minutes left for evaluation phase - see what i mean...i took too long during planning! i wrote out my priority nsg dx, completing that page and nervously handing it in to the ce. nsg dx #1: @ risk for impaired fluid, intervention #1 assess mucosa membrane, tongue, skin turgor for signs of dehydration (completed during fluid assessment critical elements) #2 encourages fluids.

25 minutes later ce came out and said...please go give vs to primary nurse...i thought oh boy...so i did.

she then congratulates me and said i passed. it was 11:45 am sunday!

in the end:

afterwards really sort of in disbelief.......trying not to cry, meeting up with a few of the other ce's and ca in the conference room, to go over paper work......they all were very happy for me. they truly want for you to succeed as long as you are doing things the correct and proper way that is!

i passed! 3 of the other individuals also passed. i am not sure if the other 2 individuals passed or not. i do know several of the folks that were there, this was not their first time to take the cpne. however they were among the 4 of us that passed. i am a first timer and very thankful i passed with no repeats.

selected areas of care mnemonics (critical elements) i was not assigned: however i was ready to pull these one out of my brain also if assigned.

muscular skeletal management

"trained" + joint

(trained mnemonic see above under mobility)

joint

joint flexibility - full range, limited

observe movement/muscle strength

implement arom or prom (you support): 1 pair flex/extend. or adduct/abduct

need heat/cold x 20 min. * when assigned.

trac

traction wt verity

rope hangs free/unobstructed

alignment correct - body

counter action provided/maintained

wound management

b a lapd

better use gloves

assess

location

appearance- no signs or symptoms of infection, skin inflamed & edematous?

perimeter edges - edges separated, reddened and edematous?

drainage - no drainage,drainage color -serous, sanguineous, serosanguineous?

o2 management

ofest aes

o2=______

flow rate/lpm?

examine ears, nose, nail bed color, capillary refill

spo2 record ____ or * take if assigned

tubing check, flow adjustments

activity level - assess.

educate pt regarding safety (sparks, matches, smoking)

safety around pts o2, remove item

respitory management

a 1/5 second r

always do respiratory assessment first and last

1/5 - respitory hygiene tasks you only need to do one

suctioning: ppes, verify-pressure, patency, do

educate - breathing in/out deep as possible (like with auscultation)

coughing: deep breathing in/out deep as poss. (like w auscultation), 3-4 times, then cough. document

on percussion clap designated chest area with cupped hands.

need mechanical device? incentive spirometer

deep breathing in/out deep as possible (like with auscultation), 3-4 times

re-assess respiratory assessment asap post resp. hygiene treatment

pain management

ask 1/4 square

ask pt what they would like/need

scale pain level adults 0-10 - ask to rate! happy face scale, or flacc kept up on pain meds? get rn if not assigned to give meds

1/4 - 4 square is as follows: i draw a square and divide it into 4 sections writing rub, relation/distraction, reposition, hot/cold pack (if assigned) , in each square.

patient education

eval

educational needs, id barriers and readiness

verbalize - have pt then pt to demonstrate

accurate and appropriate information provided

learned doc. assessment of need/readiness, implementation, response of pt?

irrigation

irrig

inspect tube placement

right solution, temp?

reposition pt for correct flow

instill @ correct flow rate

good return and record documentation; assessment, implementation, response

cpne conclusion: one final mnemonic

"i can do it"

invest in your future

cpne - know it inside and out

apply

need support - talk with others

develop your educational plan

organize your mnemonics (grid)

implement your actions with sincerity and integrity

tell yourself i can do it!

good luck, i hope this can help somewhat!

gail (soon to be rn)

g:d

[NC Girl BSN]

Super Duper Journal! Thanks for sharing!

[SuesquatchRN, BSN, RN]

Gail, this is great!

You know, there are several threads stickied with mnemonics and stuff. Maybe we should combine the three and sticky that. This should certainly be included. Great information!

[ougreene]

well....thank you........ i know it is a little on the wordy side...well lets say allot wordy :typing....(more than just 2 cents worth:twocents:) but i just didn't know how else to express my whole....... shall we say......."event".

i guess you could say i have been debriefing myself.........getting it all out of my head so i can go on..... and ....um...a little unsure how to make it an attachment via my posting....etc...

still learning.....

g:d

gail (soon to be rn )

[SuesquatchRN, BSN, RN]

i guess you could say i have been debriefing myself.........getting it all out of my head so i can go on..... and ....um...a little unsure how to make it an attachment via my posting....etc...

a mod has to do that.

:)

[Raggedy Ann]

Thanks so much for sharing all of this wonderful material. Traci

[Elektra6, ASN, BSN, RN]

So helpful, thank you!

[BBFRN, BSN, PhD]

If someone can find the other Mnemonic threads for me, I can try to combine them all & sticky them.

[SuesquatchRN, BSN, RN]

If someone can find the other Mnemonic threads for me, I can try to combine them all & sticky them.

Mine has a lot.

Maybe we sould combine and lock, since people start asking questions in them. And then when more mnemonics are added it can be unlocked, added, and locked again.

?

[SuesquatchRN, BSN, RN]

You want me to do it?

[BBFRN, BSN, PhD]

Hmmm...if someone is willing to send me the links to the threads where the mnemonics posts are, I can make a sticky thread with that info, and keep it closed, so no one can post questions in it. That may work.

[bjbabs24]

THANK YOU!!!!

I really love your mneumonics-they seem like something I would have an easier time remembering than the ones I started doing.

Again, congrats!!!!!!

For the most part were you able to do all your implementation phase at once without leaving the room or did you have to leave at any time during your pcs? If you did leave were you able to document/chart at that time?

THANKS!!

BJ