any help on vital in cpne...

frankie,RN · Aug 5, 2012

During my cpne last december, i had an older lady and i couldnt get a brachial pulse on her. she did have some bruising on her arm. but i just let the ce/ca? know and she said dont worry. and so i cont'd on.

Truth be told, i think vitals was one of the scariest part of the cpne, because you could fail w/o even really having your foot in the door. old vitals may possibly give you some type of baseline, but vitals do change. and you do have to have your vitals within a certain rangeof the evaluators. i think the hardest is the first blood pressure because its manual. after that, its automatic. i also think a lot of people fail vitals because theyre so nervous. you have to be calm beause you need to concentrate.

as far as the apical pulse goes, hopefully you'll get that unless maybe theyre morbidly obese or in the process of being deceased(hopefully not). the good thing is that the evaluator uses the double stethascope, so they hear everything that you do. unless the students hearing isnt great, then if you dont hear it then they probably dont hear it either.

word of advice... definitely practice vitals with someone else priorto going for the cpne. we take vitals so many times that we do it like second nature. practice taking your time. even something so simple as inflating the cuff has to be done a certain way...i think no more than 30 above the baseline. so you dont want to over/underinflate. also the good thing about taking your time with vitals the first pcs is that you will have already had your careplan done so you should have maybe a little bit of time to make sure your vitals are right. but dont take too much time because you dont want to run out of time in the end. the paperwork at the end is another story itself.:)

t-lo · Aug 6, 2012

just my 2 cents worth

1^st i need to comment what was posted by ineverseeu aug 4

****“i can't get vitals from some elderly people -- sometimes radial, sometimes apical.

is it ok to spend 10 to 20 minutes just on pulse, as long as i finish the whole implementation on time?

no it is not ok to spend 20-30 minutes on just a pulse. a pcs is a total of 2.5 hours and that includes reading the chart, writing your care plans, all of implementation and the evaluation phases. a student only spends 1hour- 1 hour 30 minutes in the room tops. so to spend 20-30 minutes just on a pulse…is not practical and it doesn’t show proficiency. to be successful at cpne ™ not only do you have to do things correctly but you have to be proficient at them, show organization and manage your time.

the only way you get proficient is by practicing… so grab your family and friends and do extra at work and you will become proficient and successful at vs for the clinical.

also if you can’t feel a radial pulse cdm can be invoked and you can do an apical.

frankie is correct the b/p cuff can only be pumped up to no more than 30 mm above the baseline. do you know how to establish the pt’s baseline systolic…. the student has to take the last 24 hours, prior to the pcs, of systolic’s add them together and then divide them to get the average…. the last b/p on the chart is not the baseline.

the b/p cuff also as to be place on the arm correctly…. mid way between the shoulder and the anticubital….and the arrow on the cuff has to point to the brachial area and the brachial pulse needs to be assessed prior for stethoscope placement.

i know a student formally on this site that failed a pcs because the arrow on the cuff wasn’t placed correctly on the pt’s arm.

frankie is also correct many times students take vs for granted…. you’d be surprised how much your head is pounding when you try to take a b/p or a pulse and how it disturbs our hearing….

ineverseeu….it’ s time to grab that stereoscope + b/p cuff and attack your family, friends, pt’s at work and co-workers to practice ….practice… practice so you can also be successful at cpne ™

t-lo · Aug 6, 2012

a pcs runs like this and this is a basic time table

30 minutes in planning

1 hour- 1 hour and 30 minutes in implementation

30 minutes to complete the evaluation phase

a pcs is a total of 2.5 hours start to finish.

the ce will review the pt assignment kardex and then mark the start time. students then have the 2.5 hours to read the chart information write the care plans, highlight the forms, make the grid, complete the time in the room for implementation and complete all the narrative charting, the evaluation form of the priority problem and finish the fluid management sheet.

2.5 hours seems like a long time, but i promise it will fly by and students are wishing they had more time. don’t waste time!

students have

30 minutes in the planning phase to: read the pertinent chart information, write 2 relevant care plans to get them in the room, make a grid with all the mnemonics, and highlight their pcs form.

the implementation phase is the time spent in the room and should be approximately 1 hour.

then there is a 30 minute bumper… in case something goes wrong, or you spend a few extra minutes in planning…. figure this 30 minutes as 15 minutes for something to go wrong and 15 minutes to fix it

and then a student will have 30 minutes in the evaluation phase to complete the charting, evaluation page and the fluid management page of the pcs packet.

and for your own sake…. don’t think a quiet place will be provided to chart…most times the ce puts students at the nurses station with the phones ringing and people talking. if…and only if you have a nice ce and if there is a quiet place available for you to chart….consider yourself lucky

hope this helps :)