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Post by Admin on Jun 21, 2015 4:01:33 GMT
Here is another test experience from my past files.....
I went on April 4-6 to SRMC. I did not attend any workshops, but I did do the Excelsior online skills workshop. This workshop definitely helped me with documentation aspect. You give sample documentation and the instructor evaluates it and lets you know if you hit all the critical elements. You also are able to read what everyone else wrote.
For the labs, with the syringes, make sure you open them up and feel how hard they are to pull back on. Before I drew up meds, I would loosen it up by pulling the plunger (without touching the sterile part) back, then forward again. Play with all of the stuff at each station. Also make sure you tell the CA if any of the IV tubing has air before you begin PCS so that she can get air bubbles out before everyone begins. It will be one less thing you have to worry about.
For PCS, ask, ask, ask the primary nurse about the patient. I was assigned respiratory assessment a lot, so before starting the PCS I asked the nurse about what she thought about lung sounds, and made sure that is what I documented. Also, write down her (nurses) phone number on PCS form so that you can call her because she is all over the place and you don't want to have to take a lot of time searching for her.
When you get to the floor look for a dynamap when CE is giving you orientation to the floor so that you can grab it as soon as you start and not waste 10 minutes looking for one. Make a mental note for at least a couple machines.
Memorize the critical elements and make sure you documentation reflects all the critical elements.
One girl failed PCS because she was assigned radial pulse that was irregular. She declared it, and it did not match the CE's. She should have invoked CDM and stated that she will take an apical pulse for a full minute due to the irregularity of the radial.
The CA tells you not to talk about your experience with others so that you will not get stressed out, but I did to see exactly what each CE is expecting.
PCS #1 40something year old who had his intestine perforated during procedure. He was on continuous NG wall suction and had new colostomy. Was also on IV fluids. Make sure you know how to clamp off NG tube. I had to ambulate the guy, and if it were not for another student taking CPNE telling me how, I would not have remembered what end goes where.
Dx: Alteration in comfort r/t tissue trauma AEB patient grimacing when getting out of bed
Goal: Patient will verbalize increased comfort level during PCS
Intervention : Assist patient with mouth care (toothbrush)
Reposition x1 during PCS (to chair)
I asked the patient if he felt more comfortable at end of PCS than at beginning. He said yes, and then I asked “how so.” For documentation, I wrote exactly what he said about his comfort level.
Dx: Risk for injury related to hospital environment and its hazards (I used this one for all 3 PCS)
I cannot remember the other dx for the other two PCS, but I know that for both of them I used for goal“Patient will maintain normal skin color and temperature during patient care simulation” because for the last 2 PCS I was assigned respiratory and PV assessment. Interventions were something like 1. Obtain O2 sat
2. Assist with coughing and deep breathing (these things were assigned).
I
I had a good experience in GA, but it’s like the CA told me once I finished “Everyone’s experience is based on how prepared they are.” CE’s were nice, some dropped hints, other’s didn’t say a word.
I have done floor nursing for 2 years on telemetry and have been asked to do things 10 times harder than what was assigned in CPNE, but I still found myself shaking when doing something so simple like drawing up flushes for lab. So do not get a big head. STUDY, STUDY , STUDY, and practice.
Good luck to everyone. Email me at panchavilla97atmsn.com if you have any questions because I hardly log in.
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Post by Admin on Jun 21, 2015 4:10:54 GMT
Here is another test experience from my past files...
I ahve been watching and reading and learning from others. So here
is my experience at CPNE 1/25 – 1/27 at SRMC in Georgia. I passed
with no repeats!
LABS: I was surprised that I was not as nervous as I had feared. I
was on high alert but I know I had practiced until I had it perfect
and I also had a lot of faith in the prayers of many people. Best
advice here, do them step by step at home, start to finish. I put
the sample pages in plastic and wrote different meds on them in dry
erase markers so I was prepared for any drug calculation. I had
a "sharps" container at home to get in the habit of putting the
syringes in it. My husband made me a patient, we called him Lefty.
He had a 2 X 4 arm with a glove, an ID band to check and I taped the
main IV to his arm so that I had the flush set up. He also had this
horrible wound on his arm that I had to dress over and over again.
His cardiovascular system was a balloon.
IV drip: I don't remember the drug but they are all 50 mg mini bags
so just know the calculation and practice getting the drip right. My
CE counted with me and didn't make me count with her. You must
check IV site and ID pt. Practice everything! You can take off your
gloves to count gtts, then sign MAR. The CE will ask you if you
have completed all the clinical elements……….I always said to
myself "I hope so" but aloud said yes.
IV push: This one got interesting. The syringes at this site were
in plastic sleeves with a screw on bottom. The syringe fell out
when you took off the bottom. There were only 3 and 5 cc syringes
available. You get to check this all out before you actually have
to start. So I have drawn up my medication. I got some drug, don't
remember what, 10 mg and the vial available was 5 mg/ml. So be
prepared to calculate. Simple yes, but when you are nervous you
might just miss something simple. I had 2 ml over 1 min. I drew up
the 2nd flush and couldn't find the plastic sleeve. Uh oh. I didn't
know what to do with it. I had to put it somewhere so I could put
on gloves, ID the patient and check the IV site. I tossed it in the
sharps container and drew it up again. Then I dropped the med
syringe just before giving it on the table. Tossed it in the sharps
and drew it up again! I was sweating but I never broke asepsis so I
passed!
Wound was a breeze! Just be careful, go slow, you have plenty of
time. Open your packages carefully. This CE wasn't even looking.
She was sitting down and couldn't have seen if I messed up anyway.
IM/SC – I had insulin. Made a point of rolling the NPH. The only
surprises here, look at your syringes during the orientation they
give you. If you have to do IM, the choices at this site were a
22G 1 ½ " and a 22G 5/8" syringe. That's it, so pay attention. If
you picked the 5/8 " for an IM you fail.
First PCS: I had a 48 y/o pediatric substitute. The peds unit
at SRMC is closed currently. Pt was 2 days post op
parathyroidectomy and cholecystectomy. I was assigned abdominal
assessment, neuro assessment and meds. She had an IV, I was to
ambulate and do I/Oand pain with vitals. She was so sweet. My dx
was acute pain r/t tissue trauma aeb pain 6/10, and risk for
injury. She had a pain rating of 6 when I got there so heck, I had
to go tell the staff nurse first thing. I couldn't do anything
without putting her in physical jeopardy right? So lesson #1. Be
flexible because you have to go with the flow. Anyway, she was a
wonderful patient and let me do what I needed to do. The CE had
assigned ambulation in hallway but told me I could let her walk in
the room. She had her own routine, walking as far as her IV let her,
turn around and that's that. I had to give her all oral meds,
including 2 antihypertensives. I knew I wanted to check her B/P
prior to giving them, had even asked the primary nurse the
parameters of how long before giving meds should I take B/P and she
said no parameters. So, guess what I forgot to do? As soon as pt
took them, I said "Oh I forgot to take her B/P" Asked the CE should
I still take it? She said, that's up to you. She was so cool. I
said "I think I will take it. I had passed the manual B/P already
so I grabbed a digital and took her B/P for MAR. I made a point of
saying to the pt "Now I know I just took your blood pressure 3
times (I really did, just to be sure with manual) but I need to do
it again. Don't know if I really needed to actually do it again or
not, but hey, I passed. Even though the care plan was done the
night before and I had already looked at the chart, I still took
most of the 2/1/2 hours. Some will tell you they had plenty of
time, perhaps so, but I took every bit of my time. So I planned on
being more organized next PCS. Right.
#2 What was that about being more organized? Well, perhaps the
key is more like thinking on your feet. This time I had a 72 y/o
male who was S/P lap colon resection. I was assigned Resp Man w/
D/B/C & IS, abd assess, PVA upper extremities, and comfort man. He
had an IV and I/O. A lot more stuff second time around. The nurse
in report told me his wife had been ambulating him and I was
assigned ambulation in hallway X1 w/student. I asked CE if wife
wanted to ambulate him was that OK? She was little snotty at that
time. "What does your assignment say?" All righty then. I decided
then to just ignore her and go out there and show her I knew how to
do this. I almost let her upset me but decided that her attitude
was not going to get to me. When we were on the way to the room I
saw an elderly man, his wife and that same nurse in the hallway.
Could this be my pt I asked. Why yes it was! SO I just joined
right in the party then. I introduced myself and we continued on
down the hallway to his room! Done! Housekeeping was changing his
sheets then so pt sat in bedside chair. I was trying to stay out
the way and CE threw me a bone when I heard her say "you could
help" Oh yeah! I have comfort management! "Here, let me help you
with the sheets I said" One down. So they will clue you in
sometimes, pay attention. I used DX: Impaired comfort and risk for
injury I think. This guy was a joker and never really complained
about being uncomfortable but he really did have surgical pain that
I could see when he got in bed so it was r/t tissue trauma aeb by
grimacing. Again, I took all of my time because I checked, checked,
and triple checked in documentation that I got everything. I had
forgotten to declare my vitals earlier, and the CE did not ask me
for them, so I went through the whole thing and handed in my
paperwork including the vitals at the end. She kept me waiting for
quite a while and then we had to walk downstairs to the CA because
the CE "had a Question". Crap. I sat around and waited for another
five min before she came back and said I passed. Yeah! I almost
cried at that point due the intense nature of this whole thing.
Held it together and took myself out to dinner.
#3 A 59 y/o female w/exacerbation of COPD. I was assigned Resp
assess, oxygen man and meds. She was on Digoxin. Your mneumonics
better remind you to check AP or BP. She was I/O and had a hep lock
which I was not assigned. I had to be very flexible with this
one. She was very cooperative but respiratory came in to do
breathing tx and the meds weren't ready the 3 times I left the room
to check. I used Ineffective breathing patterns r/t COPD aeb by
rapid, shallow breathing and risk for injury again. This pt never
got out of bed and I never did reposition her except to have her sit
forward for coughing episodes and resp asessement. She was able to
reposition herself easily and get out of bed on her own. By now the
CE knew this pt very well. Apparently other students had had the
same pt. She did not need repositioning when I suggested it and
the CE said it was OK. So at that point, I looked at the CE and
said that I was not going to reposition this patient because she was
able to do it herself. I made the point that I knew I had not done
that but it was understood that it was not required in this
situation. The CE asked at one point if I wanted to declare my
vitals but I said I wanted to check her radial pulse again since it
was like 116 and I thought that would be a good idea. But before I
gave the Digoxin I did an apical and it was also 116 I figured I was
good and never did the radial again. I showed her the vitals just
before starting the evaluation phase. I never did have to go back
in to the rooms after I said good bye but each time I left I told
them that I would be back if I had forgotten anything. Still only
had 5 min left at the end. This time the CE made me go downstairs
again and wait while she discussed something with the CE regarding
my charting. I don't know what it was, they never did say but she
came out and said I passed! Yeah! Now I felt like crying again.
The emotional release is amazing!
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Post by Admin on Jun 21, 2015 4:18:31 GMT
here is another experience....
It's finally OVER!!! Want to start by saying thanks to everyone for
your help, support and prayers. I couldn't have done it without you
all.
My experience at SRMC in Georgia... I want to start by saying that
all of the CE's and the CA were GREAT! They were very helpful and
wanted you to pass. The hospital was very clean and nice. The staff
didn't mind taking the time to help whenever possible to make it more
pleasant for us.
When we finished our orientation and was waiting in line to go in
and start our lab stations someone made the comment.. We are all
lined up like we are waiting for a firing squad.. that kind of broke
some of the tension and made us smile.. so remember that as you stand
and wait!
The labs are pretty straight forward, no surprises. The math was
simple so don't stress over having some off the wall difficult dose
you have never heard of. Make sure when you do your dressing change
that you DATE, TIME and INITIAL!! Someone failed this one for leaving
off the time. The most common thing I saw on the IVP station was
people not aspirating before they did the flush. The time on that
one... 15 minutes.. is very close especially if you get it first
before you have time for you jitters to calm down like I did. I think
I went about 10 seconds over 15 minutes.. the CE and CA talked and
she OKed the PASS while I waited in the hall for my results.One thing
I want to stress, just because you finish a lab station or a PCS and
they say I have to talk with the CA wait here... It doesn't mean you
failed it. I passed that lab station and a PCS after the CE and CA
talked it over. When you are doing your stations and you realize you
did something wrong just tell them and start over! When I did my IM
injection I figured my doses, I had to give 1 ml of Toradol and 1/2
ml of another med. I cleaned my vials with alcohol, put air in the
first one flipped it and started drawing up.. got my 1/2 ml, showed
the CE.. went to draw up my second med and realized that I hadn't
injected the air prior to drawing the other med. I told the CE... I
forgot to put air in the second vial.. I need to start over.. She
said that's fine I want to remind you that your time is still
counting.. I started over.. cleaned tops
again, air in BOTH this time. Drew up, she checked dose and for air
bubbles, then gave it back to me to inject... Passed that one.. No
dings for the restart, they do give you room for error! Made it
through all the labs with no repeats!
After the labs you go upstairs and they show you around the floor
where your first patient will be.. med room, ice machine, utility..
ect. They then give you your kardex and the chart for this patient,
and blank note card and let you have 20 minutes or so to take notes
and gather information that might be helpful for you to complete your
areas of care and care plan. You can write ALL of the care plan that
night in your room and bring it with you.. however you can not do any
other writting on your kardex, including looking up assigned meds or
your grid. You have to wait until the next morning to do these
things... What I did do however is write my grid in the hotel room on
a seperate sheet of paper, all my mneumonics and looked at it so I
would have a good idea what all I wanted on it the next day. You will
be very nervous so check and recheck yourself to make sure when you
do the grid you are going to use that no areas of care are left
off.....
My first patient was a 56 yo F with a total hip
replacement. .. I was assigned meds.. po and a SQ Lovenox 6 total
meds. Comfort Management, PVA lower ext, I/O and I think one more
area, don't remember which one. I was almost done when I realized I
had completely left PVA off my grid!! I added it and did it, but
would have missed it if I hadn't checked and rechecked... When I got
to the room she was already up in the chair. Cooperative and
smiling.. I straightened her bed for 1 comfort measure, I offered
wash cloth for face and hands which she refused.. had mouth care
assigned also stated she had already done that. Was assigned pain
scale on VS.. she stated was 7-8. I reported this to the primary
nurse, that was my comfort measures. The CE had noticed that the
patient would be going home on lovenox, so we talked her through
injecting herself and the pt. did her own inject.
Care Plan on this Patient... Acute Pain... RT Tissue Trauma... AEB
Rating pain 7-8 on 1-10 scale #1 intervention Reposition, #2 Mouth
care Pt will state pain 3 on 1-10 scale at end of PCS..... Risk for
Fall... AEB Use of external devices (Walker). Patient will remain
free of injury during PCS.. #1 side rails up x 2 #2 Encourage to call
for assist with activities. Evaluation stage Care plan not met due to
rating pain 8 on 1 to 10 scale. Passed, but had to wait in the hall
for CE and CA to talk before they decided that I did. No idea what
for.. whew!!
Second patient... 40 something. New Dx Cancer with 17 cm mass
removed from abdomen.. Hysterectomy, bowel resection.. ect. due to
tumor size. She had an epidural in so couldn't use pain as a problem.
She was up in the room and doing alot for herself
She had an NG tube. They had assigned for me to irrigate the tube,
however there was new orders to clamp tube and remove when pt. able
to pass air.. whew! The CE marked out this procedure and changed it
to teaching on mobility. Had Abd. assess, resp management with IS x
10, PVA, teaching, I/O. Forgot to palpate during my abd. assess, but
remembered it during my evaluation phase and went back and did it,,
the CE just stated I knew you would remember!! and smiled!
Care plan was hard on this one because she didn't have pain. I
used Impaired mobility RT Use of external device ( IV pump ), AEB On
my evaluation page I put "IV pump in use" failed this PCS on the
evaluation due to IV pump in use is a "treatment" not a Sign and
symptom.. It should have read.. Requires assistance with IV pump
when ambulating.. or something like that.. This was my peds stand in
and I had to repeat it on Sunday.
Patient # 3 40ish female Dx Intractable pain due to cancer with
mets to liver had colostomy. Assigned comfort management, abd.
assessment,resp. assess, meds, I/O. Was told by CE during report that
comfort measures would be difficult on this patient due to she was in
alot of pain but also very independent. She said if TV was on that
could be 1 measure, and if patient wants to take her own bath that
was the second one. Patient wanted to do just that! I did my ABD
assess before she got up.. and very gentle palpation due to liver CA
and pain! I asked her if she could sit up in bed to listen to her
lungs she hopped right up on side of bed.. great pt! Did this.. asked
about wash cloth for hands and face, she said she would like to take
her own bath. I gathered her supplies extra soap she asked for, also
took her lotion. While she was up in shower I changed her bed. Did
her meds when she got out and was done. They had medicated her for
pain just before I got in to the room so this worked out well.
Care plan. Acute pain RT disease process AEB Rating pain 4 on
1-10 scale. after shower rated pain 3 so interventions helped..
I did risk for constipation RT chemo as my second dx...
interventions was 1. Ambulation 2. push fluids.. I was told in report
that they had to administer laxative the day before, this is why I
chose this dx. Passed!!!
Patient 4 Was 40's with CVA due to uncontrolled HTN. I was
assigned to check residual and flush G-tube with this one along with
the normal PVA, Neuro, I/O.. She couldn't tell me her name, but did
follow several commands.. I documented what I saw. LOC.. Unable to
tell me her name, but did ID visitor as "friend" when asked friend or
family. ECT.. I did
mouth care on this pt. per CE request.. wasn't assigned, but since I
was almost done and had plenty of time she wanted me too.
Care plan.. Impaired Bed Mobility RT don't remember what I used
AEB Requires assistance to reposition in bed Pt. will assist with
repositioning during PCS.. 1. reposition 2. Place pillows for proper
alignment. Risk for falls RT weakness 1. Side rails up 2. Bed
in low position. Will remain free of falls during PCS.Evaluation
Partially met.. Able to reposition left arm for comfort, however
requires max assist for all other repositioning. NOTE on VS I was
assigned Pain scale 1-10.. I asked her are you hurting she said yes.
When I asked to rate 1-10 she couldn't. I just noted on pain
section "Unable to rate" circled it and declared my VS. This was
fine!
Passed! ALL DONE!!
I/O and pain scale assigned on ALL of my patients! That is my
experience, please feel free to e-mail me with any question you have.
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Post by Admin on Jun 22, 2015 23:22:41 GMT
Southern Regional Medical Center, GA
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Post by Brandy on Sept 16, 2016 14:13:17 GMT
I had found this post about 2 weeks ago thank you so much for the risk for injury idea. I will be stealing it thanks
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