Post by Admin on Jun 21, 2015 3:41:01 GMT
Here is another student test experience from my past files....
My CPNE experience in Plano, TX.
We met the first CA at the lobby of the Medical Center of Plano as a group. The small talk and chatting begins. As I expected, you here of what people have done or not done and I personally don't like to listen to it. Unless you are the type of person that needs to be in a support group, then I suggest doing things that keep you away from the other students in general. I rented a car even though there is an inexpensive shuttle from the airport to the hotel. The La Quinta also has a free shuttle and breakfast bags for students to take to the hospital, but I just used the car. The La Quinta provides a decent breakfast, and even makes a goody bag for CPNE students because time is short in the morning on Saturday and Sunday.
Labs Day 1:
• They will let you into the room to look at the equipment. They allowed us to open supplies, practice, whatever. They were available for questions. Except for the sterile gloves, I believe all of the supplies we're exactly the same as what I practiced with while using the Coursey CPNE Skills Bag.
• I passed on the first try for all of the labs. You are in a pretty cramped room with multiple stations running at the same time, personally I was so focused that the background noise was completely filtered out. Be aware that it could be potentially crowded and noisy.
• I had trouble with the Insuling syringes that also happened during practice. When you are drawing up the NPH (second drug), the syringe is pretty sticky and it caused me to draw past the correct mark. I discarded the syringe and started over, I went faster because I was a hair more frantic. I carefully kept the syringe moving to right spot but it was nerve wracking. Another student had to do it 4 times and still passed within the 15 minute time frame. BE CAREFULL.
• Next we got a tour of the floors, then we were given the patient chart of our likely patient for PCS 1. We were able to study it as long as necessary. Then the CE gave us the Kardex for the patient. We were able to take these away just for the Care Plan. You are not allowed to write or do anything else on it!
PCS 1:
Pediatric substitute
Approx. 65yom., c/c of diverticulitis. Per his chart though, he had a lot of problems that included broad spectrum antibiotics and contact isolation precautions. This means that as long as I'm in the room then the gloves stay on. Srx2, OOB with standby assistance x1, I/O, vitals, pain level, abdominal, respiratory assessment, no meds to give, drainage assessment only on a JP drain. Went to the room and wrote care plan. Impaired Comfort and Risk for Injury r/t environmental hazards. Care Plan accepted and then off to the room. JP drain removed when we got to the patient, CE modified assignment to replace assessment of JP drain to assessment of wound. The only I/O was urine in urinal. I was able to complete all of the assessments in the room with no problems, patient was uncomfortable but cooperative. I modified the care plan for something minor and made all of the interventions more specifically appropriate. Didn't want to leave anything to chance, interventions had to be performed or you fail.
PCS 2
80+ yom with c/c head injury and altered level of consciousness. Pt. initially described as uncooperative, difficult and hard of hearing. He was definitely hard of hearing but only uncooperative when he didn't understand what was happening. Care plan was initially ineffective airway clearance (lung sounds were diminished on the baseline vitals) and risk for injury r/t altered level of consciousness. Srx2, confined to bed/reposition x1 during pcs, abdominal assessment, respiratory assessment, neurological assessment, pva. (no meds again). Performed assessments with only partial cooperation from patient. I think this can be an advantage because the CE can see you problem solve, and implement CDM. I never actually said “invoking CDM”, but I would describe a rationale for modification and the CE would nod in approval. (i.e. Patients nails wouldn't allow sp02, so I described other clinical signs that I was assessing – cyanosis, cap refill, resp. rate and pattern etc.) This was important because the CE was concerned that the altered LOC could have been from low O2 sats. We eventually got a pediatric probe on the forehead that confirmed 99% sat and the CE felt that it confirmed my assessment findings. Modified the care plan a lot. New actual diagnosis of impaired physical mobility and risk for injury r/t unfamiliar environment, he was only in the hospital for 12 or so hours.
PCS 3
92yof with c/c fall injury and knee pain. Care plan of acute pain, and risk for injury related to maturational age. Srx2, reposition x1 with assistance, I/O, abdominal assessment, respiratory assessment, pva, meds (1 PO, lovenox, and a lidoderm pad to the swollen left knee), comfort management. CE assisted a lot on this one, the pedal pulses were very weak and when she saw me taking time, she came over and did a rapid check and said “they're good”. She was trying to keep me moving. I was somewhat less stressed (but still focused) and not having any problems, she just wanted to get it over with it seemed. I actually put that my outcome was not met because I wanted a report of pain less than 3 during pcs but patient never got less than a 6 despite comfort measures and pain measure being performed by assigned nurse.
Observations:
• After the first PCS the CA came to me and said she heard I did really well. This means that they are talking amongst themselves in between students.
• A couple of times I did some comfort measures even if they weren't assigned, they really liked this.
• Plano hospital is very nice, although for students space is limited. The CE's and CA's are generally more on the professional side versus getting you to pass, however when you come in prepared - they know and I think it affects how you are treated. The CA was very nice and supportive, she is a real advocate for you there.
• Practice labs and PCS's on anything with a heartbeat every moment possible. Have the mnemonics memorized obviously.
• Tina's workshop was perfect.
My CPNE experience in Plano, TX.
We met the first CA at the lobby of the Medical Center of Plano as a group. The small talk and chatting begins. As I expected, you here of what people have done or not done and I personally don't like to listen to it. Unless you are the type of person that needs to be in a support group, then I suggest doing things that keep you away from the other students in general. I rented a car even though there is an inexpensive shuttle from the airport to the hotel. The La Quinta also has a free shuttle and breakfast bags for students to take to the hospital, but I just used the car. The La Quinta provides a decent breakfast, and even makes a goody bag for CPNE students because time is short in the morning on Saturday and Sunday.
Labs Day 1:
• They will let you into the room to look at the equipment. They allowed us to open supplies, practice, whatever. They were available for questions. Except for the sterile gloves, I believe all of the supplies we're exactly the same as what I practiced with while using the Coursey CPNE Skills Bag.
• I passed on the first try for all of the labs. You are in a pretty cramped room with multiple stations running at the same time, personally I was so focused that the background noise was completely filtered out. Be aware that it could be potentially crowded and noisy.
• I had trouble with the Insuling syringes that also happened during practice. When you are drawing up the NPH (second drug), the syringe is pretty sticky and it caused me to draw past the correct mark. I discarded the syringe and started over, I went faster because I was a hair more frantic. I carefully kept the syringe moving to right spot but it was nerve wracking. Another student had to do it 4 times and still passed within the 15 minute time frame. BE CAREFULL.
• Next we got a tour of the floors, then we were given the patient chart of our likely patient for PCS 1. We were able to study it as long as necessary. Then the CE gave us the Kardex for the patient. We were able to take these away just for the Care Plan. You are not allowed to write or do anything else on it!
PCS 1:
Pediatric substitute
Approx. 65yom., c/c of diverticulitis. Per his chart though, he had a lot of problems that included broad spectrum antibiotics and contact isolation precautions. This means that as long as I'm in the room then the gloves stay on. Srx2, OOB with standby assistance x1, I/O, vitals, pain level, abdominal, respiratory assessment, no meds to give, drainage assessment only on a JP drain. Went to the room and wrote care plan. Impaired Comfort and Risk for Injury r/t environmental hazards. Care Plan accepted and then off to the room. JP drain removed when we got to the patient, CE modified assignment to replace assessment of JP drain to assessment of wound. The only I/O was urine in urinal. I was able to complete all of the assessments in the room with no problems, patient was uncomfortable but cooperative. I modified the care plan for something minor and made all of the interventions more specifically appropriate. Didn't want to leave anything to chance, interventions had to be performed or you fail.
PCS 2
80+ yom with c/c head injury and altered level of consciousness. Pt. initially described as uncooperative, difficult and hard of hearing. He was definitely hard of hearing but only uncooperative when he didn't understand what was happening. Care plan was initially ineffective airway clearance (lung sounds were diminished on the baseline vitals) and risk for injury r/t altered level of consciousness. Srx2, confined to bed/reposition x1 during pcs, abdominal assessment, respiratory assessment, neurological assessment, pva. (no meds again). Performed assessments with only partial cooperation from patient. I think this can be an advantage because the CE can see you problem solve, and implement CDM. I never actually said “invoking CDM”, but I would describe a rationale for modification and the CE would nod in approval. (i.e. Patients nails wouldn't allow sp02, so I described other clinical signs that I was assessing – cyanosis, cap refill, resp. rate and pattern etc.) This was important because the CE was concerned that the altered LOC could have been from low O2 sats. We eventually got a pediatric probe on the forehead that confirmed 99% sat and the CE felt that it confirmed my assessment findings. Modified the care plan a lot. New actual diagnosis of impaired physical mobility and risk for injury r/t unfamiliar environment, he was only in the hospital for 12 or so hours.
PCS 3
92yof with c/c fall injury and knee pain. Care plan of acute pain, and risk for injury related to maturational age. Srx2, reposition x1 with assistance, I/O, abdominal assessment, respiratory assessment, pva, meds (1 PO, lovenox, and a lidoderm pad to the swollen left knee), comfort management. CE assisted a lot on this one, the pedal pulses were very weak and when she saw me taking time, she came over and did a rapid check and said “they're good”. She was trying to keep me moving. I was somewhat less stressed (but still focused) and not having any problems, she just wanted to get it over with it seemed. I actually put that my outcome was not met because I wanted a report of pain less than 3 during pcs but patient never got less than a 6 despite comfort measures and pain measure being performed by assigned nurse.
Observations:
• After the first PCS the CA came to me and said she heard I did really well. This means that they are talking amongst themselves in between students.
• A couple of times I did some comfort measures even if they weren't assigned, they really liked this.
• Plano hospital is very nice, although for students space is limited. The CE's and CA's are generally more on the professional side versus getting you to pass, however when you come in prepared - they know and I think it affects how you are treated. The CA was very nice and supportive, she is a real advocate for you there.
• Practice labs and PCS's on anything with a heartbeat every moment possible. Have the mnemonics memorized obviously.
• Tina's workshop was perfect.
...). I heard patient say something about pain,