Post by Admin on Jun 21, 2015 3:46:41 GMT
Here is another student experience from my past files...
St Clare’s Schenectady CPNE minus 24 hours
It was an uneventful trip north to Schenectady. The drive took 4 hours and 20 minutes from Delaware and it passed blissfully free of police, idiots, and accidents. Aside from the numerous tolls on and around the Garden State Parkway in Jersey, it was as painless a trip as I’ve ever taken
By virtue of being the first hotel listed on Excelsior’s information packet, I chose to stay at the Quality Inn and Suites in Latham, New York. The hotel was easy to get to, being right on Route 7 just off of I-87. (FYI, Excelsior has it listed as Clarion, not Quality….)
The room is nice and has the standard cable TV and game console. As a nice bonus it also has a microwave, refrigerator, coffee pot, and WiFi connection. The last two are my personal favorites. The bed is firm and comfortable and just what my aching back needed.
The information packet related that there is a Bennigan’s on site. From the look of the building, it is either getting a refurb or out of business. If you make a left from the hotel onto Route 7 (east) there is an Appleby’s and a Starbucks (very important) a couple of lights up. On Route 7 (west) there is a Ruby Tuesdays and a Carrabba’s Grill within walking distance. There is also a Target nearby in case you forget anything or need some comfort items.
St Clare’s Schenectady CPNE minus 4 hours
I divided my evening between writing a few practice care plans and grids and playing on my laptop. I was awoken early, about 0600, to the yells and screams of children. It went on for about an hour and forty five minutes before the jackhammer working at the Bennigans started. Overall, it was not how I planned to wake up, but I made the best of it and wrote another care plan and went over mnemonics. After that I made a test run to St Clare’s. It was 15 minutes from the hotel, no surprises and very clearly marked.
St Clares Schenectady CPNE post-labs
I arrived 20 minutes early sat down and surveyed my surroundings. 3 of the 6 candidates were already there. The other folks arrived within a few minutes and soon after, Carolyn, our CA, collected us. The intro was scripted and everything went according to what was outlined in the study guide. After our 15-minute orientation to the stations, we were introduced to the CEs and began to test. It was nerve-wracking, but I passed them all first time go. A few observations:
Wound Dressing: The work area was kind of small, I wish I had practiced in more cramped circumstances. I moved a lot of the supplies that had been laid out, but still wish I had more space. I broke my sterile field during set up on my abd pad twice. I just made sure I verbalized that I knew what had occurred and got new supplies--no worries. I ripped my surgical gloves and had to put new ones on. Again I verbalized and drove on. One thing of note, I was not required to document the dressing change. I had been practicing documenting it. The examiner was very cool about the whole thing despite my trashing of his station and excessive use of supplies.
IV Drip: This was my easiest station. It was an easy calculation (volume/time in minutes multiplied by drip factor) and there were no tricks. I just made sure I read the MAR. All the information was there. Remember IGI twice and do your counts like Tina taught us all to do. The CE was very cool.
IV Med Push: This station was almost my undoing. The vials were self venting needle-less adapters. I performed my calculation (desired dose/dose on hand multiplied by mL) no problem. It ended up being a 5 mL push over 2 minutes. I drew up my med no problems. I drew up my first flush and set it back in the plastic tube the syringe came in. I drew up my second flush and when putting it back in the tube I touched the outside. I realized I broke sepsis and had to draw up another flush. No worries; I had time. I gloved up and reconfirmed my pt and IV site and first aspirated and then flushed. Again, no worries. My problem occurred when I dropped my meds onto the floor. It was an “oh crap” moment as I knew time was ticking. I quickly drew up another 5 mL of the med and advised my CE that I had already confirmed my site and performed the flush so I was going to just do the drug push. She concurred and I drove on. By the time I was done I literally was out of time. Again, the CE was very cool.
IM Push: This was my quickest station. It went according to plan and I was in and out in about 6 minutes. As with the other stations, the CE was cool.
After the labs my CE took me to the med surg floor where he gave me an orientation to the floor and my kardex for the first PCS. I have an elderly gentleman with a lesion and cellulitis to a toe on his foot. The CE assigned me peripheral vascular assessment and respiratory assessment. I am also assigned the 0900 medications.
I chose “impaired skin integrity” as my first diagnostic label. I chose “assess temperature of skin” and “assess capillary refill” as my two interventions. I chose these because the pt had had no pain or reported discomfort on the last two shifts. My second diagnostic label was “risk for injury” My intervention were “perform frequent visual safety checks” and “encourage use of call bell.” My pt requires a walker to get around and is legally blind so I think I will be able to negotiate that. I will see what happens in the morning.
St Clare’s Schenectady CPNE post-PCS 1 and 2
After a night of fitful sleep I climbed out of bed at about 0545. Morning ablutions complete I dressed in my whites and headed out to the hospital. I caught a glimpse of myself in the mirror as I exited the room and realized I looked like a very worried Stay Puffed Marshmallow Man. It was a great way to start out.
I fortified myself with a coffee and sat with the rest of the candidates in the cafeteria. In a sick way I was gratified that everyone else looked as worried as I did and it seems nobody had gotten what you’d call as a god night’s sleep. One we arrived, the CA took us upstairs and paired us up with our CEs.
The PCS went wel, all things considered. I wrote out my grid and presented my care plan with no problems. My pt was a really nice guy and liked to talk, so time was a bit of an issue. Additionally his breakfast was delivered early on, that took time too. I assisted him with chow and ended up assisting him to the commode before I got anything more done than the 20-minute check. While cleaning it out, my pencil fell into the urine. Nice; into the trash it went. After chow he needed to toilet again. The only thing out of the ordinary was that during the pva, I couldn’t find pedal pulses, so I mentioned the chart said that a Doppler had been used in the past. The CE just had me document that and drive on. I couldn’t do a crt on the affected toe due to a dressing so I substituted it with skin blanching and the CE was cool with that too. My meds were all po so that didn’t present any problems. The chart was with the meds so documenting it was easy and quick. I completed all my implementations and proceeded to documentation. It was straightforward. I had kept a running tally of what the pt drank and measured the urine as I cleaned so input and output was easy. I followed Tina’s mnemonics for documenting and hit everything. The CE wanted to see that I documented what the pt said in response to some of my tests. (e.g. quoting “I can feel that” when I palpated his feet during pva.)
After being told I passed I was sent to the cafeteria for a 20 minute break and cool down. I was a long 20 minutes and my stress level started to peak out again. I was tired from the first one and not looking forward to the next one. One of the other students sat down with me. This student received a no-go on their first PCS due to a disparity between blood pressures.
My second PCS was with a 97-year-old woman who had been admitted with dehydration. The CE assigned my neuro assessment, respiratory assessment, and peripheral vascular assessment. I got a report from the CE and the patient’s tech. She mentioned that the patient had complained of back pain just before I arrived so I keyed into that. I chose “acute pain” as my first diagnostic label. I chose “assess pain level” and “reposition patient” as my two interventions. My second diagnostic label was “risk for injury,” interventions were “perform frequent visual safety checks” and “encourage use of call bell.” My pt was weak and had macular degeneration so I figured it would be good. I filled out my grid and presented my care plan which was accepted no problems.
My patient had difficulty seeing and hearing (I suspect) and I adjusted care accordingly. It went smoothly and I just followed my grids and chatted the pt up. She was very nice and patient with me. Although I encouraged fluids she never did drink anything nor did she need to be toileted, so that was an easy thing to chart. The assessments were according to the grid and went quickly. I rolled neuro into pva and they complimented each other. Respiratory tied into vitals and I was told to use a critecon automatic for the blood pressure. When I assessed pain, the pt related it was a zero so that put a kink into my plan for acute pain. The patient was fidgeting and I asked about comfort. The patient said that she was uncomfortable so I advised my CE that I needed help repositioning the patient and afterwards I adjusted the linens. The patient said that that made her comfortable, so I made impaired comfort my label and the repositioning covered my mobility and comfort measures. After that it was just a matter of documentation which was too easy after the first PCS.
Overall, the first day of PCSs when well and just like what Tina told us to expect. Remember the grids and just follow them down the path.
St Clare’s Schenectady CPNE post-PCS 3
I got a fair night’s sleep on Saturday night. It was not what I’d call a good night’s sleep, but it was certainly better than Friday. I made a quick stop at Dunkin Donuts on my way to the hospital and was the first one to the cafeteria. Everyone came in and by the time the CA showed up we realized we were one short. It seems we lost one to the first two PCSs.
My third PCS was with an 11-year-old boy who had been admitted for an incision and drainage for an infection on his ankle. The CE assigned me meds, comfort management assessment, and peripheral vascular assessment. I was also assigned to walk him with his walker and get him to brush his teeth. After I got a report from the CE and the patient’s nurse I chose impaired comfort as my first diagnostic label. I chose “reposition patient” and “distraction” as my two interventions. My second diagnostic label was “risk for injury” and the interventions were “perform frequent visual safety checks” and “encourage use of call bell.” I filled out my grid and presented my care plan which was accepted no problems.
While I was doing my introductions I mentioned to the patient that he shouldn’t be nervous about anything I was going to do because I certainly felt more nervous than him. My CE didn’t really like that. She didn’t say anything, but there was frowning and writing. I didn’t think anything good could come of it, but I was going to drive on until she pulled the plug. I kept up with my rap and we quickly got on the subject of Pokémon. (He had a game cube on his table and I knew Pokémon was a Nintendo game….) As my boys love the critters, I am something of an idiot savant of Pokémon. We had to have spent 10 minutes talking about all things Pokémon and the lad became my instant best friend. He was nice, helpful, and fun. The CE seemed genuinely pleased that things went so well. I got everything I needed to do done very quickly and long story short, I passed. On the way back to the CA, my CE told me that she almost failed me for emotional jeopardy, but I turned it around so quickly and had such a rapport with the patient that she had to change her mind. Thank you, Cartoon Network!
48 Hours Post CPNE
I made the drive back and traffic was horrible. I didn’t mind too much, in that I was still on the high from passing everything first time go. I had time to reflect on the whole experience and here are a few observations.
Tina gives you everything you need to know to pass the examination. Take the information, learn the mnemonics, and use them.
Make a study schedule and stick with it. Don’t be so insane about it that pisses off your whole family. I did an hour and a half to two hours a day and was confident in my skills.
There is nothing you can really do about the stress and nothing I can say will probably matter all that much. (I’ve been a career paramedic in the fire service for 15 years and been to Iraq on the pointy end of the stick. I like to think I’ve been there and done that and the damn test made me more stressed than anything I can remember in years…) Find something that works for you as a distraction and use it. I played games off my laptop and watched Cartoon Network.
The CEs are not your enemy--they are there to see if you know the information. If you know the information, and after the workshop you will; you will pass the CPNE. Just show the CE you know your stuff and they will pass you. (They may even give you a bone here and there……)
In my opinion, the NPAC CEs are not the ogres some of the boards make them out to be. I found the ones on my team to be fair and they even had a sense of humor about the thing.
If anyone has any questions, feel free to drop me an email and I’ll be happy to help out.
Dave
St Clare’s Schenectady CPNE minus 24 hours
It was an uneventful trip north to Schenectady. The drive took 4 hours and 20 minutes from Delaware and it passed blissfully free of police, idiots, and accidents. Aside from the numerous tolls on and around the Garden State Parkway in Jersey, it was as painless a trip as I’ve ever taken
By virtue of being the first hotel listed on Excelsior’s information packet, I chose to stay at the Quality Inn and Suites in Latham, New York. The hotel was easy to get to, being right on Route 7 just off of I-87. (FYI, Excelsior has it listed as Clarion, not Quality….)
The room is nice and has the standard cable TV and game console. As a nice bonus it also has a microwave, refrigerator, coffee pot, and WiFi connection. The last two are my personal favorites. The bed is firm and comfortable and just what my aching back needed.
The information packet related that there is a Bennigan’s on site. From the look of the building, it is either getting a refurb or out of business. If you make a left from the hotel onto Route 7 (east) there is an Appleby’s and a Starbucks (very important) a couple of lights up. On Route 7 (west) there is a Ruby Tuesdays and a Carrabba’s Grill within walking distance. There is also a Target nearby in case you forget anything or need some comfort items.
St Clare’s Schenectady CPNE minus 4 hours
I divided my evening between writing a few practice care plans and grids and playing on my laptop. I was awoken early, about 0600, to the yells and screams of children. It went on for about an hour and forty five minutes before the jackhammer working at the Bennigans started. Overall, it was not how I planned to wake up, but I made the best of it and wrote another care plan and went over mnemonics. After that I made a test run to St Clare’s. It was 15 minutes from the hotel, no surprises and very clearly marked.
St Clares Schenectady CPNE post-labs
I arrived 20 minutes early sat down and surveyed my surroundings. 3 of the 6 candidates were already there. The other folks arrived within a few minutes and soon after, Carolyn, our CA, collected us. The intro was scripted and everything went according to what was outlined in the study guide. After our 15-minute orientation to the stations, we were introduced to the CEs and began to test. It was nerve-wracking, but I passed them all first time go. A few observations:
Wound Dressing: The work area was kind of small, I wish I had practiced in more cramped circumstances. I moved a lot of the supplies that had been laid out, but still wish I had more space. I broke my sterile field during set up on my abd pad twice. I just made sure I verbalized that I knew what had occurred and got new supplies--no worries. I ripped my surgical gloves and had to put new ones on. Again I verbalized and drove on. One thing of note, I was not required to document the dressing change. I had been practicing documenting it. The examiner was very cool about the whole thing despite my trashing of his station and excessive use of supplies.
IV Drip: This was my easiest station. It was an easy calculation (volume/time in minutes multiplied by drip factor) and there were no tricks. I just made sure I read the MAR. All the information was there. Remember IGI twice and do your counts like Tina taught us all to do. The CE was very cool.
IV Med Push: This station was almost my undoing. The vials were self venting needle-less adapters. I performed my calculation (desired dose/dose on hand multiplied by mL) no problem. It ended up being a 5 mL push over 2 minutes. I drew up my med no problems. I drew up my first flush and set it back in the plastic tube the syringe came in. I drew up my second flush and when putting it back in the tube I touched the outside. I realized I broke sepsis and had to draw up another flush. No worries; I had time. I gloved up and reconfirmed my pt and IV site and first aspirated and then flushed. Again, no worries. My problem occurred when I dropped my meds onto the floor. It was an “oh crap” moment as I knew time was ticking. I quickly drew up another 5 mL of the med and advised my CE that I had already confirmed my site and performed the flush so I was going to just do the drug push. She concurred and I drove on. By the time I was done I literally was out of time. Again, the CE was very cool.
IM Push: This was my quickest station. It went according to plan and I was in and out in about 6 minutes. As with the other stations, the CE was cool.
After the labs my CE took me to the med surg floor where he gave me an orientation to the floor and my kardex for the first PCS. I have an elderly gentleman with a lesion and cellulitis to a toe on his foot. The CE assigned me peripheral vascular assessment and respiratory assessment. I am also assigned the 0900 medications.
I chose “impaired skin integrity” as my first diagnostic label. I chose “assess temperature of skin” and “assess capillary refill” as my two interventions. I chose these because the pt had had no pain or reported discomfort on the last two shifts. My second diagnostic label was “risk for injury” My intervention were “perform frequent visual safety checks” and “encourage use of call bell.” My pt requires a walker to get around and is legally blind so I think I will be able to negotiate that. I will see what happens in the morning.
St Clare’s Schenectady CPNE post-PCS 1 and 2
After a night of fitful sleep I climbed out of bed at about 0545. Morning ablutions complete I dressed in my whites and headed out to the hospital. I caught a glimpse of myself in the mirror as I exited the room and realized I looked like a very worried Stay Puffed Marshmallow Man. It was a great way to start out.
I fortified myself with a coffee and sat with the rest of the candidates in the cafeteria. In a sick way I was gratified that everyone else looked as worried as I did and it seems nobody had gotten what you’d call as a god night’s sleep. One we arrived, the CA took us upstairs and paired us up with our CEs.
The PCS went wel, all things considered. I wrote out my grid and presented my care plan with no problems. My pt was a really nice guy and liked to talk, so time was a bit of an issue. Additionally his breakfast was delivered early on, that took time too. I assisted him with chow and ended up assisting him to the commode before I got anything more done than the 20-minute check. While cleaning it out, my pencil fell into the urine. Nice; into the trash it went. After chow he needed to toilet again. The only thing out of the ordinary was that during the pva, I couldn’t find pedal pulses, so I mentioned the chart said that a Doppler had been used in the past. The CE just had me document that and drive on. I couldn’t do a crt on the affected toe due to a dressing so I substituted it with skin blanching and the CE was cool with that too. My meds were all po so that didn’t present any problems. The chart was with the meds so documenting it was easy and quick. I completed all my implementations and proceeded to documentation. It was straightforward. I had kept a running tally of what the pt drank and measured the urine as I cleaned so input and output was easy. I followed Tina’s mnemonics for documenting and hit everything. The CE wanted to see that I documented what the pt said in response to some of my tests. (e.g. quoting “I can feel that” when I palpated his feet during pva.)
After being told I passed I was sent to the cafeteria for a 20 minute break and cool down. I was a long 20 minutes and my stress level started to peak out again. I was tired from the first one and not looking forward to the next one. One of the other students sat down with me. This student received a no-go on their first PCS due to a disparity between blood pressures.
My second PCS was with a 97-year-old woman who had been admitted with dehydration. The CE assigned my neuro assessment, respiratory assessment, and peripheral vascular assessment. I got a report from the CE and the patient’s tech. She mentioned that the patient had complained of back pain just before I arrived so I keyed into that. I chose “acute pain” as my first diagnostic label. I chose “assess pain level” and “reposition patient” as my two interventions. My second diagnostic label was “risk for injury,” interventions were “perform frequent visual safety checks” and “encourage use of call bell.” My pt was weak and had macular degeneration so I figured it would be good. I filled out my grid and presented my care plan which was accepted no problems.
My patient had difficulty seeing and hearing (I suspect) and I adjusted care accordingly. It went smoothly and I just followed my grids and chatted the pt up. She was very nice and patient with me. Although I encouraged fluids she never did drink anything nor did she need to be toileted, so that was an easy thing to chart. The assessments were according to the grid and went quickly. I rolled neuro into pva and they complimented each other. Respiratory tied into vitals and I was told to use a critecon automatic for the blood pressure. When I assessed pain, the pt related it was a zero so that put a kink into my plan for acute pain. The patient was fidgeting and I asked about comfort. The patient said that she was uncomfortable so I advised my CE that I needed help repositioning the patient and afterwards I adjusted the linens. The patient said that that made her comfortable, so I made impaired comfort my label and the repositioning covered my mobility and comfort measures. After that it was just a matter of documentation which was too easy after the first PCS.
Overall, the first day of PCSs when well and just like what Tina told us to expect. Remember the grids and just follow them down the path.
St Clare’s Schenectady CPNE post-PCS 3
I got a fair night’s sleep on Saturday night. It was not what I’d call a good night’s sleep, but it was certainly better than Friday. I made a quick stop at Dunkin Donuts on my way to the hospital and was the first one to the cafeteria. Everyone came in and by the time the CA showed up we realized we were one short. It seems we lost one to the first two PCSs.
My third PCS was with an 11-year-old boy who had been admitted for an incision and drainage for an infection on his ankle. The CE assigned me meds, comfort management assessment, and peripheral vascular assessment. I was also assigned to walk him with his walker and get him to brush his teeth. After I got a report from the CE and the patient’s nurse I chose impaired comfort as my first diagnostic label. I chose “reposition patient” and “distraction” as my two interventions. My second diagnostic label was “risk for injury” and the interventions were “perform frequent visual safety checks” and “encourage use of call bell.” I filled out my grid and presented my care plan which was accepted no problems.
While I was doing my introductions I mentioned to the patient that he shouldn’t be nervous about anything I was going to do because I certainly felt more nervous than him. My CE didn’t really like that. She didn’t say anything, but there was frowning and writing. I didn’t think anything good could come of it, but I was going to drive on until she pulled the plug. I kept up with my rap and we quickly got on the subject of Pokémon. (He had a game cube on his table and I knew Pokémon was a Nintendo game….) As my boys love the critters, I am something of an idiot savant of Pokémon. We had to have spent 10 minutes talking about all things Pokémon and the lad became my instant best friend. He was nice, helpful, and fun. The CE seemed genuinely pleased that things went so well. I got everything I needed to do done very quickly and long story short, I passed. On the way back to the CA, my CE told me that she almost failed me for emotional jeopardy, but I turned it around so quickly and had such a rapport with the patient that she had to change her mind. Thank you, Cartoon Network!
48 Hours Post CPNE
I made the drive back and traffic was horrible. I didn’t mind too much, in that I was still on the high from passing everything first time go. I had time to reflect on the whole experience and here are a few observations.
Tina gives you everything you need to know to pass the examination. Take the information, learn the mnemonics, and use them.
Make a study schedule and stick with it. Don’t be so insane about it that pisses off your whole family. I did an hour and a half to two hours a day and was confident in my skills.
There is nothing you can really do about the stress and nothing I can say will probably matter all that much. (I’ve been a career paramedic in the fire service for 15 years and been to Iraq on the pointy end of the stick. I like to think I’ve been there and done that and the damn test made me more stressed than anything I can remember in years…) Find something that works for you as a distraction and use it. I played games off my laptop and watched Cartoon Network.
The CEs are not your enemy--they are there to see if you know the information. If you know the information, and after the workshop you will; you will pass the CPNE. Just show the CE you know your stuff and they will pass you. (They may even give you a bone here and there……)
In my opinion, the NPAC CEs are not the ogres some of the boards make them out to be. I found the ones on my team to be fair and they even had a sense of humor about the thing.
If anyone has any questions, feel free to drop me an email and I’ll be happy to help out.
Dave
