Hawaii Medical Training Center-

 

HONOLULU/KALIHI--Dillingham Business Center--Dillingham & Waikamilo. Across from Mcdonald's, behind Dillingham Saimin

CPNE TIPS from Kimo

Kimo’s  CPNE tips                                                                                                Saratoga Springs Hospital

                                                                                                                                 Saratoga Springs, NY

#1 most important: You must CONTROL your NERVES!!!!

                CA & CE’s are on your side, they want you to pass!

#2: Know your grid. Your nmemonics. These will be your answers as you do your PCS, especially your documentations.

                -write them out first, before writing your care plan and interventions. You may use a sheet of paper or tear off the back page of your kardex-packet, the one that has the Excelsior stuff on the back. You can write on it, then carry that along with the rest of the packet, and hand it in at the end of the PCS. You can write on the kardex too if you like.me

                -use a red pen to circle the actual interventions that the CE writes for you to do on the kardex, beneath the assigned AOC’s. That way you know not to forget them and you can kind of schedule them into your PCS-implementation phase.

                -write baseline v/s on your grid and any pain meds they’re getting or scheduled to get, from their chart. Don’t get too caught up with reading all of the other stuff, unless you think it’ll help you. About 45 minutes should be fine. If you have only 3 “assigned” AOC’s you can plan for an hour and still be fine.

#3: Know your critical elements, of course. You should know this by now anyway.

#4: STAY FOCUSED!!! Below is the first 5 minutes.

                -I.D.  I.D.  I.D.  (This is an automatic failure in both pcs's, and labs)

                -Establish a pain level. If you are not assigned pain-mgt you only need to record the level, not the local, duration, character. If it’s greater than 3/10, report to nurse as soon as you finish your 20 minute check (less than 5 minutes now).

                -Parenteral & Enteral feeding. (remember, TPN is recorded in Parenteral fluids/IV)

                 And check any IV sites, even if not assigned, and document (no edema, etc.).

RECORD 20 MIN CHECK NOW!!!!!!!

#5: ASEPSIS

                -Wash hands once, each pcs, before implementation phase, in front of CE.

                -Gel / Foam the rest of the way. Wash if you come in to contact with obvious fluids (urine measure, etc.)

                                Gel / Gloves on : Gloves off/ Gel

                                Enter room: GEL      Exit room: GEL

                                Use gloves when ever touching patient for anything, except when outside of the room (ambulating pt. in

                              hall), no gloves outside of room, EVER!

#6: Time

                -Try to leave yourself at least 10 to 20 minutes to write your evaluation-statement and AOC-notes.

                -USE GRID, when documenting your AOCs, that way you don’t forget anything.

                -Interruptions: (patient ambulates to restroom; doctor visit; pt eating, etc)

*Step out and begin writing your AOC notes, mobility, evaluation, etc., (if you don’t finish a particular  note, make an  asterisk next to your note so you know to complete it when you are in your evaluation phase). Remember: evaluation, verbatim from plan-phase.

*Re-focus after any interruption or if you take a breather. Use your grid.

 

#7: CARING: REALLY CARE for the patient! (and you can't go wrong) Don't worry so much about passing or failing. I know

this sounds contradictory to what you've learned and how you've been practicing, but the CEs will pick up on it. Just do what you normally do!

                -Invoke CDM, whenever & if it will benefit the patient.

#8: Vital signs

                -One set is fine. (I only did one set with my 3 pcs’s)

-Remember, manual BP once for the entire weekend. NO FASTER than 2mmHg / second, especially if the HR is  normal range or brady. (One student failed because of this). If you are assigned pulse ox, do that first so you can get an indication of the HR, do that also before your pulse,  check.

-be safe and count for 1-minute for your PR & RR.

I used an extra pen, and a paper towel, and wrote the vitals on the table/counter/bp machine. Then when I removed gloves and gelled, I would look at the paper towel, without touching it or the pen,  and transfer my vitals using a clean pen while I held my kardex (Kardex only stayed in my pocket). Then I would gel / glove, alcohol swab my dirty pen (make sure CE sees this and you verbalize), replace in pocket, throw away paper towel, deglove and gel. Oh yes, keep a bunch of alcohol swabs in your pocket. Swab your pulse ox too before placing on patients finger as a good idea.

#9: Use your implementation Start/Stop times to calculate ICD fluids, if the fluid runs out. (Happened to me twice. Once

              with an IV, once with TPN.

#10: I&O’s

Use the chart in the bathroom for amounts (in coffee cup, foam cups, etc.) The juice cups and jello cups have the  mls on them. 118mls usually.                                                     

#11: C.E.s: Each is different. Be flexible to each of their styles. THEY ALL SEEM TO WANT YOU TO PASS!

                -Be confident; do your thing!

                -TRULY CARE for your patients.

#12: Practice writing your eval-phase documentation.

-The AOC documentation is written in your own words: USE THE GRID TO GUIDE YOU. It doesn’t have to be pretty or in order, but what you did or observed HAS TO BE DOCUMENTED.

                -Remember to document your CDMs and why invoked.

#13: Planning Phase:  KISS!!!!!!!

                -All 3 of patients were post abdominal surgery. I used:

                                PCS 1 & 2:  Impaired Physical Mobility (rt tissue trauma, c/o pain, opioid analgesics)

                                                     (AEB slowed mvnts,  limited rom, etc)

                                                     Risk for falls (rt impaired physical mobility, HTN meds, opioid analgesics, etc)

 

PCS 3:        Acute Pain (rt tissue trauma, AEB pt c/o pain….) She was due for MS @0830. Pain was 4/10  

before and after MS administration. Intervention not met. Suggested pain mgt interventions      of distractions, reposition, backrub, etc. (documented only).

Goodluck and just know you can do it! The labs were very easy, just focus, ID and do your thing. No need to wash hands or verbalize. Wound, no need ID or document, just do your steps, plenty of time for all stations. I used 3 needles for my SQ station (kept overdrawing drew the insulin), started over 3 times! So I ran a little close there, but finished with about 2 minutes to spare.

Aloha!

Kimo MICT/MECS (Paramedic)/RN

Email me, or call me, anytime, even if it’s late.

Oh yes, one final tip. I would highly recommend attending Tina & Sebastian's CPNE- Workshop in San Jose. It was very informative and will give you extra confidence going in to your exam. Tina is very knowledgeable and funny. She has put together a very short, but concise, 5 day program which includes your workbook, food and drink, one on one tutoring, group exercises and activities, live PCS practice with feedback, and much more. I would say this workshop is a 100% MUST for anyone who does not have extensive patient care contact, and a great supplement to those who do have extensive experience. Prior to Tina's workshop I had 20 years experience as a field paramedic and paramedic preceptor and 7 years as an emergency room paramedic where I was the only provider (no other nurses or techs) working the midnight shift, alongside the physician, working in a nurse capacity. And I also have a medical training facility that I operate, and have instructed at, since 2003. And still, I found Tina's workshop invaluable as well as a great and fun experience. It's easy to get to, with hotels nearby. Although they provided a free shuttle ride from the airport and back, and also to the workshop and back, myself and a few other students walked the 3 miles back to the hotel every night. I thought that was very enjoyable. Made some new friends, and that was great. Everyone seemed to have a great time, CPNE stress aside, ha! ha! So look up Tina's workshop (San Jose, California) and give her a call. Be sure to get her workbook about a month before you attend her workshop so you can memorize her mnemonics. I got my workbook the day I left so I had to read it on the 5 hour flight but still didn't get them memorized for another 2 to 3 weeks. Luckily I was able to get them memorized as well as design a grid based on Tina's grids. Thanks Tina! Don't worry about the cost. Do whatever it takes. This will be the best money you will ever spend, and you don't want to give Excelsior any more money than you have to right! Goodluck and best wishes!

Kimo

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