20 Free Videos to Help You Pass the CPNE®

Here are 20 video tips we have put together to help you pass the CPNE®.  We’ve also included the transcripts below each video so you can read the important points you should study.  We hope you enjoy them and use them on your journey to CPNE® success.  Best of luck to you.  As always, we’re standing by if you need us. 

When to Glove at the CPNE®

Transcript:

Hi, Greg Edwards here, let’s talk about when to wear gloves. I came up with a short list of times you should wear gloves. I used a Kardex as my guide; you let me know if I missed anything, okay? To start, you should gel or wash your hands before you put gloves on, just make sure your hands are dried completely, it makes putting gloves on a lot easier.

Ready for that list? Here goes:

• When you’re doing dental care
• Deep breathing coughing exercises
• Changing a dressing
• Administering an injection
• Weighing diapers
• Assisting with a scheduled turn on a patient who is incontinent
• Carrying any device which has urine or feces in it, such as emptying a bedpan
• If you’re removing an IV
• A peripheral vascular assessment
• If you’re administering a suppository
• Changing bed linens
• Any skin assessment, just in case you find something
• Palpating around any bandage
• Any drainage or specimen collection
• Any enteral feeding where your hands may come in contact with an NG2, G2, or a PEG-2
• If you’re verifying feeding-tube placement, and
• Any times your hands may be around a patient’s private areas.

The rest of the time it’s up to your discretion, you just have to remember a few basic rules after removing gloves: you need to gel once you remove your gloves; and if you handle anything with any bodily fluids on it, like blood, urine or feces, you must, you must, you must wash your hands with soap and water, after properly removing the gloves. Just remember, be safe, wear gloves when appropriate, and gel as often as you feel necessary.

What to Bring to the CPNE®

Transcript:

Hi, I’m Greg Edwards, I want to talk you a little bit today about what can you take with you during your CPNE®.

• Cellphones? Not allowed. Leave them in your car, or leave them in your hotel room.
• You can carry a calculator with you. A non-programmable calculator. These are allowed on Friday night as well as when you’re on the floor, so that’s something you may want to carry in your pocket.
• A highlighter. This saved my life. This allowed me to really focus on my assignment and I highlighted the daylights out of my Kardex, so you’re going to need a highlighter.
• A mechanical pencil. When you chart, you’re going to chart in pencil, so use a mechanical pencil and go out and buy one of those.
• One of those retractable erasers. It gave me plenty of eraser in case I made a big mistake, I was able to correct it.
• A red ink pen. I always wrote on my Kardex in red if it was something that was very critical, like if I wanted to leave the room, I wrote “SCAB” on my grid and it basically drew my attention and kind of reminded me that if I left the room, I needed to SCAB.
• You’re going to need an actual ink pen itself. You may have to sign. If you administer medication to a patient, you may have to sign a MAR, sometimes it’s Excelsior’s MAR, sometimes you may have to sign a hospital MAR, I don’t know about your particular testing site, but you need to have an ink pen with you.
• Penlight. I get told all the time “Excelsior says they will supply a penlight.” I’m one of those prepared kind of guys, so I bought my own, real inexpensive, incandescent penlight. Don’t take an LED penlight, they’re very, very bright, and some hospitals don’t even allow you to used them, so just go out and get a nice incandescent penlight to carry with you.
• You’re also going to be allowed to carry a nursing drug guide. During your planning phase, this may become very valuable for you to have. It doesn’t necessarily have to be the latest and the greatest, but no more than a couple of years old.
• Also, you’re going to need to have your Mosby’s NANDA book. You can have the third or the fourth edition, and those are the only two NANDA books you’re going to be allowed to carry for your CPNE®.

Validation Box

Transcript:

I’m Sheri Taylor and today I want to talk with you about the validation assessment box, and what it is for.

This is one specific assessment that helps you determine that a problem actually exists. It helps you determine if your outcome is met, partially met, or not met. An assessment means that you, the nurse, is collecting data, not performing an intervention that moves the patient to the outcome.

When I say one specific assessment, it should be based on your NANDA and your outcome, and it can not be something like “PNVA”, or “peripheral neurovascular assessment,” because that encompasses more than one assessment. Therefore, to make it one specific assessment, you would say “palpate pedal pulses bilaterally.”

It helps to figure out your NANDA label and outcome first, and then come up with your validation assessment. Let’s look at another example; “ineffective airway clearance” is your NANDA, and your outcome is “the patient will have clear breath sounds bilaterally in all lobes after interventions.” The validation assessment would be “auscultate bilateral breath sounds.”

Studying for the CPNE®

Transcript:

I’m Sheri Taylor, and today I want to talk with you about how I get started studying. There are a few basic steps you need to take to get the ball rolling:

• Print out section four of your study guide.
• Put dividers in the binder and tag the following:
  • Planning phase
  • Revising a Careplan
  • Implementation phase
  • Evaluation phase
  • Clinical Decision Making
  • Each Assessment
  • Each Management
  • Physical and Emotional Jeopardy
  • Really, every bold heading on your Kardex forms in appendix H.
• Read each section one at a time.
• Write down the critical elements they expect you to know from that section, and then come up with mnemonics to help you memorize them. We teach mnemonics at the workshop, but some of you may want to create a “Things To Do” list.
• Answer the self-assessment scoring tool in the appendix section of your EC study guide, and whatever you do not know how to do, go ahead and be looking them up and learning them, you can Google or go to YouTube on just about everything.
• Appendix Q is the most commonly used NANDA labels, go ahead and be looking those up in your Mosby’s book, read the definitions on what type of patient you would assign those careplans to, and that will help you when it comes time for careplanning.
• You can tab your Mosby’s book, but on the tab only write the NANDA label on it. No writing in your Mosby’s book except for your name.
• Appendix G is your lab simulation check-offs, and it is the forms they use to pass or fail you on your labs. Have one of these available with you when you’re practicing your lab stations.
• Appendix H is all of the patient-care forms you will use during each patient care situation, so it’s very important you know the titles of each paper, and that you know what is required on each form, so when you are reading a section in your study guide, try to figure out where the importance of that section is required on that paperwork.

I hope this helps you get started in your studies.

Studying Your CPNE® Study Guide

Transcript:

I’m Sheri Taylor, and today I want to talk to you about how to break down your study guide. The study guide is very overwhelming, but breaking it down into little pieces will lessen your anxiety.

Unit four is the main unit you need to focus on, as well as your appendices. Print your Unit four, and put it into a binder, and tab the sections. For example, you would have tabs for asepsis, caring, emotional jeopardy, physical jeopardy, mobility, vital signs, and so on and so forth.

Be familiar with your Appendix H, because these are the forms that you will be using when testing. Each form has a heading, and you should take each form and go back into your study guide to read what the study guide has to say about each of these forms.

Each bold caption of your study guide should have a tab. There are five assessments, and six managements, so you should have tabs for each of those. You should also tab all of your lab stations as well.

Appendix J is a self-assessment scoring tool that you should take a look at, and evaluate yourself with regards to your skill set. If you are not comfortable with certain skills or components of the test, you should look up additional information regarding those skills to become competent with those skills prior to testing.

When you are studying, take one section at a time, and read it, thus reducing your stress load.

Revising Careplans

Transcript:

I’m Sheri Taylor and today I want to talk with you about when to revise a careplan. If you determine when you are in the room with the patient, that some changes need to be made to your careplan, you go ahead and make a clinical decision to change your careplan, and tell the examiner why you wish to change it. This is just verbal to the examiner when in the room. You physically will not write the corrections until you are finished in the room and you are outside completing your charting. So, let’s take a look at reasons why you might revise your careplans:

• The problem no longer exists and you need to completely change the NANDA to a new problem.
• The problem no longer exists, but the potential is still there, and you want to change it to a risk 4.
• An intervention was refused, or not carried out for some reason. You’d have to do another intervention that was carried out.
• Or, if the intervention did not move the patient toward the outcome.

Remember that while you are in the room, and an intervention does not work, you are going to work with the patient to determine which intervention will work to help meet the patient’s needs and move them toward the outcome, and implement that intervention before stepping out to revise.

Another tip: If you believed that an intervention you performed was successful, but will take longer for that intervention to move the patient to the outcome, you do not have to revise. For instance: incentive spirometry, or cough and deep breathing exercises, or administration of an anti-biotic.  What you would do is explain that on your evaluation form as to why the outcome was not yet met.

Reasons People Fail the CPNE®

Transcript:

Hi, I’m Greg Edwards, and today I’m going to talk to you about the reasons people fail the CPNE®.

The biggest reason is nerves. I’ve done many stressful things in my life, and I’m not going to bore you with the details. Sufficed to say, it’s a lot. Guess what? This is in the top three of the most stressful things I’ve ever done in my life. I’m not trying to scare you, you’re probably doing a pretty good job of that all by yourself, I just want to prepare you, so be prepared to be nervous.

Next is attitude. I don’t care how long you’ve been an LPN, or a paramedic, or a respiratory therapist, even a doctor for that matter. I don’t care how much experience you may have, you’re not yet an RN, and your past experience means nothing in this environment. Keep in mind, research has dictated many standard changes since most of you got into the healthcare business to begin with, so don’t let your past experience get in the way of your success in this test. Be humble, and study like your life depends on it.

The next reason people fail is not having a plan. For some reason they think they can go into this patients room and they can wing it. Sorry to disappoint you, but that won’t work in this environment. Mnemonics are word phrases or cues designed to help you remember all the critical elements for a particular area of care. Learn how to incorporate mnemonics into a plan of action called a grid. A grid is just a template for a patient care scenario.

There are many other reasons people fail, but they almost always go back to nerves, attitude, and the lack of a plan. So, in closing, remember: this is a stressful environment, and your nerves will test you. Perfect practice is the best way I know to properly execute in this stressful environment. Lose the attitude, it doesn’t matter how good you are in your job, you have to prove it in this environment, and lastly, have a plan. Rome wasn’t built in a day, but I bet that they had a plan before they started.

Questions to Ask Your Primary Nurse

Transcript:

I’m Sheri Taylor, and today I want to talk with you about types of questions to ask during report with the primary RN. You should be given the opportunity to ask the primary nurse questions before entering the room. Sometimes the examiners will step into the role of the primary nurse and answer those questions for you, so don’t let that alarm you. There are times when the information on the Kardex, and the information found in the patient’s chart are sufficient information for you to proceed, but if you would like to ask the primary nurse some questions, here are some types of questions you might like to ask:

• How has the patient’s pain level been?
• When was the last pain medication given?
• How often can the patient have pain medication?
• If the medication is not helping, is there anything else that does help?
• Were there any vital signs that stand out abnormally?
• What were the last vital signs? (Which you should be able to get this from the chart.)
• And are there any new orders? You can also get that from the chart.

If the patient is on tube feeding:

• Are there any feeding intolerances, what was the last residual, and are there any parameters?
• What has the patient’s demeanor been?
• Is there any family with them?
• Does the patient participate in their care?
• Are there any procedures or other services today, like respiratory therapy, occupational therapy, speech therapy?

Do not ask any “how to” questions.

Order of Testing

Transcript:

I’m Sheri Taylor, and today I want to talk with you about the order of testing. Many of you have asked about the flow of your testing, how will it go, so let’s take a quick look:

On day one, which is Friday, you will meet and be taken to a room with the other testers and you will be given an overview of the testing process; this could take about an hour. Then you will get to meet all of the examiners, and after that you will go into the lab and check-off on the four lab stations. Any labs that you do not pass this evening, you will be given one opportunity to repeat failed labs on day two, after you have completed your patient care.

Once you have completed your lab skills portion, you will be taken to the floor, and quickly shown the areas like the clean and dirty utility rooms, the med rooms, supply rooms, what a patient room looks like, and how to operate equipment. After that you’ll be taken to the chart and shown what to look at in the chart, and you will be given the patient care package, which is your appendix H in your study guide. The Kardex will be the only thing filled out. You may take some quick notes, being mindful of HIPA laws, and you will then go back to your hotel and work your careplans. The planning phase form is the only paper you can actually fill out on Friday night.

On day two, usually it’s Saturday, in the morning you will have one more chance to look at the chart and get report from the primary nurse, if needed, and make any necessary changes to your careplan at this time. Go ahead and write your grid, if you’re using one, on the back side of your patient care packet, and highlight your Kardex if you have not. Once you have completed all of this, and there are no blanks on your planning phase form, you turn in your packet and your Mosby’s book for your careplans to be graded, and you sit and you wait. They will come back and tell you whether you get to move on to the patient’s room for the implementation phase or not. After completing the first patient, you will then be given your second patient right there on the spot. Your assessment is given, and you look in the charts, talk with the primary nurse, highlight your Kardex, write your grid, and write your careplans.

Once you’ve completed all of this, and there are no blanks on your planning phase form, you turn it in for grading. After you’ve completed your second patient, at this time you sit and wait until an examiner can come get you to take you to make up for the necessary labs you missed on Friday, or on day one, then if you pass the labs, you go back to your hotel and rest up until day three. If you do not pass your labs at this time, you will be instructed to sign a fail and go home. So, it does not matter how good your patient care was, if you can not pass those labs, you will be sent home. This is why it’s so important to knock out those labs on Friday if at all possible.

On day three, you will come in first thing in the morning, and complete your final patient care situation. After that time, any patient care situations that were not passed on Saturday, you will be given the opportunity to make them up at this point, but keep in mind, you’re only allowed to make-up one adult, and one pediatric patient care situation.

Patient Safety

Transcript:

I’m Sheri Taylor, and today I want to talk with you about patient safety. Patient safety has to be a priority 24/7. The Joint Commission looks into safety issues with the hospitals, as well as the American Hospital Association, and are committed to improve the quality of care that is being delivered every day.
Patient safety goals include:

• The right patient identifiers; name and date of birth
• Keeping the bed low and locked, side rails up, which means the upper two side rails, unless indicated otherwise. Remember that all four side rails being up constitutes a restraint.
• Call light in reach, and wearing non-skid socks. If the call light falls on the floor, you must pick it back up and put it on the bed, or it is considered that you did not do it.
• If you have a child in a crib, the side rails must be up all the way every time you walk away from the bed. You can not leave the side rails down for the mother, you must pull them up, and then let the mother pull them down if she so wishes.

If you need to raise the bed up to your waist level to prevent you from incurring an injury, that’s okay, but you need to make sure you lower it back down when you are finished. Keep your patient informed by talking to them about what you are doing. Communication and education are key elements to safety. An informed patient can lead to safe and improved outcomes, and patient safety.

Controlling Your Nerves at the CPNE®

Transcript:

I’m Sheri Taylor, and today I want to talk with you about controlling your nerves. There are different ways to control your nerves during a stressful event, and different points of view. So, I wanted to give you just a few tips that I feel could help you during your clinical weekend.

• Being prepared for your test.
• Maintain a positive attitude while preparing for, and during, your test.
• Exercising to reduce stress, or even just stretching and utilizing deep breathing techniques.
• Get a good night’s sleep before the test.
• Show up to the site early so you’re not late.
• If you begin to get nervous during the test, do some deep breathing. Even go to the sink and wash your hands to regroup.
• Read your paperwork slowly and carefully.
• If you don’t understand directions, ask your examiner for clarification.
• Practice pacing yourself through the documentation and careplanning when at home.
• Use a kitchen timer to help you try to beat the clock.
• Focus on what you’re working on at the present time; do not worry about what’s ahead, or let your mind wander.
• Preparedness is the key.
• Tell yourself over and over “I can do this. I will do this. It’s my time.” and success will follow you.

Medication Errors at the CPNE®

Transcript:

I’m Sheri Taylor, and today I want to talk with you about common medication errors. Giving medication should be an easy task, but there are many distractions and errors that can occur. You may be assigned only a few medications, but the MAR may have more medications listed, so you have to be attentive and compare what medications are written on your Kardex, and gather only those medications.

One medication error is forgetting to ID your patient immediately before you administer the medication. This means that if you are in the patient’s room, and you never leave, you still have to re-ID the patient.

Another medication error is a calculation error on the dosage or the drops permitted on the secondary bag. An example of this would be Tylenol: 1000mg is your order, and you pull three 325mg tablets to administer, because you did not look for the 500mg tablets. The three 325mg tablets equal 975mg, but not quite 1000mg, which constitutes an error, no exception.

A common error seen is nerves getting the best of students, and they forget to wear gloves during an IM or sub-Q injection. You have thirty minutes to administer the medication, before and after the time due. However, since you only have one patient, you really shouldn’t be one minute late unless something else is making you late, like physical therapy working with the patient, but you should not be the delay.

Lovenox

Transcript:

Hi, I’m Greg Edwards, and today I want to talk to you about Lovenox injections. It should be noted that injection techniques and preferences vary, but the following instructions may be useful for you.

• Have everything you need ready: the pre-filled Lovenox syringe and alcohol swabs, and sharps container. Now, most pharmacies will provide it in the exact dose required, if not, you may have to adjust the dosage.
• Wash your hands thoroughly and glove-up.
• Pick a spot to inject. The standard sites are the abdomen, where you can pinch an inch. Make sure to avoid the belly-button area by a few inches, and try to alternate the sides left and right; left side one day, right side the next.
• Vigorously cleanse the area with alcohol swab. 
While you wait for the alcohol to dry, get the injection ready.
• Once this is done, pinch the skin and fat at your chosen injection site. Pinching the skin and fat helps to make sure that you do not inadvertently inject into a muscle.
• Remember, keep the bubble in the top of the syringe, and like a dart, inject the needle.
• Keep the skin and fat pinched throughout the entire process until after the needle has been removed, this reduces bruising.
• Take a deep breath.
• Insert the needle all the way to the hub.
• Inject the medication very slowly.
• Wait a few seconds, then remove the needle.
• Consult with your CE about your testing site’s policies regarding the application of light pressure with a 2×2 after the injection.
• Firmly push down on the plunger to activate the needle-protection device, and place the syringe into the sharps container.

Remember, questions regarding guidelines is not considered teaching questions, so if you have a particular question about protocols or guidelines, ask them.

Intervention Mistakes

Transcript:

I’m Sheri Taylor, and today I want to talk with you about intervention mistakes with careplans. Interventions are actions that you are going to complete to move the patient towards the desired outcome you have chosen in your careplan. These interventions should be something you are already assigned to do on your Kardex. Sometimes there are extra things that you can do that you don’t see directly on your Kardex, but it needs to be within your assignment, because you don’t want to add any extra steps or unnecessary work, because your time is so limited.

Interventions that are not acceptable:

• Assessments
• Referrals for other departments or outside resources. Remember that you are not the primary nurse, and you are in a facility that you are not familiar with, nor the available resources in the community.
• Calling the doctor for orders. Again, you are not the primary nurse.

Interventions should tell you what you are going to do, but not explain why. Don’t say “if possible” because if it’s not possible, you will evaluate that situation, revise the careplan, or discuss that in the evaluation phase. If you say “offer distraction” then you need to specify what type of distraction you plan on doing.

In your Mosby’s book, there are blue boxes that list interventions. It is very helpful if your interventions, that you wish to perform, are found on your Kardex as well as in the blue boxes. Remember that interventions should be actions that move the patient toward the chosen outcome, and this will eliminate the biggest mistake of putting an assessment for an intervention, which prevents you from entering the patient’s room.

Using a Grid at the CPNE®

Transcript:

Hi, I’m Greg Edwards. I want to take a minute to explain what a grid is, and the purpose of the grid. A grid is nothing more than a plan of action. When finished, the grid will serve as your step-by-step instructions for attacking your PCS. You will do a new one for every patient.

Your grid is written by dividing the back page of the Kardex into twelve sections. Once you’ve finished drawing the lines, you will write mnemonics in each square for all the overriding areas of care, and the selected areas of care that you’ve been assigned. Your strategy will be to set the grid up in the order that you want the PCS to flow. In each square you will write the mnemonic for that area of care in a vertical fashion.

• Box one is what you want to do first, and will be your entry box.
• Since I was going to do the 20 minute checks next, I wrote the mnemonic for that in block number two.
• I wanted to do vital signs as quickly as possible, so in block number three, I always listed only the vital signs I was assigned for this PCS. I also wrote the patient’s most recent vital signs in that same box.
• Block four was always my mobility box, so I wrote that mnemonic for the mobility I was assigned in that square.

Row number two:

• Block five was always my medication box. Write the meds that you’re assigned, and in red write the time you are required to administer them.

By the way, mnemonics are written based on the critical elements, and, of course, all of our mnemonics are 20th edition compliant, but you can also think up your own mnemonics, or you can use someone else’s that work for you. Just make sure all the critical elements are covered in the mnemonic.

In blocks five, six, seven, eight, nine and ten, I wrote the mnemonics for each of the selected areas of care I was assigned for this particular patient, and basically I wrote them in the order that I thought I wanted to do them. Be flexible, but still write that plan.

Now, you are probably going to use anywhere from seven to nine squares total for each patient. You can do more, and you can do less. So, your selected areas of care may flow down into the third row, and it may not.

So basically the grid is a condensed check-off sheet you create for every patient. It changes with every patient. You check it, and you recheck it after every block is completed, as a means to check yourself and the work you may have missed. I practiced writing it so much, I could, and still can, do an entire completed grid in three to five minutes. Remember, this takes practice to master, and with enough practice, you can master the grid. I hope this gives you a better understanding of the grid and a road map for mastering it.

Charting at the CPNE®

Transcript:

I’m Greg Edwards, and today I want to talk to you about charting. Charting normally takes place during the evaluation phase after you’ve left the patient’s room for the last time. This is when you would chart your nurse’s notes and also complete your evaluation phase of your PCS.

So, what’s the best way to chart? Well, I have a simple strategy for charting. Simply chart exactly according to you mnemonic. Just write the mnemonic next to the area of care you want to chart. You can even highlight the mnemonic if you need to. Then, chart each critical element one at a time until you’re finished. Keep your words simple, and do not abbreviate.

At the end of the PCS you may be chasing the clock, which adds to stress, so practice charting regularly during your study time. If you don’t practice charting, it could increase your stress in this phase, and cause you to omit a critical element in your charting. Omitting a critical element will fail the PCS, so you can see how important it is to practice this area. Now go practice.

Careplan Mistakes at the CPNE®

Transcript:

Hi, I’m Sheri Taylor, and today I want to talk to you about common careplan mistakes. Careplans, in the beginning, are one of the most intimidating parts of this exam. However, once you learn the rules of careplanning, and understand common careplan mistakes, you will become stronger in your development of careplans. There are some common careplan mistakes that I would like to discuss with you.

The NANDA label. The NANDA label must be written word-for-word from your Mosby’s book. You cannot omit words. For example: “ineffective peripheral tissue perfusion.” You cannot leave out the word “peripheral.”

The “related to.” This cannot be a surgery or surgical procedure. This is clearly stated in your study guide. The “related to” is the history of what is causing the problem, or what we call the etiology, and it’s in your Mosby’s book under “related factors.”

The validation assessment. The validation assessment is one specific assessment that you’re assigned to do to clarify or validate why you picked that primary careplan, or how it leads you to understand whether your goal is met or not. For example: a PVA is too broad, it has more than one assessment within it, so your validation assessment would be: assess pedal pulses, assess color of lower extremities, or assess capillary refill of the lower extremities.

The outcome needs to be clear and measurable. Mosby’s is a guide, and all of the outcomes are vague, so you need to ask yourself: “What do I want the patient to accomplish, and how do I know this is accomplished, and over what period of time?”

The interventions should be something you are already assigned to do on your Kardex, and it cannot be an assessment. There are many words that mean the same as “assess” so ask yourself, “does this do anything for my patient, or just give me data?”

Just these basics surrounding the careplanning will move you in the direction of writing successful careplans, so start implementing them now.

Attire at the CPNE®

Transcript:

Hi, I’m Greg Edwards, and I want to talk to you about your attire when testing.

• Since you’re in the lab, and there will be no patient contact, you are asked to wear casual professional clothing on Friday nights.
• Since you’re going to go visit the floor, you are asked to avoid open-toed shoes.
• For Saturday, you will wear white scrubs. I suggest you make sure you have enough pockets on those scrubs.
• Colored or print undergarments must not be visible through your clothing, so wear white underwear.
• A white lab coat is permitted, as long as it is free of names, titles, or hospital designations.
• Shoes or sneakers must be all white, rubber soled, and clean. Clogs are not permitted.
• No visible body-piercings are permitted, except one pair of stud earrings, and visible tattoos must be covered.
• Jewelry will be limited to a watch, and/or a wedding band. By the way, go to Walmart and buy a cheap watch with a second hand, because digital watches are not permitted.
• Hair must be well-groomed, natural in color, and pulled back if it is long enough.
• Nails should be plain, well-groomed, and, I suggest, short.
• The accepted color for polish is clear, tan, coral, or pink.
• Artificial nails are not permitted.
• Avoid wearing perfumes, and chewing gum is definitely a no-no.

Excelsior is very specific about the dress code, and students have been sent home for not honoring it.

Appendix K at the CPNE®

Transcript:

Hi, I’m Greg Edwards, and today I want to talk to you about Appendix K. Appendix K is the scoring tool in your study guide, and it’s the step-by-step guide the CE uses to grade you during your PCS.

You want to know what the CE is required to orient you to? It’s in Appendix K.
If you want to know the criteria for terminating a PCS without a penalty, look in Appendix K.
Want to know the definition of clinical decision making? Maybe the rules for asepsis? Even the guidelines for emotional and physical jeopardy, it’s right there in Appendix K.

This tool is often overlooked during study, but it is very very worth you taking a hard look at it. So, study Appendix K in your study guide, after all, it is the standard your PCS will be measured by, and you’ll be glad you did it.

Ambulation

Transcript:

Hi, I’m Greg Edwards. I want to talk to you about mobility. Mobility is an overriding area of care, and it’s assigned on every PCS. You’ll be assigned one of three different assignments on every PCS, either bed rest, out of bed to chair, or ambulatory status. Today, I want to talk about ambulatory status. If your ambulatory status is checked, you need to look further for the specific type of ambulation, and any specific considerations the CE has designated for this patient. If you have to ambulate your patient, you should look at the patient’s chart for the following information:

• Any physical limitations the patient may have.
• Any equipment the patient uses to ambulate. Examples would be canes, crutches or walkers.
• Also any limitations for the length of time that the patient is to be out of the bed, and the frequency that the patient has to get out of bed.

Attempt to identify the patient’s previous tolerance of the activity specified. Before starting, explain your rationale for getting the patient out of bed. “It’s to help you build your strength back up, so you can go home.” You should also assess for pain, if needed, using the designated pain scale. You may need to premedicate for pain prior to getting out of bed, but only if it’s necessary. If you do medicate the patient, wait about 20 minutes before ambulating. Lastly, ensure that the patient is appropriately clothed, including non-skid footwear.

The stages in assisting the patient to ambulate would be:

• Assist the patient to the side of the bed.
• Let them dangle their feet for a couple of minutes and assess them for dizziness or weakness.
• Assist the patient to stand, and if the patient has a weaker side, position yourself on the weaker side.
• Have any required assistive devices ready for the patient’s use. Remember, an IV pole is an assistive device, and should be charted if it is used when you’re ambulating.
• Now, ambulate the patient to the designated area, or for the designated length, or as tolerated.
• When ambulating a patient in the hallway, the patient needs to be positioned between you and the wall.
• Assess the patient’s tolerance to the activity, and pain level.
• Ask lot’s of questions, like
  • “How are you doing?”
  • “Let me know if you feel dizzy.”
  • “Doesn’t it feel great to get out of that room?”
  • “Walking makes you feel alive, doesn’t it?”
  • “Let me know if you have shortness of breath, or if you start having pain.”

You are doing two things when you ask these questions or questions like these. One, you are distracting the patient. Two, you’re gathering data, the very data you may use in your evaluation phase, so make a game out of it. Your strategy will be how many questions can I ask them before they tell me to shut up. The point is to get them talking and answering questions. When charting your ambulation, chart what the patient did, the distance, the assistive devices, and how they tolerated, along with pain status, using the designated pain scale, and any patient statements you can use for your evaluation phase. This is basically ambulation in a nutshell.

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