Wednesday, February 24, 2010

Links should be working!

Hi! I know I haven't been posting much lately, but as I have developed more concrete thought processes regarding the CPNE over the past few weeks, I haven't felt the need to dump my brain. Sorry! Please use the links to the right to access documents that I have created to help me. Use at your own risk and as always, refer to your study guide! Please notify me if you have any problems with the links!

Here are some recent photos of me practicing with the wound. Any feedback would be greatly appreciated! I am using 8 play gauze which is what is used at my test site. I honestly cannot get any closer to the edges!!


Happy studying! 

Monday, February 15, 2010

Light bulb - ON!

I'm not sure what happened today. Maybe it was the fact that I rolled out of bed at 5:45 and got an early start? Today, things started to click. It's the first day I felt confident in my preparation! Yesterday I made a spreadsheet outlining where I needed to focus my studies. I use that to choose what to tackle first. I have desperately been wanting to get my labs mastered and dread practicing them because it's so frustrating for me! I spent last night and this morning reviewing Sherri Taylor's videos. I also posted a video of my own showing my IV push technique. Based on peer review, it sounds as if this is an approved technique to utilize! Another major discovery today is that I found out my beloved sheet protectors work with dry erase markers! This makes practicing the lab much easier and paper/printer friendly! The piles of used gauze also work well to clean the sheet protectors off. I'm happy to say I did all of my labs correct and with a positive attitude! The only problem was I forgot to clamp my primary IV bag and found it empty around 7:30 tonight!

I took the day off from care planning. After today, I will continue submitting to Dr. A on a daily basis and I'm working with Sherri Taylor as well. Sherri sends me 2 care plans per week for a month. I'm struggling with Sherri's a little because they are actual scenarios from previous students who have completed the CPNE. The scenarios I have received contain very few areas of care assigned. I can come up with a diagnosis, but am struggling to choose interventions that are assigned on the kardex.

For my afternoon studies, I decided to sit down and do mnemonics. Yep, that's right, I'm starting all over again with the mnemonic thing. I need to settle on something. The good thing about me being so picky on my mnemonics is the fact I am really gaining great understanding of the critical elements and that's what it should be about.

Make sure you're looking at the CPNE document links! I'm trying to keep it updated as I receive feedback!

Thursday, February 11, 2010

Happy Thursday!

This week has been going typical as usual. Tuesday I was a complete train wreck trying to pull it all together. The electronic peer network on Excelsior's website is great, but it often leaves me feeling unprepared and nervous. Reading detailed posts of where others are that test at a similar time freaks me out. Some people are so detailed and structured with their studying. Me - not so much. Believe me, I try. Everyday the first thing I do is make a list of the material/skills I want to practice for the day. Does it ever happen? Nope. I end up getting overwhelmed which leads me back to the EPN! Self discipline has always been something I have lacked and no matter how much the EPN may be hurting me right now, I can't stay away!

Wednesday I ended up at "The Angelus" on the west side of Grand Rapids (right by Diamond Street Hall, damn, I wish it was Pulaski Days!), and I managed to spend $18 on prayer cards and various medals. Today, I began my day by reading them and I think it helped me a great deal. Silly, I know, but it made me attempt my studies with more patience. If you're interested in what I purchased, I provided the link on the right.

I ended up doing one of Chuck's care plan scenarios and pulling together an entire PCS. Grid and all! Then I went into our guest bedroom which now looks like a hospital and talked to the dummy I made. Boy, talk about feeling like an idiot! I completed the documentation and the evaluation phase, typed it up and sent it over to Dr. A for review. Hopefully I get decent feedback.

Later I wrote down some lab mnemonics and spent the evening practicing those. God, I love that wound. :) I'm practicing all of the labs now, critical elements included, and feeling much better about them. For the wound I always saturate at least 10 pieces of gauze and pack it repeatedly. On my last one my husband came into the room. I decided since he is a packaging engineer, he needs to figure out the best method to pack it! He agreed and said he would give it a shot tomorrow night! I can't wait to see what he comes up with!

Until next time, I'm going to keep on truckin!

Monday, February 8, 2010

My head hurts

Where should I start? I've been promising people some documents and as soon as I'm done dumping my brain onto the blog, I will make those available!

My documentation online conference has been going great. Joanne, the Excelsior staff member that monitors the theory exams was the moderator. What can I say, Joanne is wonderful! She is always full of positive and encouraging comments! I am definitely over charting and I believe it's due to being taught to 'cover my ass' at work. At work I chart the same thing in multiple places. The CPNE - you don't have to do that! Rather than complaining as to how confusing it is, I'm going with it! Do what you're assigned, where it's assigned! I will post the documentation I submitted and Joanne's feedback.

The skills conference is going ok as well. Basically, it's various scenarios that you respond to in a discussion format. It divides up the areas of care into modules and spreads it out over 4 weeks. Honestly, I could take it or leave it. I am trying to get my money's worth and will be posting any and every question I can think of about the areas of care there.

I spent the morning doing my 'workshop' things and decided to put together a PCS this afternoon. I really want to get a working grid/mnemonics going for me. After all, the clock is ticking!  Ugh! ROAD BLOCK! I sat down to do page 99, Carlos Lopez in the study guide. I am trying to work really hard with my 'initial thoughts' so I can get this stuff down on paper. I wrote down in a list form my areas of care. Ok, how do I want to organize this in a grid? Yeah.....nightmare! I moved on to the care plan. First diagnostic thoughts - Acute Pain and Risk for Infection. Acute Pain I rolled out with no problem. Back in LPN school in 02' I used Risk for infection all the time. Why am I struggling with it now? Whatever, I struggled, I got frustrated and it was 3:40. 20 minutes before my scheduled phone call with a Excelsior staff member.

I took a break (I really could have used a vodka diet), cleared my head and organized my questions. When I answered my call, it was kind of confusing with where to start (despite my nicely outlined questions). The person on the other end also works as a clinical evaluator. Sorry if this post gets a little awkward as I don't want to name the faculty I spoke with. I was asked  how my studying had been going and what help did I need.

I started with the labs. I honestly feel the labs is one of the most controlled environments we can have during this exam, and would love to say I have them all perfected.  I explained that I was struggling with the IV push. Why do my syringes keep lunging forward? Response - "we recommend you rock the plunger back and forth, and that should help." Ok, huh, that's what I'm already doing. She then advised me to try some different syringes. We'll see what I can get my hands on.

My latest thing is during the planning phase, should we always use 'actual diagnostic' codes as opposed to 'risk for diagnostics.' I read somewhere that we can always go from an actual problem to a risk, but never from a risk to an actual. That question turned into this answer:

Advice was to always go with an actual problem if possible. Risk for injury can be used for almost all children. There's almost always an impaired mobility or risk for fluid volume issue. I explained about trying to put together a 'risk for infection.' care plan. At workshops they recommend for us to stay away from that one because almost all patients in the hospital setting receive antibiotics. That was kind of the conclusion I came to when creating that care plan. Do not use pain if the patient has not recently reported pain or has been medicated for pain in the past hour.

Contraindications - will they all be communicated on the kardex? YES!

When to report to the RN - immediate change in condition.

What reference books can we bring? Drug/Care planning and that's it! I asked about looking up labs and she advised that it would be foolish to do so. They're not playing games with peoples labs and anything we perform, shouldn't affect the labs.

20 minute check (I hate that this has turned into 'slang' term just about every where.) This is what is expected in the first 20 minutes: wash hands, ID the patient x 2, Gloves - check site, gel hands, compare rate/solution to the kardex.

Last question - my fear of dealing with unknown tubes. It was advised that I refer to the policy/procedure manual or ask the staff RN. Apparently the staff RN can tell/show us anything. 

For care plan scenarios, I was advised to use "Chuck's careplans" on When submitting them to Dr. A, we can even refer to them as Chuck's scenario #4. That eliminates loads of work! I'm going to email Dr. A and ask if it's the same for the ones in the study guide and Excelsior's orientation DVD book.

The conversation was done by 4:15. I really needed a vodka/diet.

All day I had been toying with the idea of paying for Sherri Taylor's online cpne workshop. I know it's not directly from Excelsior, but I was just feeling like I need more resources. I did it, and I'm so glad! In 15 minutes, I learned so many nitty gritty details that I had been seeking. It costs $150 /month. I already sent an email to the cancellation email saying I only wanted it for a month and received notice back that it had been set up. This is the first 'outside Excelsior' product I highly recommend. The website is Sherri Taylor's Workshop and click on the tab 'online workshop.'

At this point, the only thing I don't have for my CPNE prep is someone critiquing my skills. I may make some videos for peer review!!

Tomorrow is another day and I'm hoping with my new access to Sherri's site, I can start it off a little better!

Review to the right side of the page for links..........more documents to follow.

Thursday, February 4, 2010

Death of the internet modem

I thought having the modem die on Tuesday would create a world of productivity for me. No, it has left me stewing about what is happening on my facebook, and the electronic peer network on Excelsior's website. Here I am at the library for the second day in a row. Apparently libraries are not quiet anymore and have become places where stay at home mom's bring their kids everyday. Awesome.

I have had some accomplishments this week. First of all, I have figured out a wound technique that works for me. I'm going to go with a 'flag method.' Basically, I unfold the 4x4 all the way and then lay/fold it down into my hand like it was a ribbon and/or flag. Then I hold the the gauze above the wound with my left hand and guide it into the wound with my right. I try to use only two fingers. At the end I do end up manipulating the gauze with both hands, so I want to clarify on the phone with Excelsior if that's acceptable. To practice this, I did not use gloves, I sat down with 30+ gauze pads in the tub and made repeated attempts until I was pretty good at it. By the time I was done practicing, my finger tips were prunes. I decided there's no sense in wasting more supplies if I can't even do the technique properly. Tonight I will incorporate all the critical elements and repeat it 5x.

The next lab station to tackle was the IV push. I'm still not 100% clear on this. I believe if the plunger lunges forward, it's considered a bolus. The syringes that I have, suck. I can not get a nice continuous push with them. I have found 'rocking' the plunger back and forth seems to work the best for me. I tried rotating the plunger in a full circle and it was too difficult.

I'm going to round up some practice problems to put on index cards and I will try to get those posted.

I submitted another careplan to Dr. A with full documentation and evaluation. I got a lot less red ink. For some reason, I messed up my 'as evidenced by' portion. It seems like every week I pick something new to screw up on! I hate how one week I am good at something, and the next week I flub it up completely. When the new modem arrives on Monday, I will supply a link to all of my careplans and the reviews Dr. A gives them.

While at the library, I'm going to do any required discussion posts for the online workshops and work up another careplan. It's so time consuming!! I'm working on putting together a template which I will provide a link to as well. I always write my careplans out with pencil first. That way I get an idea of how long it'll take me while I'm there. I really want to keep my planning phase around 15-20 minutes. I'm not sure how that will work out since I want to look up all of my drugs, reference any labs and look up any diagnosis/procedures I'm unfamiliar with.

My theory this week is to not stress out about the 'unknowns' of this exam and focus on mastering the things I can be prepared to know. Does that make sense? For example, I'm not going to worry about irrigating NG's and unfamiliar tubes. Because if I get one, I'm going to ask for the textbook!

Going to get started on all this work!

Until next time, keep the prayers alive!!


Monday, February 1, 2010

Fairly productive

I have decided to maintain my running program throughout my preparation. It won't be anything to brag about. I am going to focus on doing 2-4 mile runs 3x a week since I plan on doing a 5k shortly after the exam. With that being said, I started the day with a quick 2 mile run.

I had a ton of phone calls to make today and I wanted to get at least one of them out of the way. First phone call was regarding our furnace which is a little on the fritz. Long story short, it ended up with me opening the door to our furnace as it was running. If you haven't picked it up yet, I'm  a nervous nelly. It was not comfortable lifting the door off of the heating unit with an active flame.

Next business to take care of was to try to get my graduation fee waived. Being enrolled in Excelsior college requires 'annual enrollment fees' and mine was due in October. I called then and asked them if I could have my annual fee transferred to my graduation fee since I only had the CPNE left to take and I was taking Microbiology at GRCC. They told me they needed my Microbiology grade by November 31st in order for me to do that. Problem - Microbiology didn't end until December 17th. I was then told to write a letter to the ombuderspersron to have them make a decision on this. That is what I did today. Hopefully they rule in my favor!

Ok, now it's time to study! Today I was focusing on the areas of care that pertained to assessment. Thank god, Grand Rapids Community College taught me excellent assessment skills because most of the critical elements align with my current practice. I decided maybe it is in fact time to start developing some mnemonics so I can start pulling together an entire patient care scenario. I want to be able to practice writing everything out and seeing how I do time wise since we will only have 2.5 hours. Here are the mnemonics I have decided on for these areas:

Abdominal Assessment:
Pete Sake, Look, Listen, Feel, Record (Courtesy of Dana Dazet, my personal CPNE miracle) I did alter this a little
Pain? Pee? Position on back with knees flexed
Suction off
Look for distension
Listen for BS x 4 quadrants
Feel lightly - painful areas last, looking for rigidity/tenderness
Record - distension, bowel sounds, tender or rigid

Neurological Assessment:
LOGIC (Another Dana Dazet creation)
LOC - PPT (Person, place, time), object to child
Observe PERL (Pupils equal, reactive to light), fontanel on child
Give hands to squeeze
Instruct to plantar/dorsi flex or observe
Can observe noxious stimuli if needed
Record LOC, fontanel, PERL, motor response, noxious stimuli

Peripheral Vascular Assessment
Pulses - bilateral and distal
Examine skin color OR
Refill capillary
Inspect temp
Pt. tactile test
Has motor function (wiggles toes/fingers)
Records all of the above

Respiratory Assessment
Position - posterior lungs or side lying; Expose skin
Assess - deep breaths, upper/lower lobes; directly on skin
Look at breathing patterns; o2 sat if assigned
Record bilateral sounds, abnormal breathing patterns, o2 sat

Skin Assessment
Moisture - perspiration, incontinence, diarrhea
Record on 2 vulnerable areas, all information observed
Integrity - Lesions, rash, shear & pressure effects, skin tears

Now that I typed them all up, I'm still not 100% crazy about them. I hate having lengthy things to write out, but I don't want to over simplify things either! You may notice I tried to include 'record' into everything and specify what needs to be documented. At GRCC, you did everything and you documented everything. The feedback I've gotten from Dr. A, is often "don't chart that." Also, your assessment says "OR", pick one or the other to do, and only chart one of them.

Moving along to the labs. Getting better! I finally mastered the IV drip rate and am quite excited about that! I think the wound and IV push will be the death of me! I practiced the wound 3x in a row today.. each time having 'contamination' issues. I've been watching more videos on youtube and scoping out more techniques. Nothing seems to work for me! The IV Push, ugh! I still don't understand if we're supposed to only push x amount for 1/4 of the time, or make it a continuous push. Either way, I'm not doing it correctly!

My last phone calls of the day were to set up some appointments! 1 appointment to meet with my primary care physician and obtain some anxiety medication for the weekend. I really want to try Inderal but don't want to end up on the ground from a low blood pressure. I'm afraid Xanax or Ativan will have me snoozing, so we'll just let her figure it out! The other phone call was to Excelsior to set up a phone call with a CPNE advisor. I have two appointments for that and a growing list of questions!

I forgot to also mention that I signed up for the CPNE online skills conference. First impression- not worth it. I'll see I can get anything out of the discussion board. Working in the educational field for the last 4 years has made it pretty tough to impress me with learning materials.

And after all that, it's time for dinner.

Sunday, January 31, 2010


Ok, well Friday wasn't nearly as productive as I would've liked for it to be. After my 3 mile run, I was drained!! I was able to get through all the overriding areas of care and I do believe I have a good understanding of them.

I also did 1 care plan. I still have to do the evaluation phase for it which is where I tend to struggle the most. Hopefully I will get that finished up today and sent over to Dr. A for review.

Friday evening I ended up going bowling. It was great to get out and not think about the CPNE for a few hours!! Lets just say I ended up having too much fun and staying out a little too late.. I woke up yesterday feeling a little groggy!

Yesterday ended up being a great day! (Probably because I wasn't studying!) Andy and I went out for Chinese food and had a nice relaxing day at home. Michigan State played at 7 and I kind of watched the game while wasting precious time on the computer! I know, I'm terrible!! Should have got some studying in!

I hope today I will be a little more productive. That may be difficult since I am headed over to my parents at some point. Thank god I only work 2 days this week and then I'm done working until this nasty exam is over!!

I just got done practicing the IV drip and wound packing..5x in a row, each!! I'm not including each step yet because I'm struggling with perfecting the techniques. I keep trying to regulate the IV at 25 gtts per minute. What a pisser that thing is! I'm always 4-5 gtts off. According to the skills kit we can be only be 2-3 and I think that varies on the clinical evaluator.

The wound, that's an entire different story. I'm clumsy and I have fat fingers. Ah! I keep hearing about parachute techniques and ribbon methods.. neither one of them work for me! Something always touches the skin or the outside of the wound. Whether it's a finger or a string of the gauze, it's a very frustrating experience. I told my husband (who has an engineering brain), that he has got to watch me and figure out a better way for me to do these labs.

For anyone who's interested, here is the first part of the care plan I'm going to submit to Dr. A.

This was created for "Jean Kauffman" on pg. 95 in the study guide.

1. Ineffective breathing pattern (r/t decreased mobility, as evidenced by weak cough)
The patient will report ability breate comfortably during PCS
Encourage client to cough x1 during PCS
Assist client to use incentive spirometer x1 during PCS

2. Impaired physical mobility (r/t tissue trauma, as evidenced by right knee surgical incision)
The patient will demonstrate use of walker during PCS
Ambulate client with 1 assist and walker during PCS
Maintain ice bag on right knee during PCS

I'll try to get the evaluation phase done later....I hate doing that part because that means 'data' has to be made up.

Friday, January 29, 2010

New Day

I stayed up late last night (especially for me!) watching TV until 11:30 pm!! I think my mind had to unwind from my endless hours of studying. I was up at 7 and felt unusually refreshed. No sleeping pills last night! Usually I drag myself out of bed and always have a 'hangover' type feeling.

The plan for the day is to start with a 3 mile run. Not looking forward to it since I haven't ran since Monday. After that I will practice my IV drip lab. I finally figured it out thanks to the EPN and the videos I posted yesterday! I felt like I wasted so much time figuring that out. When I look back now, I'm glad it didn't go right because I feel as if I have a complete understanding how an IV works.

The rest of the day will be spent digging further into the areas of care, referencing textbooks and yes, taking more notes! I'm also going to pick one other lab to focus on and understand all the concepts/rationals that pertain to it.

Many people get through this exam by creating 'mnemonics' which are funny words/sayings that help remember the critical elements of each area of care. After the planning phase, people flip their PCS form over and place them into a 'grid.' I had several people tell me 'learn your mnemonics first.' Oh hell no, I wasted so much time sifting through mnemonics and collecting/compiling others and I still looked at them thinking there would be little details that I would forget. I decided it's best to wait until I know the material inside and out before choosing and/or creating the mnemonics I need.

For any of you who are just starting to prepare for the CPNE and seek organization, I recommend the following:

First of all, find a local print shop in your area. Have the CPNE study guide printed. I had mine done for about $12 and spiral bound. However, I now wish I would've had them punch it with 3 holes for a binder.

I used pocket dividers and divided it into the following sections:
Planning, Evaluation, Labs, Overriding Areas of Care, Required Areas of Care, Selected Areas of Care Related to Assessment, Selected Areas of Care Related to Management and Other Areas of Selected Care.

In the pockets I put blank forms for the Planning, Evaluation and Labs to practice with. I compiled all the mnemonics I had and typed them up and put them in sheet protectors associated with each area of care.

It took me a long time to figure out how to 'dissect' and 'break down' this exam. Hopefully this helps someone! It was one of those 'little' things that caused me to waste time.

Time to go run................

Thursday, January 28, 2010

Horrible Day!!

I'm preparing for the mother-load of all tests to complete my nursing degree, the CPNE. This is a 'clinical competency' exam to prove that I'm capable to function as a new grad RN. Sorry, I feel this is WAY WORSE than the NCLEX-RN. The idea of someone evaluating my performance is causing me to have constant heart palpitations and I'm currently addicted to OTC sleeping pills. The date I was given was sooner than I had anticipated and because Andy and I are more than ready to move on with our lives, I chose to keep it. I have spent the last 3 weeks scrambling trying to obtain important supplies and seeing if it was even possible for me to attend a workshop. As I look back now, I see LOTS OF WASTED TIME! And no, I'm not going to a workshop so on days like this, I feel like I'm on a suicide mission.

I began my day practicing my IV drip lab and am having a terrible time perfecting my technique. I'm not sure what I'm doing wrong and need to meet with my infusion RN friend ASAP! I felt so defeated after doing this, it kind of set up the momentum for the rest of the day.

After struggling with the labs, I sent my Aunt Kathe a note on facebook asking her for saints to pray to for tests/nurses. She is the best Catholic resource ever and I will be investing in some prayer cards very soon.

Last week I cut up an index card with all of the areas of care, lab simulations and other various portions of the CPNE study guide. This is the only way I can zero in on what I need to- one thing at a time. Each day I force myself to pick from a small dish and pick apart each critical element. I have always been a 'note taker' and I don't know why. I find myself repeating exactly what is written in the study guide. I think it helps maintain my attention while Boldreading it. But when the day is done, I feel like I've done nothing more than WASTE MORE TIME!

At 3pm I checked the Electronic Peer Network on Excelsior's website only to read of another recent failure. By 3:30 I was at Meijer buying Stouffers Macaroni and Cheese and ice cream. By 3:45 I was shamelessy eating ice cream out of the carton... I have never done this before in my life! I'm afraid preparing for this test is going to cause me to neglect other areas of my life for the next few weeks. Eating, exercising and cleaning the house will probably not be on top of my priority list. This creates another element of 'unbalance' for me as I can't stand disorganization and clutter. Not to mention, so much for losing 10 lbs before my 'dirty 30' in March.

At 4:30 pm, I realized I need to do something to help keep my emotions in check as I prepare for this test. Here I am! I'm hoping this blog will help me stay focused and deal with this emotional roller coaster.. and hopefully receive feedback from others that have been successful at taking the CPNE.

For those of you that know me, yes, I am a highly anxious person. Especially when I'm doing anything that revolves around tests. Please do me a favor and quit telling me 'you always stress out about stuff and do great.' This is not about getting an A or a good grade on a test. It's all about my ability to make clinical judgments and doing it the way Excelsior College wants me to. I'm paying them a lot of money for them to make this decision.. ok, Andy is paying most of it, but it's a tremendous amount of pressure to do this right the first time!

8:30pm: I found some videos to help me with the IV Piggyback situation. Here they are:
IV Piggyback 1/4
IV Piggyback 2/4
IV Piggyback 3/4
IV Piggyback 4/4