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
PERIPHR
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
PALR
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
METRIC
Moisture - perspiration, incontinence, diarrhea
Edema
Temp
Record on 2 vulnerable areas, all information observed
Integrity - Lesions, rash, shear & pressure effects, skin tears
Color

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.

2 comments:

  1. Hi baby girl, skills on line is the best of all the online courses that ec offers, you are doing a phenomenal job networking and studying , i gather from your post. I am working on something hope that it will be ready before you test, hard to find people to help, continue to post and i will help where i can, FORGET THE NEGATIVITY, stay focused

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  2. Erin: try to perform your AOC in a systematic way: ANOTHER THING, after your 20 min. check assess pain and pee, so that your pcs will flow: perform your aoc from head to toe: ex: abdomen: look,listen and feel that is it: no long mneumonics
    observation, auscultation(starting from the RLQ to llQ,(side by side) then right upper and left upper (do not touch the abdomen until light palpation: simple as that. Here is another one: Resp: all the CFE you need is BS BP AND Muscles used:
    Breath sounds
    breathing pattern bilaterally
    muscles used (either accessory or abdominal)
    is this making sense.

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