Sunday, February 21, 2010


I am practicing the wound each day. I need to be able to do this with my eyes closed - the time is getting short. I can do the real thing with no problem but on a manikin with no q-tips - gee that is something else.  I have my IVs hanging from the ceiling fan running in a pan for the secondary med and gtt count. I started an IV in the arm from Education. They were kind enough to lend me the arm and the hand so I can practive the pushes and the drips. I have converted Anthony's room in to a mock sim lab. My husband and parents and kids have been so patient with me.
I can not say enough good about the in Atlanta. I was able to prepare and visualize what to expect as far as the labs go. For the PCS practice I am working with co-workers in the ICU, ER, and Rehab units to get my skills sharpened and well rounded.  Jane, Pat, Deb, Jan, Lorie, Wanda, Linda, Sandy, and Vicki have been soooooo helpful. Oh well must do the CarePlan now.

Wednesday, February 17, 2010

Wound Dressing and Care Planning

Each day at least once practice the wound dressing from beginning to end. I sent an email to an Excelsior advisor 2 questions that came to mind were: (the answers from Dr. A are in the {})

1 -when is it appropriate to revise your plan of care if you find the one you have does not apply? {During Implementation.} Immediately after you initial assessment -first 20 minutes, or after you have performed all of your care? I would be inclined to do so as soon as possible so I could implement interventions and evaluate if the patient met the goal.

2 - during the sim lab for the wound, if you touch the skin with the gauze packing, is it acceptable to discard that gauze and get a new one {Yes} or do you have to re-apply sterile gloves {Only if you contaminated the gloves.}as well? (the gloves did not touch the skin). Are the gloves contaminated as well because they are in contact with the gauze? {No} - DO NOT FOLLOW THIS ADVICE!!!! I FAILED MY WOUND FOR THIS VERY SAME SCENARIO!!!! If I would have erred on the side of caution I would have changed my gloves, I questioned my instinct because there was a lot of discussion about saving money and wasting supplies in the hospitals. My appeal was denied even with this email and situation verified. - Live and Learn.

I went to a wonderful workshop - - I learned how unprepared I was. I know if I did not go to this workshop I would not pass. Sheri Taylor is the instructor and Greg Edwards assisted her. She is still helping me to understand how to write a care plan. I send one or two based on scenarios she passed out during the workshop and she critiques them and sends them back until I get it right. My husband helps me each night by playing the role of the CE during the wound station. He uses the step by step outline from the workshop. I forget small steps like asking where is the bio-hazard container and state washing hands after removing sterile gloves.

Tuesday, February 16, 2010

Hands On

I am so lucky to have such good people around me. Yesterday my good friend Sandy gave me the "tour" and in-serviced me on some of the equipment in the unit. Today I was able to "shadow" my original mentor, Jane, she took me under her wing over 20 years ago and now she is doing it again. Even wih someone so close and accepting I was still a bundle of nerves. Wow back in the unit again. I must admit I do miss it. Loads of hands on tonight, trach care, gastro tube feeding, isolation, central line, multiple drips, cooling blanket, monitors, a-line and more. I plan on doing this a couple of times a week until the clinical exam - March 12, 13, and 14. It is coming so quickly. This Sunday I will be with Deb in the ER 7a-7p and next Sunday I will be with Pat in Rehab7a -7p. I hope to have a well rounded clinical review with different people critiquing me. I don't think I can be too prepared for this exam. My advice is to keep practicing as much as you can be comfortable with strangers, be compassionate, do what you know, nursing. Oh of course, don't forget the other important things - documentation , calculations, NCP, evaluations. More on that tomorrow.

Monday, February 15, 2010

The first things to do in the PCS -
Wash hands
ID yourself, the CE and the patient
Explain your plan or activity
check parental or enteral fluid, rate, and site or placement
ask about comfort - offer to reposition
check hydration - turgor fontanel

Saturday, February 13, 2010


As I struggle to attain a long overdue goal of finishing my nursing degree, I will document my resources and emotions to help and encourage others.