Care Plan Scenarios By Chuck

I am adding this link for quick access to lots of practice scenarios for care plan critique.
Chuck's Care Plan Scenarios

I was surfing the net looking for additional resources and found one of the best yet. This was written by 2 excelsior grads to share with others totally free. Here is the link. http://allnurses.com/distance-learning-nursing/cpne-notes-ec-308371.html I hope everyone else finds this as helpful and informative as I did. Many thanks to Ivan and Lisa for posting this on the allnurses.com forum.

Documentation Tips

If you do your grid from your cardex and perform your interventions make notes that you can understand . When you are out of the patient room. start at the first system and document every thing you did, do not leave out anything, think of the mneumonic for the area of care and write what you did to met that requirement. For example it you have a Enternal Feeding - RAT FEVER is the Mneumonic


R-ecord

A-mount

T-ype

F-owler position

E-xamine gastic tube/abdomen

V-erify placement verify G tube placement by aspiration contents of instillin 20 cc of air bolus and listening

E-xpiration date of formulat

R-ecord rate in first 20minutes - a patient that has fluid running must be part of your 20 minute check,

Hope you find this helpful.

CPNE SIM LAB #4 Successful Wound Management

For successs at the Wound Station follow these steps:

ID patient against the treatment record - verbalize the patient's name, date of birth, and medical record number
Gather supplies
Ask where the location of the biohazzard container is - if possible make sure you will not have to cross your Sterile field to dispose of the drsg.
Tear tape - hang from the table edge - 3 or 4 strips
Label one end of tape with date, time, and your initials
Open all of the sterile supplies you will need
Open the Saline - do not set down the cap, pour a tiny amount in trash can
Keep label up pour saline over tub of 4 x 4 (not too much)
Don clean gloves
Loosen tape toward wound.
Remove drsg as one unit
State noting drainage
Discard in biohazzard container (DO NOT CROSS STERILE ITEMS OR YOU WILL HAVE TO DISCARD AND START FRESH)
Apply sterile gloves
Obtain one 4x4, squeeze extra saline out and open all the way do not shake

• Parachute Method -  grasp the 4x4 in the center and bring up each corner like a parachute scrunch into smaller form , place in center of wound and open carefully; do not touch the skin with the gloves or the gauze or
• Ribbon Method - grasp one corner of the 4x4 , fan fold (do not twist or it will become a rope and that is forbidden) and go around edges of the wound ;do not touch the skin with the gloves or the gauze

If you contaminate the gauze change your sterile gloves; Show the CE to avoid having to remove the dressing at the end and risk moving out of place.

this one would fail the gauze is too close on the left upper aspect.

Place dry 4x4 on top
Place abd on top
Secure with tape
Clean area and remove gloves
Verbalize washing hands prior to picking up pen to document
Sign the treatment record
State patient tolerated the procedure without incident
Declare completion

CPNE SIM LAB #3 Successful IV Secondary Med

To be successful at the secondary medication station follow the following steps:

Read the MAR
Calculate drip factor on the SIM LAB Recording Form (SLRF)
volume x drop factor/minutes - gtts/minute
Record the flow rate (gtts/min) for 15, 30, and 60 seconds
Obtain the correct medication bag from the selection
ID against MAR - verbalize to CE - Patient name, Date of Birth, and Medical Record Number
Don clean gloves
Inspect IV site - verbalize no edema, site dry, no sign of infiltration
Remove gloves
Clamp tubing of both primary and secondary fluid
Drop Primary Bag
Spike medication bag
Check for air in tubing - prime if needed
Open secondary med all the way
Adjust the rate using the clamp on the primary line
Verify rate with CE
Don gloves and check for infiltration after CE verifies gtts/min
Sign MAR and
Declare end

CPNE SIM LAB #2 IM/SQ Injection

For the successful IM/SQ Injection follow these steps:

Read the MAR
Note time, drug, dose, route on the MAR
ID the patient name, Medical Record Number, Date of Birth against the MAR
Select medications from assorted vials and correct syringe/needle from assortment of syringes/needles
Calculate the amount of each medication to be given

DESIRED/ON HAND

Record individual and total volume on Simulation Laboratory Recording Form (SLRF)
Cleanse top of vials with alcohol
Draw up air in to syringe for each medication and show CE
Inject air into vial second medication(NPH) first then first medication(REG)
Invert vial and draw up first medication and show CE
Invert second vial and draw up second medication without allowing air into syringe
Show CE for verification
Re-cap using scoop method
Don clean gloves
ID Patient to CE - verbalize name date of birth and medical record number from band and MAR
Identify site for injection
Cleanse area with alcohol useing circular motion inside to outside
Insert needle bevel up with dart like motion
Aspirate for IM
Inject slow and steady
Withdraw needle and dispose in the sharps container
Apply light pressure to area unless heparin or insulin
Remove gloves
Wash hands (verbalize washing hands in SIM LAB)
Record medication on MAR

CPNE SIM LAB #1 Successful IV Push

The successful sequence for the IVP is

Read the MAR
Get the Med
Do the math

Clean the top of the med bottle
Label 3 empty syringes
Draw up med and put the med bottle to the side
Clean the top of the NS bottle
Draw up the 2 flushes witht the amount stated in the MAR

ID the patient - Name, Date of Birth, Medical Record Number
Glove with clean gloves
Inspect IV site - verbalixe not edema/swelling/redness
Wipe IV Port
Aspirate patency

Flush the IV with NS over 8 - 10 seconds
Give med over the ordered time frame
Flush with NS over 8 - 10 seconds

Sign the MAR
Declare you have finished and acknowledge completion of all of the critical elements for this station.

Do this and you will pass the IVP
One LAB down 3 more to go.