I passed my CPNE at Long Beach Memorial Hospital on Dec 9-11. I strongly recommend Tina's workshop. She has wonderful lab there for you to practice. Excellent mnemonic
those help to assess and document for PCS. Tina's teaching power is Godgift. Everything that Tina teaches in the class is exactly as it occured during Lab/PCS. I never forgot Tina's
follow up during CPNE. Tina helped me to pass my CPNE first try at Long Beach. Tina class teach us a systematic approach for CPNE. Her wonderful husband was also there to
help us with skills. I was confident due to Tina's workshop. Thank you so much Tina!

Baldev,   (  drbaldevpatel@yahoo.com  )

Mnemonics can really help, especially during the exam when stress is running high.  Yes, even for LVNs who have been doing assessments and managements for
many years.  Using mnemonics will force you to follow procedural steps and not become victim to some of the bad habits and shortcuts that you have picked up
over the years.  For the purpose of the clinical exam, you need to prove your expertise in the clinical skills the “Excelsior way” or the way prescribed by nursing
theory.  Moreover, having the mnemonics on the back of your hand, will make you more confident about your skills.  You will find it easier to perform all the
steps without forgetting crucial aspects of assessments or managements.  You will also be able to jot them down on the grid in a matter of few minutes and be
ready for your evaluation phase.  When you are well-organized, you will fly through the PCS without any problems.

Example:  Abdominal Assessment

Abdominal assessment is usually assigned for patient who has undergone abdominal surgery or has gastro-intestinal conditions.  Use simple language.  Don't say
I'm going to do a "peripheral vascular assessment" or "abdominal assessment" now.  Instead, say "I'm going to check your feet now" or "I'm going to check your
stomach/abdomen now".  Before doing the assessment, make sure you turn the suction off.  Also assess the pain level.  Ideally you would have already medicated
the patient for pain a long time before abdominal assessment if incision is present (ask for pain level right after the 20 minute check and medicate as needed).  

4Ps --   P  P  P  P         S O D A          P O P       

P -       Privacy curtains (most hospitals have more than one patient to a room and unnecessarily exposing the patient may cause emotional jeopardy)

P -      Pee (Does the Pt need to void?  Bladder may be distended which will interfere with assessment.  Do this before you position the patient flat in bed otherwise you will have to
sit them up again before helping them get out of bed to the bathroom and lay them back in bed again.  Do NOT make extra work for yourself.  In addition, if the patient has just had abdominal
surgery, repositioning them again and again can cause undue pain - physical jeopardy)

P -       Position (“I’m going to lay you flat in bed.  Can you flex your knees?”  Pt flat in bed, knees up.  Only exception is someone on O2/Resp problems—low fowlers.  You may invoke CDM
and you can tell the CE that you don’t want to compromise the patient’s respiratory function, so you will leave the patient in low-fowler’s)

P -      Pain  (Is the Pt having any pain and where? … so you can invoke CDM if omitting a step.  If patient is extremely fearful of touch around the incision site.  But it is very important to
do abdominal assessment especially if they’ve had surgery to see if tender or rigid as it can clue to any complications.  If you’ve already given pain medication, hopefully its already working by
now.  Just explain the importance of the abdominal assessment.  But don’t push it especially if the patient is really guarding the abdomen and doesn't want you to touch.  You cannot force the
patient as it will cause emotional jeopardy)

S -   Suction Off

O -   Observe (Looking for distention, contour, size etc.. DO NOT TOUCH ABDOMEN, just lift the gown and look.  DO NOT GO OUT OF ORDER since palpation of abdomen can stimulate
the bowel and result in increase of bowel sounds.  Also make a note of anything else you see, including, incision, dressings, JP or other drains, colostomy/ostomy appliance, g-tube etc.  You may
chart on some of the following characteristics:  
S  A  C   S   A   C   S   Size, appearance, color, shape, and condition of skin)

D -    Don Gloves (Put gloves on if you think you will be come in contact with any body fluids while auscultating or palpating the abdomen)

A -   Auscultate(Check sounds in all 4 quadrants with navel as intersecting point.. it is good to listen a little away from the middle—the large intestine has more sounds – only touch
abdomen with stethoscope not with your hands.  Sounds can be classified as absent, hypoactive (1-5/min), Active/Normal (6-30/min), Hyperactive (>30/min).  You should listen
over each quadrant for a full minute especially if they are absent to ensure that there are some bowel sounds present.  After most surgeries, NPO is maintained until bowel
sounds return.  If sounds are different in each quadrant, make sure you document the quadrants separately.)

P -      Palpate LIGHTLY 1-2 cms in all 4 quadrants.  You can invoke CDM and omit any region if Pt complains of pain… Say before palpating – “Now I’m going to touch your stomach.  Let me
know if it feels tender when I touch”

O -     On Suction

P -      (Used to be Girth). Instead, substitute P=POOP, last BM? (According to the current CPNE guide, you will not be required to measure abdominal girth.  I have not removed the P out of
the mnemonics because after the CPNE, according to your workplace policy, you may still be required to measure girth for patients with certain diagnosis. And don't forget:  It is still very
important that if your patient tells you that there are significant changes in his/her abdominal girth according per their SELF REPORT, you still have to tell the staff nurse immediately of any
sudden changes according to the critical elements - any change in the patient's physical status has to be reported... just don't forget girth just because it won't be assigned )

Iformation on this page is copyrighted.     ãContinuing Health Education
YOU MUST jog your memory with mnemonics and Grid in a stressful test situation