I am a nursing student attending a 2 year program. I had other clinicals before, but honestly I feel like I still lack in so many areas. There are so many things I have not done and I am very scared. first of all, you would think I would be great in my assessments, but I am terrible. We are getting assigned 3 patients each clinical now because we are doing the 12 hour shift. I don't know where to start.

I go into each room and introduce myself. I first take vitals myself even though the nursing assistants probably took them. Then I listen to their lung and heart which honestly I'm still having trouble with. I listen to their bowel sounds, check where their iv site is, how much and what is running, ask the patient if he's in any pain as well as on the iv site. check for swelling on the feet.

Do I do this all at once? NO. I always forget something.

Can someone please help me how I can do assessments better?

Make yourself a little check list to refer to before you leave the patient's room. That way, when you forget you can take care of it before you leave the room.

We did full assessments in school. It was just head to toe.

Start with mental orientation (A and O x 3 or confused, etc);

check eyes with pen light (lights off);

check for jugular vein distention (JVD) or trach deviation;

listen to lungs and heart;

abdominal assessment (inspect, auscultate--RLQ, RUQ,LUQ, LLQ, percuss, palpate)/LBM/if they can pass gas;

check legs/ankles for edema (take the SCDs off if they have them and then put them back on);

check pedial pulses (take socks off and put them back on); radial pulses;

strength of extremities;

cap. refill;

skin tone (pale, jaundice, etc; note eccymosis/petechiae) and skin temp (use back of hand);

note any IV problems like redness, swelling, infiltration, etc.and ensure flow rate is correct and fluid is correct;

if they have a foley, note the amount, color, odor if you empty it,

if they have NG attached to suction, note that amount and color;

if they have a wound, check the dressing to make sure it is intact and the wound is not oozing blood or the dressing is not saturated with blood or anything

if they have oxygen, note what it is set on and the device (nasal cannula, mask, etc) and make sure it is on; does not good unless it is on

ask about pain;

note if family is at bedside;

make sure the pt has an armband, bed is locked and lowered, call light is within reach, room free of clutter;

if they are ambulatory and need to use the restroom, then ask them when you are there.

Get your vitals too: BP, pulse, RR, weight if they need it (some are daily weights; if the CNA hasn't already gotten it)

You need to develop a routine that works for you and do it that way until it just becomes habit. Most people I think just do head to toe as described above. I usually dont bother with asking the orientation questions, I just talk with them and you can gather how oriented someone is by your conversation. (sometimes people are a bit iffy and I will ask the questions). I start with heart and lung sounds, feeling radial pulses as I listen to the heart helps. Then I moved down to bowel sounds which reminds me to ask them when they last had a BM. Then I move down to look at legs/feel pedal pulses. If the patient is one who I know will need help with toileting I will just wait until then to look at their bottom. If its someone younger who is completely independent I usually dont ask to see their bottom I just ask them if they have any wounds/skin rashes that I cannot see. Most patients though you will see their skin throughout the day. I usually will also take a min before I see patients to think about what diagnosis they are here for and if there is anything I need to pay special attention to. For example, if I know they are in with CHF I will spend more time on lung sounds and assessing for fluid overload/swelling/SOB.

I did not realize in school how important assessments are, I realize now that its our greatest tool as a nurse. Dont worry about getting the perfect assessment down in the morning because really you're assessing your patient all day long. We spend the most time with them and as such are the first to notice when something is different.

Great tips from the other posters. I'm a new nurse, so whenever I have an overwhelming pt I take a step back and remember the ABCs right away...if those are in check I then think about safety (ex. emergency equipment, bed low and locked, allergies, etc.) Check that the equipment is working properly and their medications that are running are correct. Check the IV sites. Then talk to your patient (if you can!). Ask them how they feel/pain/how is their breathing? Often times you can get an idea where to focus your assessment based off the pts subjective reports. For a complete assessment I use a head-to-toe/systems approach.

I have learned over the years that assessment is not a one time thing. Maybe you'll document your assessment once, but from the time you meet your patient to when you leave you will learn so much about them. Every time you walk into that room you are assessing maybe without even realizing it. For example, maybe when your patient gets their meal tray you notice a fine tremor when they try to eat that you didn't notice during your initial assessment. Maybe when you give them a bath you see an area of blanchable redness on their back.

Another thing is don't be afraid to get a second opinion. If you think you might hear crackles in a patient's lungs, but aren't sure, ask another nurse or your instructor. Say "I auscultated crackles in the bases on this pt's lungs, would you mind listening as well to validate my findings?" As you grow to trust your instincts you may not need to do this as often, but it's better than being unsure and missing something that could be important.

The best way is the simplest--practice. The more assessments you do, the better you'll get. I like to do mine the same way every time, so that I don't forget anything. I walk in, say hi, ask how they're doing, and introduce myself. In that little bit, you can assess if they're A&O, skin color, respiratory effort. Then I listen to lungs, then heart, then bowel sounds. Then IV, dressing (I work post op), pedal pulses and skin temp. Sometimes if my patients are really chatty, I'll assess feet and legs first just so I can be working and talking to them. I can't stress enough the value of taking the time to make some small talk with your patients at the beginning. It gives you time to get an oval sense of mentation and overall insight into how they're doing. Plus, it sets up for a good shift you've had a chance to make a connection with the patient.

Also, the PP is spot on. Never, ever be afraid to get that second opinion. There's been times when I've caught something and had that validated by a more experienced nurse. Other times, I'm wrong. Alway better to be safe.

As you walk in, engage the patient in conversation. This way you can assess what I call the intangibles (What do you sense when you talk to them?). You can tell how they feel in the way they respond to you, you can tell if they skip words, or are out of breath or seem unwilling to talk to you - unusually quiet? Hold out your hand and see if they will reach for it and grasp ...neuro stuff. You notice change this way.

If your patient cannot respond or move at that point, ALWAYS have the conversation with them. Tell them what you are doing, also especially the longer stay patients. Speak to them as if they were totally AAO and the two of you are pals. You will be much appreciated. I have had a prior totally non-responsive patient turn to me, reach up and lightly touch my face where I had a bruise like they were going to now take care of me. I've had patients begin speaking or laugh suddenly for the first time during our little conversations. You can do all of this while you work.

To get to where it is automatic, just write out a flowchart for a cheat and practice on your roommate over, and over, and every day. Always work from the top down soon it will be almost smooth as if it's all in one motion.

Then look around the room on a treasure hunt. What is going into the patient. What is going out of the patient...