[ERRNTraveler]

Originally Posted by mom2michael

Chest pain. I focus on the neck the the peri area here.

Why would you focus on a patient's peri area when they're complaining of chest pain?!?

[loricatus]

I know how overwhelmed you must feel. I think all of us that do ER nursing can recall feeling just as you. But, you have one up on most because of your Med-Surg background------you can juggle with the best of them (or what others call, having time management skills). Now, all you have to add to that skill is constant reprioritizing as things are constantly changing.

As for learning to ask the right questions: Try to listen to the docs when they do their assessment. And, if they know that you are new (and aren't a new resident, med student or holding an 'attitude problem'), many will be glad to answer questions you may have.

Annnnnnddddd..............I am still trying to figure out why the peri area for a CP

[SDS_RN]

I also am fairly new to the ED I just started in Nov and have the same feelings that you do. Some days I feel completely lost and later of course after the pt has been xfered or left I think oh I should have listened to BS or felt their abd if they were in w/ abd pain. My orientation was much like yours if it was busy I was kind of on my own but I always ask questions if it is something that I even have the slightest worry about. I also am giving myself the benefit of the doubt because this is how I felt when I first started as a surg/peds nurse and I'm hopeful that after awhile I'll catch on and things will click again. Every new position takes time to adjust to and learn the new flow of things. Just keep a positive attitude and hopefully you won't be afraid to ask questions. The nurses and docs know that I'm new and they will tell me what I should do or should have done. I just take it as a learning experience and it's most likely something that I will not forget again after being told. Keep on with it and give yourself some time to get comfortable and regain your confidence that's what I'm trying to do.

[bigsyis]

Steve,
Use the ABC, head to toe approach to do your assessment. Once you have vitals and the three major areas covered, i.e., resps even and unlabored, 02 sat 98% on RA, Tele showing RSR at 78 w/occ PVC, then you can focus on complaints. If respiratory, what the lungs sound like; any cough, productive or non-productive. If cardiac, what the heart sounds like, what tele shows, how long the problem has been going on, where they feel it, have they ever had anything like it before? Any associated SOB, CP or pressure, N&V? Any peripheral edema? Be sure to check radial and pedal pulses. If abdominal, what area of the abdomen (belly for some) hurts? Show me with one finger. What does it feel like? Any N&V, diarrhea? How many times? Any blood in emesis or stool? If female, LMP, and is there any vag discharge?
Of course you would be obtaining hx as you go along if someone else had not already triaged the pt. You may be entirely familiar with all of these questions, but in time, you can probably accomplish a decent head to toe exam within 60 seconds.

Also, if the pt's sat is 90% or less, you'll likely want respiratory paged, and the same for a 12-lead EKG if the pt is c/o CP. If there is nobody to assist you, you will be getting at least one IV site established (and drawing blood, if that is your facility's policy) while you are obtaining the hx and doing your assessment. Sheets make good stationery until you are freed up to put things on paper or into the computer.

Keep on keeping on. You'll be fine.

[mom2michael]

Originally Posted by ERRNTraveler

Why would you focus on a patient's peri area when they're complaining of chest pain?!?

Oh, I was just trying to think of good stopping point for the purpose of the post because I hate to say...stop at the abd area and then one doesn't include the abd in that area in their assessment......because abd pain can = CP sometimes.

Besides you just never know.......

But now that I read it - it sounds funny.....of course it was 4 a.m. when I wrote the thing...maybe it was the lack of sleep.

[RNperdiem]

Remember that first year as a parent? Do you remember how overwhelming and exhausting it could be? How the "books" didn't prepare you for everything?
The first year as a nurse in any setting is like that first parent year.
Keep on keeping on. Things do get better.

[KckStrt]

Thanks everyone for the great help. All of your assessments and hx taking is what we do and of course every ones hx questions are pretty much the same. I guess so much of it repetition and becoming used to how things flow and move in the ED. My med/surg exp is an asset as far as time management and being equipped to deal with certain situations, but sometime I feel like I am too organized and need to let go a bit and "change priorities" quicker.

This has helped me feel more confident as well as discussing it with my Director, in which she said "I wouldn't have hired you if I didn't think you had what it takes to be a great ED RN."

Tomorrow is a new day and I am still scared poop less. I will be alright, I just know it.