Physical assessment- what is CSM exactly?
- 0Can someone please tell me what CSM is and how you assess for it. I work for a homecare company. And all the other nurses fill out thier assessments and just put CSM+ The patient is wheelchair bound, has spinal muscular atrophy and has no movement. I thought CSM was for circulation, sensory and movement. How can it all be positive on this patient? What is the proper way to assess for this and exactly what am I looking for?
- 0Circulation, sensation, and movement is correct when you are talking about assessment. How in the world they are getting positives on all of those for that patient I don't know.
To check circulation, I look at color and capillary refill (less than 3 seconds or so). Is the skin warm? Cold? Discolored?
For sensation, I normally have the patient close his eyes and then I move the digit or part I am checking; I see if he can tell me what part is being moved.
For motion, I see if the patient can wiggle toes/fingers, etc.
- 0Yep, it is cardiac-related, I suppose (lots of things get thrown under cardiac, you ever notice that? LOL), but it is normally checked when there might be some compromise to peripheral circulation. I have used it most with ortho patients (post-op knee, etc.) but it would also be valuable to use if you have someone with a history of DVTs, PAD, recent surgery, a non-healing wound...anything that might compromise the circulation to an extremity. You want to catch circulatory changes sooner rather than later.
I wouldn't second guess yourself about them charting "positive CSM" for that patient. I mean; it's pretty cut and dry; either the patient can move or they can't. I myself have had to learn not to freak out so much when I see charting different than mine; sometimes they're just plain wrong or made a mistake out of habit.
- 0thanks for the answers, I think the other nurses figure if they can feel her periferal pulses, they just chart +
This particlar patient has had dark nail polish on for the past two weeks, and you ABSOLUTELY CANNOT touch her toes, as they are very sensitive. So how can you check capillary refill??
just wondering?? Am I missing something?
- 0Jul 8, '11 by GrnTeathat's peripheral, meaning "on the outside edge," in this case, at the far reaches of the blood supply. i think this is another indication of a ritualistic practice (see the thread on fake charting). what they mean to communicate is that the patient's peripheral circulation is ok, because it looks to them as if the fingers and toes (or whatever they are mentioning) are warm and pink. of course, if there is no sensation or motion (as for a complete spinal cord lesion above the level of the part being checked) the "sensation/motion" parts aren't really there, now, are they?
"making a mistake" habitually or just because everyone else does it doesn't make it safe or ok; "charting differently from you" is acceptable if it is accurate. your facility probably has a list of acceptable abbreviations with their definitions. review it, and if necessary, post it for review or have the charge nurse mention this in staff meeting.
this is lazy (and inaccurate) charting. feel free, yea, feel obligated to chart accurately. "toes warm, pink/purple/grey/whatever, blanch to pressure (means they get white when you squeeze them), capillary refill less than 3 seconds (or however long it takes for the white part to pink up again)." you don't do this at the nail bed, so it doesn't matter about the polish when you check the fingers-- look at the fingertips. if it hurts for her to have her toes touched, then that should be noted too. why is that?