Quick patient assessment in morning: some tips please
- 0Feb 25, '10 by jollygirl098I am a new RN precepting with my mentor. My preceptor has over 20 yrs experience on med-surg floor. When she is doing assessmnets on patients, she just listens to lungs, abdomen, pedla pulses and she is done. I wonder sometimes why she is not looking at total skin color on feet, arms, or take a pen light and do pupillary assessments. But then I think she is experienced and she knows better.
I want to do more and can anybody tell me how you do your assessments quickly in mornings after taking in patients reports. Thanks in advance
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- 2Feb 25, '10 by rnto?I work in a Sub Acute unit, people are usually more stable but not always so. I do general assessment-apical rate, lung sounds, bowel sounds, palpate abdomen, check for edema. I don't always check for pedal pulses unless there is a reason I need to (in the hospital I did). I also ask questions-how are you sleeping, trouble breathing, trouble moving bowels, does it burn when you pee? any pain? If they say yes to any of those questions, I follow up with more in depth questions-ie, if they say yes, they are having pain-is it new? is it worse than yesterday? what makes it worse, what makes it better. Talking to them makes you look at them-are they resting comfortable or struggling to breathe? Is thier face pale? symmetric? How do they do taking thier pills? what kind of understanding do they have of thier illness? You can get alot of that info without it obviously seeming so. Also, I focus my assessment on the reason the patient was admitted. Left TKA, I assess the incision and the left pedal pulse, etc. Right carotid endarterectomy, incision, check for throat hoarseness, right radial pulse, educate the patient on what to report. I also try to do more than one thing at the same time-ask questions while I'm checking for edema. It kinda seems rude, but it's what I have to do to get done. One thing I need to get better at checking is skin turgor-can give you a good idea about hydration status but I always forget!
- 1Feb 25, '10 by rnto?I also don't usually assess pupils unless the quick assessment alerts me to some sort of problem or the patient has some sort of neuro problem, in which case I would do full neuro checks. I think it's probably overkill to assess pupils on everyone if just a med surg floor (neuro ICU would be different, obviously). I also forgot to mention that by talking to your patients, you're also assessing their speech-clear, expressive aphasia, etc. I think it comes down to using your critical thinking skills about what needs further assessment. Some nurses do just do the basics on everyone, I wouldn't want to be thier patient and have something really wrong.
- 3Feb 25, '10 by 07302003I have learned that a quick, 2 minute head to toe is a must in order to not totally fall behind, and for patient safety. I typically assess wounds, skin, surgical incisions, etc. later in the shift. I work med-surg/tele, 4-6 patients.
You walk in and greet the patient, and start chatting briefly. Ask about pain and last B.M. if not given in report.
You are assessing mental status, skin color, breathing effort, facial symmetry, while standing there. If in doubt about orientation - ask do you kow where you are and the month and year. This way if mental status changes you have a baseline.
Lungs are important to know if your patient is developing / experiencing cardiopulmonary issues. Take your time with this.
On a cardiac floor I assess heart sounds for murmurs, rhythym, etc.
While assessing bowel sounds you are also assessing for distension and ileus.
If there's a foley, glance to assess output and urine characteristics.
While doing pedal pulses you are looking at edema, feeling for circulation (are feet cold, is pulse feeble?) Do both feet feel the same?
For patients with chest tubes, PEG's, surgical drains, NGT's, you'll need to add these to your first up assessment to make sure they're not malfunctioning.
If anything is not WNL, ask patient if this is there baseline - is your breathing usually this difficult? Does your stomach usually look like this? Are your feet always cold? This helps you assess what to pass on to the MD.
Ask the patient if they have any concerns. This helps you start organizing care.
THis kind of assessment took a couple of years of experience to develop. The more you see the more you'll recognize and know what to focus in on. Best of luck!
- 3Feb 25, '10 by blondy2061hI listen to lungs, heart, listen for bowel sounds, ask about pain and nausea, check for pupillary response (direct and consensual), make sure pupils are equal, check bilateral radial and pedal pulses, check capillary refill, and look in the patients mouth (for dryness and signs of sores- probably onc specific). Throughout all this I assess alert and orientedness. If I have any reason to doubt they're less than A&O x3, I ask specific questions to assess this. I check their central line sight and try flushing any lumens not in use so I can get TPA if they're not working and get them working before I need them later. On non-ambulatory patients I check all pressure points and apply barrier cream. I check the bathroom for stool and urine to empty this and assess what this looks like. I do a quick safety check as well- is the bed in the lowest position? Call light in reach? Side rails up? I also have the patient do incentive spirometry while I'm in there to assess how well they can do it and to make sure they know how to do it. I check my IV pumps to make sure everything is running at the right rates, is the right solution, isn't about to run out, and to make sure the pump is plugged in. I check any transdermal patches the patient has to make sure they're still firmly stuck on and that the skin isn't irritated. I finally see if my patients who are allowed to have water have enough. It sounds like a lot, but it really probably only takes me 15 minutes. I've also found doing all of this at the beginning of my shift reduces call light use and makes my whole shift go smoother.
- 1Feb 25, '10 by qt2168What I do when I do my assesment is this: Greet the patient while walking in the door, start little chit chat which helps with LOC, look for JVD while talking with patient. Feel radial and pedal pulses while checking for edema. Listen to heart, lungs, bowel sounds. Ask about pain level while I am flushing IV sites. Thats pretty much it. I rarely look at pupils unless indicated.
- 1Feb 25, '10 by nicole109I would ask your preceptor about their assessment...I worked in the hospital on a neuro floor and then moved to IMC for 4 years. On the floor, we had 6 patients, in the IMC, we had 3 or 4. After getting report, I would peek in on all of my patients, assess orientation, make sure everyone is breathing and see if there were any problems. If everyone was stable, then I would go and check my meds, orders, etc. And then go back and do a more thorough head to toe. If I knew that a particular patient was going for a test or therapy or something then I would go back to them first. Or if during my initial pop-in I noticed something that needed to be addressed, then I would stop and address it then. Everyone has their own system and you will find your own way of organizing your day.