First day of clinicals tomorrow, so confused!

LouisVRN, RN · Mar 30, 2010

When you do a physical assessment just remember to go head to toe, especially being your first time I'm sure you wont be expected to do everything perfectly. Your pt may prefer to wait to get a shower. Obviously being capable of showering I would not want to be asked to lie in bed for a bath, you might instead ask him if he would like any help getting cleaned up. Pts sometimes have weird requests maybe he'd like his hair washed with a warm shower cap, or just a backrub and his hands cleaned. Bottom line is if your pt is ambulatory he may not want a bed bath. Chances are though there might be another incontinent pt of your peers that might require two throughout the day, so ask around and see if you can still get the opportunity without making your pt feel uncomfortable. Also, your pt may surprise you and like the company, or he may prefer his privacy. You can always look through the chart and his medications and try to do some education with him. Good luck on your first day.

Pachinko · Mar 30, 2010

Ask the patient how he wants to do it, and follow his wishes. He probably has a routine that he follows. Maybe he can sit on the side of the bed and turn as needed in order to get fully cleaned up. He will appreciate the extra attention :)

If you have down time (which you probably will--it's typical in most clinicals), chat with your patient, see if you can help out other patients (with your teacher's permission), or ask to observe other clinicians working. My advice to you is to keep your calm and don't show your stress; when you get scared, slow yourself down and take a breath.

You will do great!

CrazyGoonRN · Mar 30, 2010

Thank you so much for your responses! I already feel a little better :)

I just thought of something else I am confused about:

My teacher said that we must look at their peritoneal area for pressure sores. If he washes himself how will I see if he has any?

tiffanyleigh0212 · Mar 30, 2010

Hello everyone! :) I am an LPN student and tomorrow is my first day of clinicals.I will be in a nursing home. I am confused about so many things! I have to do a physical assessment on my patent tomorrow and my classmates and I havn't even praticed them yet and havn't been checked off. We have talked about assessments and watched a video about them but never actually watched the teacher or anyone else demonstrate how to do them. I am so scared! I thought we would learn how to do them today in class, but no we didn't. We have only praticed taking vitals. Any advice would be greatly appreciated !
Also, I am confused about the bed bath. I met my pt today and he is in a wheel chair but can get up and walk independently for short distances. We were told to give bed baths and do assessments after they eat breakfast. My question is this: My pt will probably be in his wheel chair when it is time for his bed bath so do I ask him to get back into bed so I can give him his bath? That dosn't seem right, but we arn't allowed to give showers. I don't know what to do.
I am also not sure what to do through out the day. I will only have one patient, and he dosn't seem to be the kind of man that wants a lot of attention. I am guessing that I don't sit in his room with him, when he dosn't need anything, but what do I do? I will not be passing meds for 2 weeks so I dont have to do that yet. Should I just help out my classmates with their pts most of the day? If my pt never pushes the call button, how often should I check on him?
My teacher is the kind that expects us to know things that she hasn't even discussed, and acts defensive when asked about those things. I do wish I had a different teacher but I dont and I am trying to make the best of it, because I know that I am meant to be a nurse. I know some of these questions seem common sense but its just not comming to me at this time.Thanks everyone for reading this! :)

You sound a lot like how I was in the beginning. We were told to do full physical assessment without being shown how to first, we did have lecture on it beforehand, but in all reality, most of was things you already knew how to do (we did have a sheet to go by) and you're a student, you're here to learn! About the bed bath, I always just ask my pts. if they need my help getting a bath or cleaned up, usually all of them would rather do it their self. So I just get all the things the need and tell them i'll be back in 20-30 minutes to check on them. You would be surprised at how long it takes to care for one pt. especially the first time, it took awhile!! But it does get better, I'm still in my first semester and I can do bath, linen change, and full PA in about 30 minutes. If you do find some free time on your hands, I'd go around and ask classmates if they need any help. Also, your school may be different, but at my school, were not out on the floor the entire time of clinical. Clinical is 7:30-1:00. We usually discuss plans for the day, get report on our pt. look over the chart, then get started around 8:30 then we would usually meet back in the classroom around 11:30 and once everyone was done, we would do post-conference and talk about what was done. Goodluck on your first day and let us know how it goes. You'll do fine! I was so nervous before clinical, then once I get in the room, it's like I'm a different person. Very nice feeling!

wahwahgerman · Mar 30, 2010

Thank you so much for your responses! I already feel a little better :)
I just thought of something else I am confused about:
My teacher said that we must look at their peritoneal area for pressure sores. If he washes himself how will I see if he has any?

It's tricky sometimes to get all your required skills done. The fact is that the patient may refuse anything he wishes, and a more independent patient will probably not want you checking out his bottom! You might get a good look at him if you help toilet him, as they often need help with getting off and on the toilet or with wiping.

We've been in clinicals for a few months and it is easier than you think! I've found it really helpful if I talk to my patient for a bit before I bombard him/her with my list of things to do. If they like you, they will be much more amenable to your cares.

As for physical assessment, it's helpful to watch some skills videos, or even a physical exam on youtube. Head to toe is the way to go for sure. Vital signs, listen to heart and lungs, assess for pain, neurologic assessment (check strength, PERRLA, gait, sensation), skin assessment (as you go along you can inspect), respiratory assessment, cardiac assessment and GI/GU. Lots of information is observed while talking with the patient or watching them swallow, walk, etc. You could probably find a head to toe assessment form online and print it out, which would be helpful during your exam!

Good luck, you'll do great. Even the most anxious person in our group did a nice job.

AOX4RN, MSN, RN, NP · Mar 30, 2010

My teacher said that we must look at their peritoneal area for pressure sores.

I think you mean perineal since you won't be able to see inside his abdominal cavity :) Good luck!