Ugh, the dreaded head to toe. Please know that you are not alone. When I started my first clinical, those very words would fill me with ice-cold fear. It absolutely DOES get better with practice, you really just need to push through it and develop a consistent system that you do the same way EVERY time and never deviate from.
I'm still in nursing school
(a little more than halfway through), but this is basically what I do from time of intro through head to toe:
Walk into room: Hi, I'm Philly85, I'm a student nurse from So and So University. I'll be helping out Nurse So and So with your care until 7 pm tonight. How are you feeling? (Respond appropriately to their answer and have general 1-2 minute convo to build a rapport). Is there anything I can get you right now? OK, I'll go ahead and grab that for you. Would it be all right if I get your vitals and do a quick assessment on you when I come back? Ok, great, I'll be right back.
AND ACTUALLY COME BACK SHORTLY - DON'T GO HIDE IN THE BATHROOM FOR 30 MINUTES FREAKING OUT ABOUT HOW YOU ARE GOING TO DO YOUR ASSESSMENT (yes, I did this several times in the beginning, lol...)
Get them whatever they need, come back (hand hygiene before coming into the room) and give them whatever was requested. Putting on gloves as you say --> "OK, as I mentioned earlier, I'm just going to get your vitals and do a quick assessment. Can you tell me your name and DOB? (Verify what they state matches wristband). --> Don't ask them if it's still a good time (unless they are eating breakfast or something). If you do, they might put it off, etc. You need to get your assessment done, the sooner the better.
Get vitals, including pain level (I'm assuming you can do this by now)
AAO x 3: You may have already determined their status just by having that 1-2 minute convo with them when you first entered the room. If not, then just ask the basic questions. "Can you tell me your nurse's name or my name (don't ask them their own name, that is too easy and is not a good indicator of if they are actually oriented to person), do you know where you are/what floor you're on, what is today's date/who is the president?)
PERRLA using penlight. Cardinal fields of gaze if not already determined by simply seeing that their eyes tracked you easily throughout the room previously.
CV: Auscultate heart sounds at all five points with diaphragm and bell - Apical heart rate if you are feeling fancy
Pulm: Anterior/Posterior Breath sounds
GI: Auscultate bowel sounds FIRST, then palpate
Now all of your stethoscope stuff is done
Check B/L radial pulses for amplitude, cap refill on index fingers, and upper extremity strength testing
Skin: You've already been assessing the skin up until this point with everything you've been doing, but now lift up blanket and inspect the lower extremities. Feel for skin temp with backs of hands going down their shins, then check for edema with thumbs going down their shins again.
Check pedal pulses, cap refill on big toes, heels for skin breakdown, lower extremity strength testing.
"OK, everything looks good" (if it does), or if something is off, let them know, but that you will have their nurse come and take a look.
"Thank you for letting me do your assessment, is there anything else I can get you? No? OK, well we'll be back in at 8 am to give you your morning meds."
If they are incontinent, check their skin for breakdown whenever you change them. Don't let the CNA's do it all the time, you need to get in there to make sure you are assessing.
If not incontinent, they are more likely to be up and walking or getting onto a commode. Check their posterior skin if you are up and walking them/assisting them during these times.
Seems to work pretty well for me, anyway. Some people like to stick strictly with the systems and go back up and down the body (strength testing all at once, cap refills all at once, pulses all at once, etc), but I find it much easier to literally stick to HEAD TO TOE - otherwise I forget stuff.
P.S. - Now is also a good time to ask them if they'd like to move from bed to chair for a little while (maybe have breakfast in the chair while watching the morning news?). Help them change into a new gown once in the chair. Then change the bed linens and spruce up the room a little bit.
P.P.S. - This may not all work out as perfectly as the above, but the key is to get in there and get this done AS SOON AS POSSIBLE. There's nothing worse as a student nurse than the feeling of knowing that you still haven't done your assessment on your patient and you are putting it off b/c you are too afraid. Just get in there and do it. And then CHART IT in the computer if your site allows you to do so as a student. Don't worry, your nurse will be doing her OWN assessment and will be charting that as well, so you won't be "messing anything up."
It may not be perfect, but usually patients are very understanding that you are a student and are learning. The more you do it, the better you'll become.