LTC Proper Assessment Skills

TheCommuter, BSN, RN · Feb 24, 2014

Here's the straight-up truth: you are not going to have time to do a complete head-to-toe assessment on every single resident, every single day, especially if you have 20+ residents to care for. This will consume all the time that you will need for medication pass, wound care, breathing treatments, charting, and the mountain of paperwork you will need to do.

If you end up on a Medicare skilled wing, you will need to do focused assessments on each resident to generate enough data for proper Medicare charting. If you end up on a traditional long term care wing, residents will often get a full head-to-toe assessment once a week, typically on a schedule.

CapeCodMermaid, RN · Feb 25, 2014

What's more important than "proper" assessment skills is to recognize changes in your residents that could signal something. Are they eating? Any increased confusion? Edema? Pay attention to the little things so they don't become big things.

amoLucia · Feb 27, 2014

Don't worry about your assessment skills becoming rusty. You'll most likely be the first person to tune into subtle S&S before they become they become full-blown problems. Like a pt who sounds a little huffy-puffy as they breath. Or the continent pt who just had an "oops leaky incident". Or it feels like muscle cramps in the posterior left leg, but not the right.

You will become so much more skillfully adept at quickie assessments during those brief interactions you have. Kind of like the quickie assessment you catch yourself paying attention to when in a shopping mall elevator as you note the other rider who's huffing and puffing.

When those little things catch your attn, you'll find yourself stopping to do a more detailed check. And that skill increases with experience - wait for it! It will come.

souleater11 · Feb 27, 2014

Don't worry about your assessment skills becoming rusty. You'll most likely be the first person to tune into subtle S&S before they become they become full-blown problems. Like a pt who sounds a little huffy-puffy as they breath. Or the continent pt who just had an "oops leaky incident". Or it feels like muscle cramps in the posterior left leg, but not the right.
You will become so much more skillfully adept at quickie assessments during those brief interactions you have. Kind of like the quickie assessment you catch yourself paying attention to when in a shopping mall elevator as you note the other rider who's huffing and puffing.
When those little things catch your attn, you'll find yourself stopping to do a more detailed check. And that skill increases with experience - wait for it! It will come.

Thanks everyone for their great response,

BTW, amolucia, what the medical indication of "continent pt with leaky incident and posterior left leg cramps"?

just curious

SquishyRN, BSN, RN · Feb 28, 2014

Thanks everyone for their great response BTW, amolucia, what the medical indication of "continent pt with leaky incident and posterior left leg cramps"? just curious[/quote']
I know I'm not amolucia, but I can help answer If the continent patient suddenly has a leaky incident, they may have a UTI. Posterior left leg cramps? Maybe DVT. Anything that's out of the ordinary warrants further assessment and investigation on your part, no matter how seemingly small. NEVER discount these little things. But with experience, you too will be able to relate these random statements with everything you learned in nursing school.

CT Pixie, BSN, RN · Feb 28, 2014

A head to toe on each shift just doesn't happen in LTC. If I have a patient who's stay is being paid by Medicare or any other insurance, we have to do a nursing note for each shift (these are usually our short term/rehab people). Those people I'll do a quick head to toe but mainly focus on the body system that is the cause of their stay. My unit is usually LTC but I do get the occasional short term'er.

Our full detailed head to toes are normally done once a week.

Working in LTC you begin to be in tune with your residents. I can normally pick up on something that is 'off' before anything would be found on a head to toe. When I sense something just not right, I'll do a head to toe to see if I can notice something that isn't within normal limits/range for that person. And listen to the CNAs!! They know their people. If the CNA says something isn't normal or right or even if they say Mr So-and-So is a little off today...make sure you listen and take a look at the person.

amoLucia · Mar 5, 2014

Sorry to be a little delayed getting back - my computer was having some more blahs r/t the snow! PP Squishy is correct. I was commenting on 2 sample pts. (Sorry if they sounded like just one.)

As for the incontinence, I was thinking UTI or OAB. And there was the one with DVT. And the resp pt may be exhibiting early CHF, COPD or URI. As I said, you'll see them early and intervene appropriately.

I've seen a whole lot in LTC - assessment just falls into place. Good luck in your new job. LTC needs you.