Do you do the full head to toe patient assessment?

aywl · Sep 27, 2013

I work in the ER and I only do focused assessments if you start assessing head to toe and doing the full assessment that we learn on nursing school I would spend all day doing assessments and not providing pt care. If I start digging to deep I will get into to much irrelevant things than what is pertinent to why the pt came into the ED today. I feel as though my job is to help provide pt care for the emergencies that the pt is seeking care for today.

Agree

CodeteamB · Sep 27, 2013

Ok, I'm a little conflicted on whether to post again, as this thread is kinda dead, but it has been on my mind so I'm going for it.

Aywl... the poster from the ER (and please correct me if I am wrong traumaqueen) is likely doing focused assessments on patients with minor concerns. From my understanding, you work in oncology and I feel that it is likely your patients are often systemically ill (keep in mind, you and I live in the same city and have probably taken care of the same patients). A patient coming into the ER who is sick enough to get admitted to the hospital will be needing, and in my experience getting, a more in-depth assessment.

Treatment modality is also different between inpatient and Emergency nursing. In one area we are often going for a "quick fix" deal with the problem at hand and send them on their merry way, the patient may be with us for only an hour. When nursing inpatients it is important to get to know much more about the patient. If for no other reason than the fact that hospitalization alone can lead to adverse effects. We need to be monitoring our patients for skin breakdown, atelectasis, nosocomial infections or procedural complications. Perhaps the last 3 days of lying in bed has led to consolidation to lung bases, which you could catch with auscultation and intervene before it becomes more serious. Maybe that patient who reports he had a bowel movement this morning has since developed problems, maybe he's lying, if you don't assess the abdomen you're not going to know about these problems until someone reports you for not assessing your patients. A good nursing assessment provides a report card for the patient and helps the entire team make decisions regarding the patient's care.

I have seen a few posts here in which you describe your displeasure at not being able to act to full scope as an LPN on your unit. It seems to me from the comments you have made in this thread that you are not even fulfilling the basic scope of your job on your current unit. I actually find it very troubling that you say you feel an assessment is not necessary for your patient as long as the vital signs are normal.

Please reflect on this, I think that this feedback from your co-worker/manager could be the start of a positive change in your practice that could help you become a better nurse.

Fiona59 · Sep 28, 2013

Inpatient surgical patients differ greatly from elective same days.

A choli that is open due to complications needs to assessed more fully than a day surgery uncomplicated choli. The latter gets the once over, clear lungs, bowel sounds, no fever, pain managed and off home they go. A choli that was open can be on IV antibiotics, have drains and needs to fully assessed with every shift change. Those bad boys while usually straight forward can go nasty fast.

It might not look like we perform a full assessment but with experience, you learn to eyeball the skin integrity, guarding for pain, are the pupils focussed. Quick listen to lungs and belly while assessing dsg/steri strips, and a hows voiding? and you're done. You can fully assess a patient in less than five minutes. You look at the skin when checking the IV sites. You visually follow the cather and ask the patient if there is burning and can you get them some washcloths for peri-care?

It's fast, its' easy and it's essential.

aywl · Sep 28, 2013

Summarize: for complicated patients, for sure we should and I did full assessment, for pt's with minor surgery, like D+C, laparoscopy (this kind of pts most Likely go home the same day after surgery, or stay 1 night then go home the next day once they meet the d/c criteria), i do think i don't have to listen to the lung sound if the o2sat is above 90%, I don't have to listen to their bowel sound if pt told me she passed gas;

No matter how, it never happened I missed some significant issues, never happened to me, if that happened to me, I believe I was fired already;

aywl · Sep 28, 2013

Summarize: for complicated patients, for sure we should and I did full assessment, for pt's with minor surgery, like D+C, laparoscopy (this kind of pts most Likely go home the same day after surgery, or stay 1 night then go home the next day once they meet the d/c criteria), i do think i don't have to listen to the lung sound if the o2sat is above 90%, I don't have to listen to their bowel sound if pt told me she passed gas;
No matter how, it never happened I missed some significant issues, never happened to me, if that happened to me, I believe I was fired already;

...............................................................................

Besides, when I found other nurses make mistakes and I never reported them, I believe nurses get enough stresses from pts and their family and nurses should not fight each other;

aywl · Sep 28, 2013

Besides, when I found other nurses make mistake or missed something, I never reported to the management, I just corrected it if I can, I believe nurses got enough stresses from pt and their family, should not get stresses from inside;

CodeteamB · Sep 28, 2013

What do you have to lose by doing an assessment on your patients? You have already been spoken to by management for not doing it, and as I have described there can be adverse consequences for the patient if the nurse is not vigilant.

You asked a question, I (and several others) have answered. Yes, we assess our patients and so should you, and no, vital signs are not an adequate assessment.

You don't have to agree, but, again, I recommend that you make routine assessments a part of your practice.

lemur00, BSN, RN · Oct 1, 2013

I work in medicine/renal. We do a head to toe assessment (rather than a systems assessment) on all patients at the beginning of shift except those who have been approved for LTC, who are assessed twice a week. On the surgical wards they usually do focused assessments, but in medicine patients often have multiple problems involving many systems so you have to check everything. These patients can come in with one complaint and very quickly have something else entirely go wrong.

A head to toe assessment only takes about 5 minutes because you are able to assess more than one system at once. Even the charting is relatively quick because we use a guide with tickboxes. I remember having to write out EVERYTHING as a student, which took FAR longer than doing the actual assessment. Blech.

The logic on LTC patients not being assessed btw is that this person is at their baseline of health and thus doesn't need assessment (if they had a place to go they would not be in the hospital). When they go to LTC, they are considered to be living at home. Most stable people living in their homes don't require nursing assessment twice a day and it would be an imposition to them. This doesn't preclude doing an assessment at any time their condition changes.