Assessment - seriously what are you supposed to do? - page 2
Okay - I'm a nursing student already thru med surg and onto peds. I've NEVER seen any of my instructors do an assessment of a patient, and I've never seen any of the nurses do an assessment. I saw... Read More
May 6, '10Man that sucks! I feel your pain! In my senior placement i had a clinical instructor that totally scared the living poop out of us! In retrospec it was the best experience of my life. He taught us to never to take short cuts on assessments and to always anticipate what could happen (the whole critical thinking). In my opinion was truly a REAL NURSE...
My advise to you is to be honest and tell him/her that you are a learner and as such have a right to learn! Then ask him or her to provide a demo on how one would complete a "systems" assessment.
I also studied "bates' physical assessment.
Totally wishes there was some vids. that i could have refrenced... i'm a visual learner!
May 7, '10The nurses on the floors that I have been on let the students do their assessments and then they check over our charting and sign off on it. When I was in critical care, both my nurse and myself would do our own assessment and chart and sometimes there were discrepancies (for example I would think radial pulses were +1 while my nurse thought they were +2...but of course comparing my own pulse to that patient's pulse I definitely would think it was a +1, but I also think some of charting is based on your own opinion)...and course my nurse would always check my charting. In the ICU (at least where I was at) they did full head-to-toes q8h and then there were q2h "mini assessments" as well as I/O measurements q2h. I would do those on my own and my nurse would just review my charting to make sure I wasn't forgetting anything.
Anyway, I ask them to tell me their name/DOB, ask if they know where they are and who the current president is (or month or season or something)...assessing their orientation. I have never seen nurses check pupils except in the ICU, because checking pupils is the #1 indicator in the unconscious patient and a lot of times you will have patients in the ICU who are on ventilators and are sedated. I always check pupils whether my clinical is in the ICU or on a med-surg floor. I check for hand grasps/pedal pushes/pulls. Assess their skin for color/temperature/integrity/skin turgor/edema. If you have a patient who is a turn have someone help you turn them so you can look at their back/bottom to see if there are any areas of redness. check pulses - bilaterally, but of course never check bilateral carotids at the same time! check cap refill. I listen to lung sounds anteriorly & posteriorly, heart sounds to see if they are regular/irregular or distant/muffled (could be a sign of cardiac tamponade)...listen to bowel sounds in all 4 quads (I generally listen in 2 places per quad) as well as palpating and assessing for any tenderness. check IV sites to make sure they are patent and make sure there is no swelling/redness/tenderness. Check your IVs to make sure all whatever is supposed to be hanging is hanging. Check to make sure they are set at the correct rate.
there are other things that you would assess as well but of course it depends on your patient. If your patient is in restraints make sure you check for circulation around the wrists/ankles and release them at least q2h to provide ROM, whether active or passive. Not all patients are on ventilators but you want to assess for that, such as making sure the settings are correct, checking at what cm the tube is at, checking around the mouth for necrosis d/t the tube/bite block (that has happened before! ), listening to lungs to make sure you hear sounds bilaterally...if your patient has an NG/OG/PEG tube you want to check for placement via air bolus and also check for residuals and record the amount.
etc etc etc.
I know it has been awhile since you have posted this but I hope you have gotten more experience since then!
I also like Bates' Physical Assessment. They have a nice pocket guide! My school used Jarvis' Physical Examination & Health Assessment book - great read! And in simple language that even the most basic student can understand, which really helped me when I took my health assessment class.
May 7, '10Be fearless-the ones who are not... don't learn, don't progress, can't take adequate care of their patients (too frightened to ask questions, too frightened to become "personally-involved", don't question the "status quo", don't make the move to initiate the massive changes that need to occur in healthcare)... also fear can mean you are not inquisitive enough to find out all you can about each and every patient--meaning your unique abilities and raison d-etre as a nurse are being compromised.
May 7, '10I didn't raelly understand assessments until my instrcutor said "you need a baseline to know if something goes wrong". That was my lightbulb moment. It bothered me to go in a room at 7am to be doing an assessment. I thought I could wait until they woke up and do it then. But after I heard that it made sense that I'd have to do it as soon as I got there, so I knew that person's "normal". For me I used the flow sheet as my assessment guide and made myself a flashcard with the order to do everything and kept it on me at all times. But, as everyone said, assessments are key and really what a nurse is there to do. So definatly gain experience doing them. Best of luck to you
May 7, '10I've noticed a lot of nurses in clinicals don't do half of the things that are taught (btw, are you in a BSN or ADN or LVN program?) but as the saying goes "do as I say and not as I do". YOU are the only person responsible for your education and it will be up to you to pass NCLEX and progress. The worst thing you can do in clinicals is hide. You're just wasting time. I've noticed that nurses are more apt to teach if you show initiative, especially the recent grads. When you are in clinical, don't be afraid to ask a nurse something, what is she doing, can you observe, and next time can you assist her (depending on your instructors policy). I've had many nurses try to out run me in clinicals (i'm 3rd semester BSN student) and get annoyed with all my questions but you know what they don't pay my tuition nor give me my grades. My philosophy with that is, they are working at a teaching institution and as far as i'm concerned it's part of their job! The better i do in school the sooner they can retire! Bottom line, be aggressive, if you want to learn, then ask. your teacher will recognize your initiative and you may see an improvement in your clinical grade.
As for assessments, those are pretty important like someone mentioned so you have a baseline. and what you learn in theory will make more sense and stick better if you apply it somewhere like clinicals. i don't think i've done a complete head to toe on a patient but i've done like a general once over i guess. But like if the patient is in for cardiac issues then i would do a more thorough cardiac assessment. Remember your ABC's so respiratory and cardiac are pretty essential on all patients.
GOOD LUCK TO EVERYONE KILLING THEMSELVES OVER FINALS!!!!
May 10, '10I just wanted to add a comment... You should do your full assessment at the begining of your clinical. You want to have a record of your patients baseline data. Many things can develop, in as little as a few hours. If you do your full assessment as soon as you get on the floor you, can do a more focused assessment each time there after. You will also be able to catch things as they arise.
Also, are you charting at your clinical site? I ask this because the assessment sheet that you should be filling out lists things by body system. You would need to check each of these things before charting.
Best of luck!
May 11, '10Always do the full assessment, even if it seems a little silly and not related to the patient's condition. First of all just because the problem is in their foot doesn't mean they can't develop symptoms in their lungs. Secondly as others have said you need a baseline if anything goes wrong. Thirdly, the more practice you get at doing assessments the easier it becomes to recognize the abnormal signs. Once you've listened to a dozen normal lung sounds you'll be able to tell the one that's unusual.
May 14, '10I don't see how "should I do a full assessment" is being asked. The forms require you do to a 5 minute head to toe for every patient regardless of diagnosis.