assessment or meds first?

shygoofyone · Sep 19, 2011

Real life nursing vs. school life nursing is different in a lot of ways. I have been known to take medications into a patient's room prior to assessing them, but I do my assessment at that time! About the only time I've given a med without performing my own assessment is when the trays arrive and a diabetic (and accucheck is not too low) or pancreatic enzymes need to be passed and something crazy is going on with another patient, but that doesn't happen often at all, luckily.

Meriwhen, ASN, BSN, MSN, RN · Sep 19, 2011

Always assess first. If you can't do a head-to-toe, at least do a focused one so you know what you're dealing with...and won't do things like give metoprolol to someone whose BP is 80/50 :)

LRC_RN · Sep 19, 2011

Hello :)

Even though I'm just a new grad RN, I've noticed throughout my schooling how many different ways nurses (and other members of the health care team) do things! As for the meds or assessments first, I always do my assessments first. Not only is my license on the line, but so is the health and well-being of my patient- I could go in for a 7am shift and maybe a lot has changed since a) the last nurse went to check on the patient, 2) the nurse checked the patient's vitals, etc. Secondly, I won't give a med unless I'm sure that my patient needs it (i.e. I won't give a antihypertensive if my pts blood pressure is all of a sudden very very low and unlike their usual pattern) so I always assess vitals first.

I have worked on wards where resources are slim and there was only one bp machine, thermometer, etc to go around (for a good 30 patients) so it was hard to do assessments first thing in the morning unless you were the lucky first person to get your hands on the machines. In that case, I would just give the meds that I was sure I could give (i.e. a medication that just needs someone's respiratory and/or heart rate measured, etc) and then leave the other medications for later if I needed to use the bp, thermometer, etc. first

Hope that answers your question :)

RyanRNBSN · Sep 19, 2011

I always do a basic baseline assessment prior to med administration. I usually do a diagnosis focused assessment and then anything related to a medication I will be giving (i.e. HR with dig, etc.). Sometimes I defer some of the assessment until after my medications depending on how busy I am. For example pnuemonia patient... I don't focus on GI right off the bat. However, usually the majority of your assessment can be done by interacting with the patient during medication administration.

LouisVRN, RN · Sep 19, 2011

It depends on the med. I have no problem hanging an antibiotic on stable Mr. Smith then going to assess and medicate a more critical Ms. Jones then coming back to assess and give Mr. Smith the rest of his medications. Sometimes I'll even go see an in pain Mr. Johnson check his vitals, assess his pain/respiratory status, give his pain medications before getting back to Mr. Smith. To me this is part of the fun of working Med/Surg because you constantly have to be thinking and reassessing your game plan for the night based on your patient's conditions and needs. Sometimes it is critical that medications be administered on time so that takes priority and any assessment that is required to safely administer the medication of course goes with it. The rest of the assessment will take priority when there is time. That being said I usually do not have any difficulty assessing and passing all medications on 5 patients within 2 hours. Our hospital policy is for rounding hourly then q2 hours at night. Because of this I am in and out of the patients rooms usually at least 3-4 times in those 2 hours.

divaRN* · Sep 19, 2011

When I worked med-surg I would bring my meds in the room with me. Do my assessment and then medicate. In ICU I have more time and I usually pop into the room to say "hi" and see what the pt might need me to bring back. Ill also grab a set of VS at this time. Then Ill go get my meds (or chart depending on when meds are due) and administer them. there is no right or wrong answer. It is what ever works best for you. But make sure you ALWAYS check a BP and HR or BS if giving cardiac meds, diuretics and insulin.

classicdame, MSN, EdD · Sep 19, 2011

meds might need to be held if your assessment indicates! Don't want to find out too late that the med should not have been given.

AngRN6726 · Sep 19, 2011

I worked my per diem last saturday on the floor for the first time, no orientation. I always do my assessments first no matter what even if its just a quick 2 to 3 minute head to toe check. Like LRC RN said, it is your license on the line and the well being of your patient, so you want to make sure you check your patient. Then if I dont have time to chart it right away I make my quick notes on my clipboard. Then I pass meds. Went back the next day for IV's and noticed the nurse for the same patients didnt do assessments first and was pouring out all her meds for all the patients.Of course she probably finishes a lot faster than I did.In my opinion, thats not a good way to work but I guess we all do things differently.

serein · Sep 19, 2011

Thanks for all your input! It really helps. As a new nurse, I'm leaning towards assessment first because that's what I'm comfortable with right now but we'll see what happens once I'm on my own.

serein · Sep 19, 2011

By the way, I do like the idea of doing assessments and taking in your meds with you! I think I'll try that first! I'm preceptoring during days but I forgot that once I'm on my own I'll be on nights so I probably won't have as many meds to give.

anotherone, BSN, RN · Sep 19, 2011

I bring in the meds when I do my assessment and assess first then give meds. Sometimes I assess patients first then go back and do meds. Depending on how many meds I have to give, how many patients, if patients are going anywhere (tests, OR, etc), I might assess all the patients than go back and do meds. Giving some medications depends on your assessment.