Published Feb 5, 2014
hello i am a nursing student who is undergoing assessments. I am given scenarios and skills but dont know what they are until i get there. I am confused on how to prioritize my assessments for specific pathologies: COPD, HTN, pulmonary embolism and shock. I know ABC's are first priority but then what? VS chest lung assessment? if anyone has any tips it would be greatly appreciated! Thank you
dudette10, MSN, RN
This is what I want you to do: imagine you're getting report on a patient diagnosed with COPD exacerbation. When you walk in the room, what do you expect to see? What questions will you ask the patient, what focused assessments will you do? Look up the signs and symptoms of each disease process and then create the patient in your mind. Start there, and the answers should start coming to you. Good luck.
anon456, BSN, RN
I always do a head to toe (which gets faster with time) and then focus in on the main reason they are there. Oftentimes because multiple body systems are involved, a good head to toe can catch signs that things might be getting worse. For example you have a patient who is there for pneumonia with expected breath sounds, and then you notice their ankles and feet have developed edema which was not there or noticed on a previous shift. So now maybe the pre-existing heart issue that the patient was managing well is now needing further intervention. Or maybe a suspicious area on the heel that could be a developing bedsore. It's important to have a system of head to toe assessment and follow it every time.
This little book was very useful to me in nursing school and even now I pull it out to refresh myself on what I need to look for with specific conditions.
nurseprnRN, BSN, RN
This is where your prereqs on physiology and pathophysiology come in. One of the ways you will use to prepare for your skills lab testing is to refresh your memory on the common medical diagnoses and what they look like, and why. Have your physical exam book open next to the patho book and see how they fit together. This will be far more useful to you (and will take longer, but so worth it) than trying to memorize a checklist of what to do, even assuming one exists. Anon456's book is a great adjunct text for students learning how to do assessments.
We took health assessment before medsurg and honestly health assessment is now recently making more sense, becoming so much more appreciable and relatable.
So here's my advice:
KNOW the pathophysiology.
KNOW expected symptoms of those pathologies.
KNOW therapeutic and adverse effects of medications.
Additionally remember that assessments include everything .... not just the patient but equipment and family and items in the room.
Lev, MSN, RN, NP
You are right, airway+breathing, then circulation is how you prioritize. Other high priorities after that include new change in mental status, severe pain, abnormal labs that are not respiratory or circulation related, and dehydration.
As other posters have mentioned, you must know the pathophysiology behind these conditions in order to know what you would expect in an assessment. Think about a person with pulmonary embolism. There is am embolus or traveling clot of some sort that has wedged itself into the main arteries or one of its off shooting branches in the lungs. There is a clot in one of the blue arteries or one of its branches in the picture that carries blood from the heart to the lungs to be oxygenated. What would you expect to see in your assessment? If there is a very small clot, you may not see anything at first, but clots can grow as other materials stick to it.
Esme12, ASN, BSN, RN
remember for every patient....If they aren't breathing they aren't leaving. If they don't have a pulse the only place they are going is the morgue. Check you vitals....the target the disease. KNOW your symptoms/presentations of different diseases.
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