Assessments every shift?

Nurses General Nursing

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So, I'm about to get out in the real world of nursing. I worked as a tech for awhile on a busy med/surg unit so I feel like I have a little real world experience that will come in handy. I realize that not everything you learn in school is practical in practice, but I have a concern about the lack of physical assessments I've witnessed (or failed to witness) by the nurses.

Of course, they tell us in school that we're to do a full physical assessment on each patient at the beginning of our shift. That would include listening to heart/lungs, checking the skin, pupils, etc.

The only time I ever see a full physical assessment is upon admission. I'm wondering, do the nurses just trust that the nurse who admitted the patient documented everything accurately and go by that? What if the patient had a pressure ulcer or something and the admitting nurse didn't see it, or actually didn't even look?

I'd like to do full physical assessments on all my patients, but I am naive to think that's possible? Do you do them each shift? I know that a lot of times you can assess a patient without being obvious so just because I might not see the nurse take off the patient's socks and feel their pedal pulses doesn't mean they didn't do it. However, I have seen patients come in wearing blue jeans and never take their jeans off when the shift changes. So, I KNOW they didn't even glance at the patient's back side, etc.

What do you do?

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Specializes in Home Health/PD.

I try to do a full assessment on everyone. Usually a pt is half asleep so I am not going to get them to roll over so I can see their bottom. I will assess their bottom/back more when they get up. I will try and get them to turn if there is a wound reported on the backside. I like to see what's going. I know Pts feel like it is an inconvenience, but I'm sorry they are in the hospital and I am responsible for making sure that I know how my pt is at the beginning of the shift. It takes time, but it takes less time than getting in trouble if you "assumed" what the nurse before you did and "trusted" what they said. I have learned to not trust most and get your own personal assessment without basing it on others.

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I try to do a full assessment on everyone. Usually a pt is half asleep so I am not going to get them to roll over so I can see their bottom. I will assess their bottom/back more when they get up. I will try and get them to turn if there is a wound reported on the backside. I like to see what's going. I know Pts feel like it is an inconvenience, but I'm sorry they are in the hospital and I am responsible for making sure that I know how my pt is at the beginning of the shift. It takes time, but it takes less time than getting in trouble if you "assumed" what the nurse before you did and "trusted" what they said. I have learned to not trust most and get your own personal assessment without basing it on others.

Yeah, I don't trust other people's judgements - especially when it's going to be my license and after seeing some of what I've seen. You said you'll try to get them to turn if there's a wound reported on the back side. I guess that's the kind of thing I'm wondering though...what if there's not a wound reported? Wouldn't you still need to look for yourself? What if there's not a wound reported because nobody checked?

I don't know if I'm just being paranoid. That's why I'm asking because I don't want to be the "new naive nurse" who annoys my co-workers by wanting to see everything for myself. I'm guessing if the admitting nurse missed something then she would be liable, but since every shift has an assessment to be signed off, I would be liable for signing off on skin integrity if it was later found that there was a wound.

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Yeah, I don't trust other people's judgements - especially when it's going to be my license and after seeing some of what I've seen. You said you'll try to get them to turn if there's a wound reported on the back side. I guess that's the kind of thing I'm wondering though...what if there's not a wound reported? Wouldn't you still need to look for yourself? What if there's not a wound reported because nobody checked?

I don't know if I'm just being paranoid. That's why I'm asking because I don't want to be the "new naive nurse" who annoys my co-workers by wanting to see everything for myself. I'm guessing if the admitting nurse missed something then she would be liable, but since every shift has an assessment to be signed off, I would be liable for signing off on skin integrity if it was later found that there was a wound.

I work in med surd. If the pt is from a nursing home or some other instution, big mobility issues, I check, if it is a wallkie talkie I do not check their buttocks /sacrum for a wound unless they already have a wound recorded. Many of our patients are incontinent and you check when you change them also. i ask the pt, You can document what areas you did not check. I always check pupils, pulses, listen to lungs, heart and abdomen. palpate abdomen. I do not do a full skin check on everyone every shift. I don't know what kind of unit you were on where nurses never used a stethoscope? I work in med surg and check bowel sounds, lungs, many times a shift.. scary.

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Specializes in ccu.

For ambulatory patients who are A/O I just ask them if they have any open wounds any where.

If they are from LTC, non-ambulatory and/or incontinent I check their butt's myself.

As far as a full head to toe goes....I always listen to heart/lungs/abdomen and check for pulses 2x/shift. The additional assessments I do varies pt to pt. I work on a cardiac/neuro IMCU, so if I have a 40y/o chest painer who's troponins were negative and EKG was fine I probably won't do a full neuro check on them, kwim?

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Do an assessment. My stepdad was in the hospital after a bowel resection surgery to remove a tumor and not a single nurse on the med/surg floor that took care of him checked his abdomen after he came back from recovery. His bladder distended and he was unable to urinate with 1500cc of urine in him, he had an obstruction above his stoma site and backed up and no one caught that distention (he had to have an ng placed), and he had a staph infection in his incision site that no one caught. So please do an assessment. Not all patients know what is normal and what is not.

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If you don't actually assess the patient, what are you going to put down for your charting of assessments?

When I worked med-surg, assessments took awhile to do and chart since mornings are busy and interruptions are constant. I pushed through and usually finished charting on my last patient by 0900 (just in time to start meds).

This is where you will find the infiltrated IV, the incision looking red, the stoma looking dusky or something you didn't get told about in report.

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If I work nights, sometimes I have to do my full assessment in bits and pieces, but I do still do one. When I am doing the 9pm drug rush, I will quickly listen to heart lungs, anything that is important to the meds I am giving then move on. If I have a patient that I need to look at the bum, I call the NA and tell her that if the patient goes, to call me, that I will change them. Never fails, they call me every time. Then I get a good look at the bum, legs, back.

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Well, I've also heard of psychiatric patients showing up to the psych hospital and having foreign objects in body cavities. This was after they had been to the ER in the hospital where they were supposedly assessed. A lot of psych patients are "walky talkies" and you wouldn't know they had mental illness until after talking for awhile. Do you have any wounds or anything on your bottom? No? Well, you're right...that keychain in your orifice isn't a wound! Oh, lordy......I hope I have time to do full assessments.

@anotherone - I didn't say the nurses never used a stethoscope. I'm not sure where that came from?

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Specializes in medical, telemetry, IMC.

Of course I assess my patients at the beginning of every shift. I listen to their heart, lungs, abdomen; check their pulses; check for edema in the lower legs/feet ans ask them about last bm. Then I focus in on their problem area (why they are in the hospital). If I have a 50 year old that's in with COPD exac., I will focus on their lungs (listen front and back from top to bottom of lungs, ask about coughing (productive/nonproductive), do they get SOB when getting OOB? ....). I won't check the pupils on a pt. like that.

If a pt. is in with TIA, r/o CVA, I won't listen to their lungs front and back from top to bottom, I also won't be asking him about coughing. Instead I will be doing neuro checks.

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Well, I've also heard of psychiatric patients showing up to the psych hospital and having foreign objects in body cavities. This was after they had been to the ER in the hospital where they were supposedly assessed. A lot of psych patients are "walky talkies" and you wouldn't know they had mental illness until after talking for awhile. Do you have any wounds or anything on your bottom? No? Well, you're right...that keychain in your orifice isn't a wound! Oh, lordy......I hope I have time to do full assessments.

When talking about 'full assessments', I do hope you're not planning on doing a rectal examination on walkie talkie patients because they might have psych issues---and might have a keychain up there ;)

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I don't think you would have to do an actual "rectal exam" to see that something is off.

What if a "walky talkie" patient says everything is fine down there so you take their word for it and chart it.

Then, in the middle of the night, they claimed to have fallen down on their way to the bathroom....and low and behold, there is a bruise covering their entire backside? Well, the bruise wasn't there before (according to your charting, even though you never looked) and now it is...so there's the "proof."

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