Can you please school me?

MissJulie · Sep 16, 2011

I'm not a nurse, just a student like you, but what worked for me was starting at the top of the head and working my way down to the feet. For example, with the head, I assessed the scalp, then the ears/eyes/nose/mouth, then neck, then with the chest was the lung sounds/cardiac landmarks, then bowel sounds, etc. until I reached the feet where I checked dorsal pedis/posterial tibial pulses and reflexes, etc.

It worked for me, maybe it'll work for you. Oh, and maybe your school is like mine, if you forget something, you can go back and do it as long as the instructors didn't catch you.

Good luck, though! :)

SweetseRN · Sep 16, 2011

Start at the head and work your way down, head to toe assessment. Sounds like it is too late to practice with a classmate, but that would be a good idea for the future. Hopefully your instructor will prompt you if you get totally stuck. I am sure you know more than you think you do, just do your best and don't be too hard on yourself. Good luck!!!

MN-Nurse, ASN, RN · Sep 16, 2011

Hey nurses, silly question but I wanted to ask...we have a bedside assessment practicum tomorrow. When I have my sheet with me, I don't forget any details. But we will be tested without any sheet available...and I really have trouble remembering every part of the assessment. I will run through it practicing or in my head and get to the end and find a few things I missed. I took the school's assessment worksheet and kind of "re-ordered" it, like made it my own and rearranged it into an order that makes more sense in my head. BUT IT'S STILL NOT STICKING! And practicum tomorrow aside, I'm having the hardest time making assessments seem/feel natural with patients in clinical . I feel so frustrated! I'm so good with people and communication and studying, but when it comes to executing a simple assessment, I am a blathering stuttering idiot who looks like she's never seen a pt in her life. I'm feelin' like a loser today. Any wisdom?

Practice without a sheet. Practice at home on a "dummy" consisting of pillows covered by a blanket. Practice it over and over again.

The more you do it the easier it gets. I actually had the hardest time in clinical checkoffs working with the manikins. A person was no problem - a plastic dummy and I was clueless.

canesdukegirl, BSN, RN · Sep 16, 2011

Step outside of yourself when you are assessing a pt. Don't focus on YOU, focus on the patient. When I say this, I mean TALK to your patient as you would anyone else that you have a conversation with.

It might be helpful to imagine yourself as the patient. What would you first notice about your nurse? What would you want your nurse to be like? Would you rather your nurse know everything there is to know about labs, assessments, values, etc., and listen as they proceed to spout off information that doesn't pertain to you, or would you feel more comfortable with a nurse who comes into your room, greets you with a genuine smile while recognizing what a crappy position you are in simply by being a patient?

The tagline on the bottom of each post that I write holds a very powerful, yet simple message: "Your patients don't care how much you know until they know how much you care."

You must first learn to take the focus off of YOU. Take the 'performance anxiety' off of yourself by understanding that the care that you deliver is not about you. I had a hard time with this myself, because initially, I felt that everything that came out of my mouth was being mentally dissected by my pt. Throw that idea out...the patient just wants to feel better and know that they have a caring nurse that will advocate for them.

When you get past the mental roadblock of being under a microscope, you can then approach assessment as anyone would. What does the pt's skin look like? Color, turgor? Wet, dry? What does the facial expression of your pt tell you? Are they in pain? Do they meet your eyes when you are talking to them? Are they frowning? Are they drowsy?

Can your pt talk to you? Are they answering your questions appropriately?

What do you find upon auscultating breath sounds? What does their heart sound like?

Do you feel a strong pulse in each extremity? Is edema present?

Are the peeing? Taking anything PO? Pooping?

Can they ambulate?

These are all things that you can assess in less than 2 minutes. When you come into the room to greet them, you can get much of your assessment done simply by asking how they are doing.

I will never forget the nurse that I had when I was in the hospital. She was my favorite. She came into my room first thing in the morning, took my vitals and then went over the docs orders for the day. When I asked her questions, she would answer the questions that she knew. When she didn't have an answer for me, she told me honestly, "Mrs. X., I really don't know. I will page the doc and ask. It might take a while for them to get back to me, but know that I will be vigilant and get you an answer. I will be back in 2 hours to check on you. Call me if you can think of anything else that I can ask your doc." Before she left my room, she took my hands in hers, looked me in the eye, gave me a quick squeeze and nodded. I knew without a doubt that she would take good care of me.

The key is to RELAX. You know the science behind the assessments. You just have to jump the hurdle of feeling like you are being judged by your patient.

trauma_lama, BSN · Sep 16, 2011

thanks a lot everyone...so helpful!! keep 'em comin if you have other insight for me :rolleyes:

Mukfay · Sep 16, 2011

All the latest research points to doing rather than "running through it in your head." Do it over and over and over - oh, and over.

If you can do it on a person, go for it. And don't beat yourself up when you forget something. That creates a neural pathway that leads to ... beating yourself up.

One more thing. Don't start at the beginning every time you practice. You'll hit the same sticky spots. Practice from the first place you forget a few times and then go back to the beginning.

It is not normal to remember this many steps in a few series of practices. You have to log a ton of them. Also, try to remember that when you're practicing, you're not testing. If you're anxious during practice, it won't sink in (didn't learn that until 3rd semester Psych nursing).

Repetition on the sticky spots, and no anxiety because you're not testing during practice. Run through fast and pick it right back up and do it again fast after you forget something.

Good luck and let us know how it goes.

(btw - this works for straight memorization of material too).

Isabelle49 · Sep 16, 2011

Close your eyes, take a few deep breaths and relax. Imagine in your mind the patient sitting or lying near you and in your mind proceed with your assessment. You'll do great!

CrimsonAlchemist · Sep 16, 2011

I checked off on my bedside assessment 2wks ago. I started at the head and work to the feet, and doing vitals last

Tinknurse2B · Sep 16, 2011

:tinkbll:i would like to say good luck and you can do it!!! i have to check off tuesday....so i'm practicing on family members over the weekend...i figure by tuesday i should remember something if not everything. you'll do great! :)

trauma_lama, BSN · Sep 16, 2011

thanks a lot. ya'll are awesome...I'll let you know how it goes tomorrow!

jadelpn, LPN, EMT-B · Sep 16, 2011

Don't forget the "other" stuff. Wash hands/use sanitizer first. Introduce yourself, and identify patient--name, dob.(What is your name? Dob?) Look at allergy bracelet. Vitals. Then head to toe. Does patient know where they are? The day/month/year? If they do not, make sure you tell them--pupils sluggish? Slurred speech? and a big one PAIN do they have it, can they rate it? Diet? Can they eat on their own? Can they raise their arms and squeeze your hands? Weak on any side? Neck supple? Heart regular rythym? Lungs clear? abdomen softly non-tender? Have they voided? BM? Are they incontinent? Do they need to use the bathroom? Do they have an IV? Where? Site benign? Does it need rotation today? Edema anywhere? Good pedal pulses? Can they ambulate? Using what? What does the skin look like? Coccyx not red? Then, explain you would set them up for breakfast, discuss plan of care for day (PT/OT? IV antibiotics? Possible discharge? ) and that you will be back with their am meds in an hour....Good luck, and let us know how it goes !