Assessment Skills

  1. Am going to be new to Emerg soon. Wondering if all you experienced ED nurses can talk about your assessment skills, namely, how you specifically approach your assessment, how to "assess the pt in 2 minutes" and what this means, etc. I feel fairly confident assessing peds pts, as this is all my backround is, but I'm feeling nervous (and excited) about working in an adult emerg. Any tips will surely be appreciated by all!
    Thanks!
  2. Visit cari rn profile page

    About cari rn

    Joined: Oct '06; Posts: 22; Likes: 4
    Starting soon in ED (after babies!)
    Specialty: 7 year(s) of experience in Peds Oncology, Public Health, Peds Emerg

    14 Comments

  3. by   Jennifer, RN
    Working in the ER means focused assessments. We assess the complaint only. The exception is if you have a critical pt, then you have to take the time to do a full head to toe assessment. If pt c/o asthma exac, you assess lungs and circulatory system. If pt c/o headache, you assess neuro. If pt c/o left arm pain, you assess left upper extremity. If pt has abd pain, you assess GI/GU, sometimes cardiac. Fast assessments come with time.
  4. by   bill4745
    After 12 years of ICU it was an adjustment to only focus on the main complaint (except critical patients) but it's the only way to function in the ER. You also must have the pt focus on their main problem and keep them from meandering and elaborating.
  5. by   cari rn
    Thank you, that was another question I had: do you have to assess the WHOLE person, or just specifically related to their concern? Sounds like it's only the latter.
  6. by   bill4745
    Addendum: You tend to only focus on the main complaint unless you notice something else significant. Example - a pt c/o possible broken toe, attending orders xray, nothing more (pt has no significant medical history). An experienced nurse mentions pt seems rather pale, finally convinces attending to do blood work: Pt with Hg 5.2, BUN 48, ECG with major changes, etc. Score: RN 1, MD 0.
  7. by   treborhon
    can you please help to do a 3 minutes assessment?my clinical instructors say that they could do a 3 minutes assessment.Pls anwer me.Im a student nurse...Nd im new here..Thanks in advance
  8. by   treborhon
    can somebody help me how to do a three minutes assessment?Coz my clinical instructor said that they could do a 3 minutes assessment.Pls answer me.Im a nursing student.Hoping to learn here..Thanks in advance...
  9. by   traumaRUs
    Am unsure by what you mean about a 3 minute assessment. What components is it suposed to have?
  10. by   treborhon
    Quote from traumaRUs
    Am unsure by what you mean about a 3 minute assessment. What components is it suposed to have?
    sorry.I mean the head to toe assessment to patient.Is it possible to do it in just three minutes?
  11. by   er_guy2003
    I'm with the other ones above. Not sure what you mean by a 3 min assessment. We do focused, sometimes across the room assessments. I also agree with Bill, you'll develop that "extra sense" that may make you look at another system, but that comes with time. I teach my preceptees 1 thing that may help. You will develop this with time: Just by looking and talking to someone for 10 seconds you'll decide 1 of three things.
    the pt is OK, the pt is not OK, or the gray area, We're Ok now, but we may not be in a few minutes. It's the latter that seperates the outstanding ER nurse, from just a good one.
  12. by   cari rn
    I agree with the previous poster, especially as it relates with peds. Kids can crash so quickly; can go from looking just fine, to being septic the next minute. This is why good assessment skills are so essential.
    Again, I'm comfortable assessing kids, but how about adults? Can/do they crash as quickly as kids do? If so, I'd love to hear from people their experiences with adults suddenly crashing on them (anticipated or not). What sorts of situations/illnesses etc. can cause this?
  13. by   Jennifer, RN
    kids can seem hemodynamically stable for a while, even with a large amt of blood loss, but then tend to crash suddenly. Kids also respond very well to fluids and O2.
    adults usually give more s/s of pending doom. Dialysis pts and acute MIs seem to be the most likely pts to suddenly crash, of course other than trauma or serious injury pts.
    I had a pt on the floor that went to dialysis and came back just feeling "a little sick". No specific complaints, just not feeling well. VS were all WNL, no change in mental status, pt suddenly went into asystole, we coded her but never resuscitated her. Very sudden and unexpected.
  14. by   RunnerRN
    I assess differently when I'm working w kids or adults. Adults, unless I get that kick in my stomach, get the focused assessment. You can tell alot by the way they speak and skin tone. If I have someone w abd pn and I'm doing bowel sounds, I automatically move up and do a quick lung listen. I check a radial pulse on everyone.

    Kids are different to me. Unless it is a basic injury, and kid is acting normally per parents, I do pretty much a full assessment. Heart sounds, lung sounds, (I forgo the bowel sounds unless there is an abd c/o), peripheral and central cap refill, fontanel for infants, etc. My favorite question to ask mom and dad - "is he/she acting like himself?" A kid who has been puking all day that is playing with the WR toys is a much lower risk than the kid laying there in mom's lap (obviously).

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