Failed the head to toe physical assessment...please help :(

[Disc_Chick]

My instructor failed me for my head to toe physical assessment check off. I did everything correct. She said because I didn't start with the head and went out of order I failed.

She is requiring me to complete 2 hours in practice lab and then do another evaluation next week!

Does the head to toe have to start at the head? I went right from vitals into grip strength, arms, breath sounds, chest, etc, and then came back to the head. It just felt more fluid doing it this way. I still completed all aspects of the assessment.

[SubSippi]

No, when you're working as a nurse, the way you do your assessment is completely up to you. But, when you're in school, your instructor gets to decide.

I think the reason why, in school, they want it to literally be from head to toe, is because it's easier to leave something out if you don't go "in order." Even if you included everything this time, next time, it could be easier to forget a part. My health assessment teacher let us do it in whatever order we wanted, but I can see how it could be beneficial to a beginner to do it that way.

I know it's irritating, but the fact that you failed means that you have a good instructor, who cares. It would have been easier for her to just go ahead and pass you, because now there's more work for her.

I'm bringing this up because learning how to do a good head to toe assessment is one of the things that will differentiate a good nurse from a great nurse. If your instructor is willing to invest extra time teaching, take advantage of it, ask for lots and lots of feedback, and ask for tips.

[RescueNinjaKy]

It's also cuz when you give a report or write your notes,a head to toe format flows much better. But to each their own.

[nurseprnRN, BSN, RN]

I agree ... go back and do it again in the lab, make her happy, and move on. You may find that you'll find new things to assess doing it this way, anyway.

I use a hybrid system-- top to bottom, sort of-- neuro (CNS, including pain), chest (cardiac, pulmonary), belly (whatever is going on, or not going in, in stomach, intestines, liver, pancreas, including nutrition and tubes and all), lower belly (GU and all that), and peripheral (ortho, pulses, color, temp, movement, positioning ...), and then psychosocial. Modify prn depending on what's in the bed and your assessment findings.

[christina731]

At my school they make us go system by system in lab for check offs but in the clinical setting we are to do assessments as quickly as possible to keep the patient comfortable. I try to start with my head stuff first, then I do similar things together such as auscultating the heart, lungs and abdomen at once, then ask the patient to turn so I can listen to the posterior lungs while I check out their back side for skin integrity. This allows me to do my "stethoscope stuff" all at once without having to put my stethoscope on 4 times. All of this also depends on how cooperative my patient is and what's going on with them. Some patients have an area that's more focused than the other. I basically have learned that I need to tailor my assessments to the patient, not to tailor my patient to my assessment sheet that goes system by system.

[LadyFree28, BSN, LPN, RN]

My instructor for health assessment practicum was the same way; it needed to be "in order" so one wouldn't forget, according to the instructor; she also felt in order gives one a more fluid picture; so when a nurse gives report they would leave anything out...that was her interpretation.

Once you touch a pt, most assessments can be clustered to give a good picture of you pt; I find my focused assessments give me the ability to also cluster additional assessments that may support additional factors in the focused assessment.

[203bravo, MSN, APRN]

be thankful that you get another chance -- in my program a failure of the head to toe assessment was a failure of the entire health assessment course.

[JBudd, MSN]

Head to toe gives you a systematic way of doing it consistently so you don't inadvertently leave things out. Also, starting out with the head gives you time to establish a little bit of rapport before moving to the more "intimate" areas, that require you to get in close, such as the heart and lungs with your scope. I do "head, heart, lungs and belly", then periphery; if your pt tires out quickly or you don't have a lot of time, you have gotten the most critical areas done before having to quit.

[Esme12, ASN, BSN, RN]

Head to toe actually has good reasoning behind it. Most important to least important. THINK about it.

You start with what is important....the head. With the head you encompass breathing. If they aren't breathing they aren't leaving. It is more important to know if their airway is compromised than if they have equal hand grasps or can wriggle their toes. H to T HEAD to toes....start with the head and work your way down.

[Dressagern]

If there is one thing I have learned in nursing school....do what your teacher wants :)

[smf0903]

When we did our head-to-toe we were allowed to do it whatever way we felt comfortable, as long as everything was covered. Our instructor said you develop your own "style" of assessment. We got two chances at the assessment...and thank goodness because I was a bundle of nerves doing it and completely...I mean COMPLETELY, missed the entire abdomen! LOL!! Oy...now I'm at a point where I think "how in the world did I mess that up?!" But I agree with everyone else...practice how the instructor wants it done, do it, and put that check off behind you Good luck!!

[3peas]

I'm sorry you failed. I failed too and was devastated. In the end it was the best thing that happened to me. My assessment skills are awesome now and I can rock a head to toe in no time. Plus I had to redo mine right before finals, so it was less study time. Like others have said do it her way and then find your groove later. Cooperate to graduate.