Having a difficult time with physical assessments

[MB37]

Question: I'm in Fundamentals and Physical Assessment this semester, and I'm doing well in my didactic courses. I've gotten essentially good feedback from my preceptors and my instructor so far, and my patients have all seemed to be appreciative of having someone extra around to help care for them. Each week, we do a PAT (patient assessment tool) on one patient, and we do the assessment of all the systems we've learned so far. Most of them, I understand the need for. I listen to the lungs and heart in the morning after vitals, check the skin throughout and if I assist them with a bath, and we just learned GI but I have been trying to listen for bowel sounds already.

What I have a hard time making myself do is the stuff that my preceptors don't do: a detailed HEENT, percussion, and deep palpation of the abdomen (which I'm not sure my instructor will ask for, we just learned it). So far, we've been allowed to mix and match on the PAT - we can do one patient's lung sounds, another's skin, and our lab partner's eyes and ears. However, we weren't moving on to DPIE and we need to by the end of the semester. It seems like we'll have to do the whole head to toe on one patient for the diagnoses and planning to make any sense. What do you more experienced students say to the patient to get them to let you practice all of this on them? I don't want to tell them it's just for practice, but I also don't want them to get worried. I want to learn good technique, but I'm not really sure how. We're all split up on different floors, so our instructor just makes rounds on us and we only see her for maybe 10 minutes of the clinical day.

And advice is welcome! Thank you!

[MEO82]

I would simply ask if it is okay if you listen to their lungs, heart, etc. They know you are a student. Don't say practice - say that you need to get used to hearing the sounds. Most people love the attention. :)

I'm surprised you are doing deep palpation. We were told that RN's only do light and even that is rare. I am having trouble with percussion! I can only hear the bone in my finger! :)

Good Luck!

[RheatherN, ASN, RN, EMT-P]

i was also surpised by the deep palpation, we are not allowed to do that either.

As for the other ?, play the student card!! i still do! tell the pt you are their for them, which you are anyhow, but if they refuse or give you a hard time, tell them the instructor makes you and if he/she finds out you didnt..oh my!!! they totally understand, you just dont tell them you are "practicing".

besides, we are ALL practicing right? i will be until i quit nursing.

GL!

-H-

[MB37]

Thanks so far - we practiced deep palpation on each other in lab, but I didn't subject my patient to it last week. My CI says RN's don't actually use percussion that much, but she didn't say the same about deep palpation. I wound up having a young patient who was in overall good health (in for DKA, getting d/c'd that day) and we had a lot in common. She seemed genuinely interested when I explained all the stuff I was doing early in my assessment and asking history questions (i.e. no one had ever showed her how to do a breat self-exam before, she hadn't realized it was so easy), so I explained that I had to write a "paper" on her and asked if she'd mind if I tested her hearing, checked her eyes, did the mini mental status exam, and everything else. She didn't, and we had fun with it. I guess I'll try something like this from now on, but I still think it'll still be hard on an older frailer patient. Anyone else? Tips? Again, it's not listening to the heart and lungs that I have trouble with, it's the stuff that isn't warranted by anything in the patient's condition, like using the otoscope/ophthalmoscope. Thanks for the answers though, I started to think no one would respond!