head-to-toe

[Medsport, LPN]

Hope this is'nt a stupid question, but what exactly do we do in a head-to-toe exam? The peds instructor passed out a form similar to the one we used last semester to highlight expected or ineffective behaviors. Most of it can be filled out by asking the patient questions, looking in their chart or doing the basic VS. There were some additions to it such as reproductive. I did'nt fill that part out because nobody ever told us we had to inspect the genitals and ask the patient (if they are not an infant or toddler) about whether they are sexually active or not. We had a lab that showed us one way to do head-to-toe, the book has some differnt things to do and the films we had to watch went into alot of detail I'm sure we are not supposed to do, such as using an ottiscope to inspect the eyes and eyes. I'm going to my second clinical day at the peds hospital tommorrow and I'm still not sure what we're supposed to do. We only have 4 days total there and then go to OB for 4 days (1 day a week). My gf told me you are supposed to get another nurse or the parents when you do the genital area inspection, but the instructor or paperwork does'nt say. Maybe we're just supposed to do a general survey. Think I should I ask the instructor to help when I do an assessment tommorrow? I think the plan is to have us start passing out meds and charting too. I have'nt done either yet. The charting is on the computer which we did a demo on at home, but its not the same...

[neneRN, BSN, RN]

In your lab, did you cover neuro exam (pupils, hand grip/leg strength), respiratory (breath sounds, quality of resps), cardiac (heart sounds, cap refill), abd (inspection, auscultation, palpation), etc. for all body systems? I 've only touched on a few highlights, but these are generally types of things you are assessing in a head-to-toe.

[Future_Nurse_Natalie]

Follow the charting and add in some extras. that's how I always do it. The extras are for the CYA factor (Cover Your A**) :chuckle

[Scrubz]

It's good to know how to do a complete physical assessment, but the funny thing is I've never met a nurse who's had to do the whole thing start to finish... Not any nurses at the hospital I work at anyway. Luckily I have a pocket handbook that reminds me of all the steps..

[Daytonite, BSN, RN]

in general, genital exams aren't done by general practice nurses, especially on kids. being a male, i wouldn't advise you to ever attempt to do one on a female without their consent and another female present. and, then, you better have a real good reason for it because it is going to be questioned. for a general nurse any genital exam amounts to nothing more than inspection. as a male that's about all any male patient would expect from you too--period. anything beyond that should be deferred to the doctor. now, if your instructor is at your side and is telling you something different, use your best judgment, but as a male i think you need to be careful with this part of any physical exam. most doctors don't even do genital exams either and write on their history and physical "deferred" for that part of the exam.

i can also tell you that doing a genital or lady partsl exam on a child is not an easy thing. when i was a supervisor i happened to be making rounds in the er when a 3 or 4-year old girl was brought in with a laceration of the lady partsl area that she got when she somehow got mangled in the top of a fence she was climbing over. she wasn't about to let anyone touch her! what ultimately ended up happening was that she had to be taken to the or and given a general anesthetic where the wound could then be adequately examined and properly sutured.

with teenagers you can ask them if they're sexually active (have another female with you if you are talking to a teenage girl) and if they are, are they using any kind of protection or birth control. this is just a question that is part of the history taking.

you will find lots of resources on physical assessment including videos from some of the medical schools on this thread:

• https://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - health assessment resources, techniques, and forms (in nursing student assistance forum)

the basic nursing assessment goes quickly and is not as detailed as what the doctors do. here are a couple of links. the first one is one that most students really like because it gets right to the point and is focused at the general nurse:

http://www.mededcenter.com/module_viewer.asp?module=+118#headtotoe - this is a great guide to physical assessment. it is called head to toe assessment in 5 minutes (well, maybe a little longer than that)

http://web.archive.org/web/20041115042143/www.vnh.org/shipwreck/shipwreck.html - the u.s. navy's shipwreck's go-by physical examination guide used by naval corpsmen. an excellent source for learning how to do a physical assessment

http://www.childbirths.com/euniversity/taking%20history.htm - taking a history. a brief discussion about talking with a patient while performing a history and review of systems and how to actively listen.

you need to keep in mind that when you are assessing children what stage of emotional and life stage development they are at.

here is an example of narrative charting:

• http://www-isu.indstate.edu/mary/chart.htm - this is a sample of how to do a narrative charting of a head to toe assessment. it is for a patient with a recent cva.

[Barb101]

Thankyou daytonight I have allways watched other nurses DO a head to toe but it allways seemed like something was missing. I have a print out of the HA HA 5 min assessment. Now finially I have a guide that is to the point and reveals a true reflection of the pts condition at the time of assessment.