Head to toe assessment, New grad ED

[summerforever]

I am currently a new grad and doing internship in the ED. I am with a preceptor. On my first day, I was told to go do a head to toe assessment on a patient who had their triage done. I asked my preceptor if I can observe her doing it first, said no. I did the assessment as I learned from nursing school. When I came out, my preceptor said it was too long. Any advise on how to do a quick head to toe assessment? Do you really do it as you learned from nursing school?

Thanks!

[emtb2rn, BSN, RN, EMT-B]

We do focused assessments in the ed based on the complaint. Head to toe means a quick look to ensure the pt does indeed have a head and that there is a foot at the end of each leg (toes are optional & only if part of complaint and/or a diabetic issue). If a cardiac component, heart, lungs, lower legs get checked. Assessments take about a minute unless it's a nursing home poor historian. Then i do a true head to toe, mostly checking skin integrity.

That's me, YMMV

[Nalon1 RN/EMT-P, BSN, RN]

Yup, head to toe is a quick scan, talking to the pt while checking pulses quickly. Focus on the complaint and any systems directly related to it (resp and cardiac complaints go hand in hand, migraine's and a quick neuro check, isolated trauma, look to see if there is something else injured that they don't mention). No major trauma's require a more detailed, but no initially.

In EMS I learned your initial assessment, takes less than 30 seconds. Get a feel for what is going on, medical, trauma, major, minor issues etc.

It is a skill to do quick accurate assessments and takes time.

While I can't fault your preceptor for making you do it, was there any advice given on what you could do differently?

[summerforever]

Thanks for your comments. I hope I can improve on it.

Nalon 1> My preceptor didn't go in with me. I just went in by myself. When I came out, she said it was too slow... I hope it gets better...

Thanks,

[Lev, MSN, RN, NP]

Find out your hospitals policy for how detailed your assessments should be based on ESI/how sick they were triaged to be. The more assessments you do, the faster you will get at them.

[ParalyticAgent]

In time, you'll be able to have done 90% of your assessment by just looking at and talking to your patient. But that takes time. You're going to be slow for a long time. Anyone who expects anything different is delusional.

[CamillusRN, BSN]

Check your CAB's, and if all is well, move on to a focused assessment of the primary complaint. Have you taken TNCC? ENPC? ACLS? PALS? STABLE? These are great ways to learn rapid assessment of life threats and prioritizing emergency assessments. For the most part, these classes are provided free of charge to employees by most hospitals - some even require them to be taken within a few months of hire. I only had to pay out of pocket for ENPC ($350) and STABLE ($70).

[NurseOnAMotorcycle, ASN, RN]

In the E.D. we see people from all walks of life in every mode of dress and undress. Our head to toe assessments is usually just an quick eyeball for danger signs:

1. are they sweaty?

2. unable to talk in full sentences

3. "just don't look right" (pale, jaundiced, dusky, facial droop, whatever)

4. can they move around in bed independently

5. Hands and feet tell you a ton about their circulation and ability to care for themselves.

Dirty or damaged hands and feet make me do a full skin assessment because those are the first things most people clean. If those are bad, other areas are worse.

[Guest219794]

I am currently a new grad and doing internship in the ED. I am with a preceptor. On my first day, I was told to go do a head to toe assessment on a patient who had their triage done. I asked my preceptor if I can observe her doing it first, said no. I did the assessment as I learned from nursing school. When I came out, my preceptor said it was too long. Any advise on how to do a quick head to toe assessment? Do you really do it as you learned from nursing school?

Thanks!

Er nurse for over 10 years, and thanks to travelling, have worked in 7 ERs. I would have no idea what an ER "head to toe" would be. I am perfectly capable of doing an extensive ICU head to toe, or a rapid pre-hospital head to toe, but do not do a head to toe in the ER.

Rather than ask you to do something for which you have not been trained, your precepetor could have demoed what he/she had in mind ,then observed you doing the same.

Good luck and have fun on the rest of this rotation.

[summerforever]

Thank you so much everyone for leaving comments!