Head to toe assessments

mandana · Dec 30, 2005

Have they not given you specific guidelines to follow for the check-off? We had certain things that were required.

My best advice is to practice, practice, practice. I'd have every member of my family over, and go through it 100 times a day.

I also figured out a systematic approach that worked for me. It's sort of this:

General assessment - ability to communicate effectively? Speech appropriate? Ability to identify self? Orientation x3? Height and weight proportionate? General overview of person.

HEENT - Does head appear normal size, shape? Palpate lymph nodes/thyroid/sinuses, look into mouth while continuing to talk and with person sitting upright. Check pupils/eyes.

Thorax - Person still upright. Check A/P ratio, listen to heart. In my program, it was required that we listen to heart before listening to breath sounds, theory being that having patient breathe for you could change heart sounds. Listen at all four valve areas. Then I started breath sounds, started in the back, then the front.

Extremities - arms - while still sitting upright, I'd check their arms for equality of strength, grips, and ability to push/pull against resistance. I'd also palpate pulses, it was easier for me if they were still sitting to have both arms in front of them. Then, I'd help them lay back to a 30 degree angle.

At this point, I'd jump back up to check for JVD, carotid pulses one at a time, palpate thorax and assess respiratory excursion.

Abdominal assessment - bowel sounds, palpate for tenderness, inguinal pulses, femoral pulses, visual assessment of the skin of the legs and ask about any genitourinary concerns. Of course, if there's a foley, I'd do an assessment of that.

Then cover the person up, and expose the legs. So many of my patients had real circulatory issues that a leg assessment was always important. I palpated the popliteal, dorsalis pedis and posterior tibialis, then capillary refill, strength, skin of the feet/shins.

If there was reason, I'd do more specific assessments like CMS checks or neurovascular assessments, but during check-off there wasn't anything specific we were looking for.

Hope this helps a bit and I'm sure that others will fill in what I've left out and correct any inaccuracies.

Amanda

L&Dwant2b · Dec 30, 2005

ok so for our senior semester we have to do a physical assessment check off and we only get two chances. i am realllyyy nervous about it. i have done many head to toe's as an lpn but its diff with the instructor standing over you. does anyone have any advice or any websites that would help..or anythingg??? thanks!!!

my advice is to just practice because when you get in there in front of the instructor we tend to be nervous but when you get rolling you become more confudent especially if you have been practicing and know what you are doing. they make you guys wait until senior semester? we had to do it in the first semester. imagine that, so we really did not know what we were ausculatating,inspecting ,palpating or percussing. lol

KatieBell · Dec 30, 2005

The best way I can advise you is to make a Mneumonic to go along with the assessment that your instructors expect you to do. Do only what the instructors want, try not to add anything in that will be extraneous and throw you off.

There is a ABCDEFGHI assessment for TNCC and as long as the participant actually remembers the mneumonic and does the steps involved they pass.

So if you can make a series of letters, especially sequentially, then you will know automatically if you miss something. Though you have to slow down. Once when I was doing the TNCC I got so nervous I forgot about I, and since it is the last, well, I forgot it, but I still passed because I had done everything else.