How to make a good head to toe assessment?

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I have my first official clinical rotation in 2 weeks and I want to start thinking about how to make a good head to toe assessment. What sort of questions should I be asking myself? What should I be looking for? I am asking because it is hard to practice head to toe assessments on healthy 17-20 something year olds. We will be working with older adults and I am on a stroke floor if that helps with anything. I was also told finding pulses on older adults is a lot harder to do than on younger people who we spent the entire semester practicing on. I don't live with my grandmother anymore and my mom is still pretty young and has pretty strong pulses. Does anyone have any advice for how to take pulses or vitals in general for older adults?

Thank you so much for taking time to read and or answer :)

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Specializes in General Surgery.

Practicing on your young fairly healthy classmates is actually a good thing. You'll establish a baseline of what is the ballparko of normal.

There is absolutely ... very little you can do to become any better at feeling crappy pulses until you've felt a bunch of crappy pulses.

What I'm trying to say is ...

Practice will come, that's why you're in school ...

Edit: I don't bother too much with poor pulses. Whip out that doppler baby!

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Specializes in Emergency Department.

You should be looking for things that aren't normal. Your classmates should be an excellent base of comparison for "normal" precisely because they're healthy. The hard part for you right now is that all you know is the "normal" and you don't have examples of the abnormal stuff... don't worry, that will come and that's one of the things that school is for.

When you do your assessments for the first few times, expect it to take a long time because it's a relatively new skill. I was very well educated, trained, and experienced in doing patient assessments before I got into nursing school... here's the problem: I was also very rusty at it. I probably took well over 30 minutes to do my first assessments as a nursing student because I hadn't done one in quite a while. I got much faster at it very quickly because I was able to knock some of the rust off of those skills... however one of the "bad" things about being experienced, especially if you're a Paramedic, is that you tend to want to do focused assessments and not a full assessment. While I'm not quite as fast as I once was (full time work would cure that), I'm actually pretty quick at doing assessments again.

You shouldn't worry about comparing yourself to me... because you're just starting out and I'm done. I simply offer this as a comparison between where you are now and where you will be when you graduate. You'll have come a very long way!

Your school should have provided you some kind of cheat sheet or some kind of reference material for you to follow when you do your assessments. Follow those and you'll find yourself doing that stuff faster and faster and you'll notice that your patients do tend to have problems that your classmates don't. Something that's commonly found by students is these furry white patches on the tongue, especially in patients on antibiotics... because sometimes the rest of us get rushed or a little lazy or whatever and we forget to look into the mouth at the tongue for this stuff.

My program had us do assessments by system... and it worked out OK except that our bodies aren't built system by system from head to toe. Eventually you'll work out a reasonably good system for assessing patient in head to toe fashion and cover all the systems in the process reasonably efficiently. It will just be a natural progression. Allow the system to work and you'll do just fine.

Really. You'll do just fine.

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Specializes in General Surgery.

Oh also ... assessment isn't just what you gather from the pt directly but the room too!

Are their SCDs on? IV pumps correct? PCA? IS at bedside? Is there family at beside? Any buckets with emesis near by? Any urinals that need to be emptied and recorded? Is pt using a lot of blankets or all blankets off? Does pt have walker or crutches near by? Call light at bedside?

Mhmmm =) the things a few months of real life nursing has done to me... I sound like my PROFESSORS!

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there's a word document out there one of the guide/moderators made... it has all the body systems and what to look for. i'll post if i can find it.

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Don't you have a physical examination lab text/workbook? Don't you do labs on this sort of thing? What confuses you?

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Specializes in Hospice.

If you just follow the order of head to toe you probably won't forget anything of major importance. Eyes, ears, mouth, ROM of head, neck (trachea midline? thyroid enlarged? glands swollen?). Lungs and heart- are they breathing with accessory muscles? Appear SOB? Auscultate. Abdomen- check appearance (distended, or soft), auscultate for sounds in all 4 quadrants, palpate last. Push/pulls, and pulses somewhere in that order. Check Homan's if your instructor wants it but I don't know if hospitals are using this much anymore. My brain is on winter break so I probably left something out, but that's a brief assessment you can do in a short time.

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Specializes in Hospice.

And of course all the while you are observing/asking questions about pain, and voiding/elimination patterns (or check foley etc)....... we must never forget that!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Just remember Tyra Banks.....H2T....head to toe

attached is a good document to guide you

Pt Assessment Tool.doc

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Thank you for the advice especially about the pulses :) So far even though they aren't strong I have had no issue finding them so far :D

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Thank you very much this is actually helpful :)

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Thanks and yes that is very important we just had a test on this 2 weeks ago

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