ICU Assessment

[sheika21]

Hi, all. I am a new nurse and got hired in the ICU. My preceptor is extremely smart but works too fast and doesn't explain the steps well enough for me to learn the how tos from her. I've been there a month and am afraid to touch anyone because I don't know what it is I am supposed to be doing. Please help a sistah out, and tell me what are the steps to completing a Head to Toe ICU assessment. Any other info you would like to pass on to a new nurse in the ICU would also be greatly appreciated.

[loveSBK]

You need to start assessing patients in order to learn. Even though your preceptor doesn't explain everything, watch her attentively and make notes. Try to do an assessment after her and then explain to her your results. Practicing is the only way you can learn. Also, watch YouTube videos on head to toe assessments and they will help you. Good luck!!!

[dexm]

I agree with the PP, and would like to add that if you have questions, you need to ask them! Even if she is going too fast. Pull her aside and tell her she is going too fast for you to learn, and then ask the questions you need to ask. She might not even be aware she is going too fast for you, and she will never know if you don't tell her. Unless you are going so slow that it creates a problem with time management, she will most likely make adjustments for your learning style.

However, it's not acceptable to have been there for a month and still be afraid to touch a patient because you have no idea what you're supposed to be doing. I don't mean to sound harsh, but preceptors on my unit would start questioning their preceptees' abilities to be assertive and a safe nurse (if they hadn't started questioning that already).

[anon456, BSN, RN]

You need to touch the patient to get comfortable. I KNOW it's scary, believe me. Ask if you can do things while she watches you and gives you feedback. If you are not comfortable with that yet, follow her exactly as she assesses. For example she listens to the lungs, then you do. She checks pulses, then you do. You need to learn with your hands, not just your brain.

Prioritize what needs to be assessed first based on the patient's condition or potential condition. Then do the whole body.

For example you have an intubated trauma patient with leg and skull fracture, you would assess

1. Airway (including securement and breath sounds)

2. Vital signs on monitor (the basic ones, plus art line, ICP, etc.)

3. Neuro

4. Neurovascular check of leg and leg wound

5. Rest of the body per the basic head to toe assessment including devices, lines, IVs, etc.

6. Urine output and I&O's

Don't forget skin assessments including monitoring for devices that may create pressure ulcers. When turning the patient always check the full back and sacral area, the back of the head, the c-collar for any areas where the pads may not be on right and may be creating a wound, and check the bottoms of the heels. Also check the lip of an intubated patient for too much pressure, and check the nare of any tube coming out of it for pressure ulcers. These things can happen fast if you don't pay attention.

And at the very first assessment, assess the room, too, for emergency equipment such as ambu-bag and suction.