Physical assessment help?

[Kind-N-Caring]

Hello, I am a first year nursing student trying to perfect my physical assessment while staying in my scope of practice as a nursing student. I understand the concept of looking at patients skin and the importance of it, my issue is when i perform my physical assessment in clinicals my instructor always brings up the fact that i did not remove bandages to observe drainage and the condition of the skin. my question is as a nursing student should i be removing badges, even if they were on just for blood draws.

Thank you, to anyone who replies

[Banana nut, BSN, RN, EMT-B]

I would say personally before i do my assessment i look for any special orders regarding wound care and when the last dressing change was and when the next one is scheduled. If the dressing is dry intact and there are special orders saying that the surgeon wants to be the one to do the dressing changes or that the wound care nurse is doing them then i would verbalize to my instructor For instance this patient is postop day 1 and the surgeon has specific orders to leave the dressing so I will not be visualizing XYZ But if there are dressings that are soiled or anything that can be visualized without a special order then I would definitely at least take note of it

[Kind-N-Caring]

Thanks for the help, when I go to clinical I will remember to check any orders for the dressing changes as well as telling my instructor if I have any issues regarding orders that would prevent me from removing the dressings

[kkbb, MSN, RN]

At my hospital we have 2 nurses do a skin check together at the start of each shift. At this time we can check under bandages (unless orders to not do so). So if we have a student with us, this is the time for bandages to be looked at. But that is for my hospital specifically, which most likely isn't going to help you. What I would do is talk with the nurse you are with and ask about checking under bandages and if they want to be with you when you check (if acceptable for you to be checking bandages at all). My thoughts are that bandages should not be removed a million times per shift.

[katyq82]

What I would do is talk with the nurse you are with and ask about checking under bandages and if they want to be with you when you check (if acceptable for you to be checking bandages at all). My thoughts are that bandages should not be removed a million times per shift.

This (as well as checking for any orders). In most cases you could probably remove an old bandage that is just covering where blood was drawn, but you might not know when the blood was drawn, if the patient is on a blood thinner that might make a difference, etc... I would just check with the nurse. Then you can say to your instructor, for XYZ reason I did not remove the bandage but I looked for signs of moisture, saturation, skin irritation, etc.

Sometimes your instructor might say, "why didn't you do ABC?" and it might not always mean that you should have done it, she might be trying to see if you just overlooked it or if you know the reason why you wouldn't intervene in that situation.