problems encounter of students in doing physical assessment

suzanne4, RN · Aug 6, 2005

Listening skills can be one of the most important in doing an assessment.

Both for the actual physical assessment, as well as what the patient is telling you.

And I am not meaning just "hearing" skills, but listening skills.

**RosesrReder, BSN, MSN, RN** · Aug 6, 2005

Hello, and welcome to the wonderful family of allnurses. Good luck to you. :icon_hug:

Editorial Team / Admin · Aug 6, 2005

hello fellow students of nursing
has anyone of u guys encounter some problems in doing physical assessment? what are those problems? what hinders you? are knowledge and skills important for physical assessment
pls pls pls share ur experience, opinions, :)

you must utilize your senses. hear what is said. see the facial expressions and body language. feel the abnormality or lack of. smell the wound, yes, the wound. tells you alot. you have to learn to put it all together with the skill of doing a head to toe assessment.

siri, crnp, clnc, rlnc

Daytonite, BSN, RN · Aug 7, 2005

Is there something in particular about physical assessment that you are worried about?

I always keep a little picture in my mind of just where I am in the assessment process with a patient. I try to work from head to toe, but some patients will get me off track, so I have to go back to the little picture in my head and see if I forgot anything. When you start out doing assessments take an assessment form with you if such a thing exists where you are and use it. Over time you develop your own style of asking questions of the patients for your ROS. Make sure your hands are not cold (if you can). This is a little hard to do if you are nervous. Hold the bell of your stethoscope in your hand to warm it up a little before putting it on somebody's skin. Practice on someone else a few times so you kind of have a plan of how you are going to do an assessment with a patient. Respect their privacy. Don't expose parts of their body unnecessarily. If they refuse to let you look at a body part I would still attempt to get them to let you see it, but don't push it. Be very non-judgemental. You will see some things that will just make you sick, but to the patient it may be what they consider their normal condition. And, whatever you do, don't let the patient see you register any shock at what you are seeing, hearing or touching on their body.

Is this the kind of information you're looking for?

leopold · Aug 7, 2005

I have a hard time hearing breath and bowel sounds. I asked my instructor to bring a double stethescope so she could help me and she did once then said I needed to learn to do it on my own. :confused: Anyway, I found a great web site with audio of breath and bowel sounds:

http://www.wilkes.med.ucla.edu/inex.htm

DeanG · Aug 8, 2005

Just to let you know, my first skills check off was for a pysical assessment. It took me 30 minutes. I was so scared, I keep thinking things like "did I forget to check for Edema, did I remeber neck vein distention?" I got an 80, which is just passing! The last skills check off I had, just a week ago was the last of my first year's skills check off. First year is Fall, spring, and Summer. I'll be a 2nd year student in one week yeah! Any way at that check off we had to pick a task out of a hat and it could be any skill we learned through out the first year. So of course, I got an assessment. But after 3 semesters of school and clinicals, I did it in 8 minutes and did so much talking, that my teacher said "yeah, yeah you got it" and cut me off with a 100%. The point is, with practice, an assessment becomes second nature. You start to see your patient as a flow sheet :) Good luck!

maryangelgrace · Aug 8, 2005

thanks daytonite :) it helps me, with my problem...thanks a million who reply with my post..hope to hear more about ur experiences

thank a lot....

godbless to all nurses and future nurses... :balloons:

maryangelgrace · Aug 8, 2005

thank to all who posted there experience and share there opinions...thanks a lot...hope to hear more lot from you..it helps me lot... :) :) :balloons:

Daytonite, BSN, RN · Aug 9, 2005

I thought of something else. All you guys should carry your stethoscopes with you. Practice on your family and friends. You can do a little experimenting with them, most won't know what you're listening for anyway. Distinguishing the subtle differences between the different heart and lung sounds gets better as you listen more and more. The problem with it when you are starting out to learn this is that you really have no baseline to compare everything to. After you have listened to hundreds of hearts and lungs you will know normal heart and lung tones when you hear them and pick up on something abnormal right away. As well, you have to hear adventitious heart and lung sounds many times over to really recognize the subtle differences. If you have a cat or dog, volunteer them. Compared to us humans they are a bit tachycardic.

Good luck, all. Keep practicing!

MicheleSN · Aug 9, 2005

Hi:

I'm new to allnurses. I'm a second-semester student and physical assessments are where I feel weakest, clinically speaking. I have two main problems.

a) My hearing isn't great to begin with, so although I can hear breath, heart, and bowel sounds, I sometimes wonder if I would miss abnormal sounds either because I didn't hear them or not recognizing them as abnormal if I did hear them (thanks for the link to the auscultation assistant!!)

b) When I go in the pt's room to perform the PA, I'm timid. I introduce myself as a student nurse and explain I'll be helping take care of them. Then I hear myself saying something like "I just need to look at a few things..." I'll note the IV fluid and rate, and any IVPB's hanging, then my confidence completely leaves me, and worse yet, I'm afraid the patient/family can tell my confidence is lacking. I know there's little I can do about that but study PA procedures and practice. The really funny thing is that if I need to go in to do an Accucheck or draw a lavender top, for example, I'm fine. I know what I'm doing, I'm not timid at all approaching the patient, etc. It's weird.

The good thing is that with each clinical, I gain a little more confidence and experience.

I'm so glad I found this forum to know I'm not alone.