Question about head to toe physical assessments

[Mell Bell]

I am in my first hospital clinical rotation (orthopedic floor), and the main things we are doing is passing PO meds, physical assessments and vital signs. My question is, when you start working as an RN, do you actually do things like PERRLA and test strength (strong against resistance, strong against gravity...) and Range of motion every time you assess a new patient? I'm just a little foggy on how nurses actually go about assessing once they're in the field, I don't see any of the nurses on the floor assessing they way we are being taught. Can anyone give me a general idea of how you assess your patients? Step by step, or any tips would be so helpful.

[kimmie4476, ASN, RN]

It depends on the patient. Here's my general head to toe; walk in the room, look at the patient (assessing skin color, diaphoresis, flushed, edema etc.) talk to the patient introduce myself, ask what's going on, try to make them smile (observing speech, slurring, orientation, facial drooping, etc.) Listen to heart, lungs, (making the stethescope leave a ring to check cap refill time) bowel sounds (ask about last bm and urine and any problems) have patient squeeze hands bilat (assess ROM and strength). Look at legs, assess pedal pulses (both at the same time also assessing edema and you could also do cap refill here) then, while my hands are still on top of the feet, have pt pull toes up, then move hands to the bottom and have pt push. Done. It takes less than 5 minutes on a relatively healthy patient. If you find something wrong, then you investigate further, like if your patient doesn't answer questions appropriately, then you need to find out why and do a full neuro, if there's a wound, then you assess that etc.

The reason why you have to do all that stuff like PERRLA on every patient in nursing school is so that when you are in the real world doing a head to toe like the one I described and find something wrong, then you CAN assess it. You have to know normal to know abnormal.

Don't forget that as a nurse, you will constantly be assessing your patient. Not physically putting your stethesope on them of course, but like I explained in my assessment the things I'm looking at just while talking to the patient.

[Mell Bell]

Thank you for your reply, I really like checking cap refill by leaving a ring with the stethoscope - I will definitely use that.