am i really for nursing?

Getting into a routine takes time. Some nurses who have worked the floor for a year are still trying to find a routine that best suites them. It is okay. As for the assessment, I always: check vitals, listen to the heart, lungs, and bowels. I also check the patient’s orientation and their skin. The rest of my assessment depends upon what is wrong with the patient. For example, if I had a patient with a head injury, I would incorporate frequent neuro checks. Think about what you would be watching for the kind of patients you receive.

Here are a few simplistic suggestions

Congestive Heart Failure (CHF) Knowing the pathophysiology of CHF, we are going to be concerned with fluid overload. So, we would check lungs frequently. We would also check extremities for edema.

Patient has a fracture of the femur and is in traction. What would we look for? Depending upon if it is an open or closed fracture, we would assess for signs and symptoms of infection at the break. Regardless, we are assessing for neuro/sensory function and blood flow to the extremity. How do you think we check those things?

It will come with experience. You ARE NOT expected to know everything upon graduation.

Hi,

This is what I do when am at clinical.

1. As soon as I go into the patient's room, I look at their skin (see if it looks normal, blue or pale).

2. Check if they respond to opening of the door, my voice, turning on the lights or touch. (Best eye opening response- Glasgow coma scale). Then, I introduce myself to them.

3. Take vital signs and especially note the BP, so that any antihypertensives can be put on hold, if BP is low. [i don't know why but, I am always concerned about the BP eventhough the nurse might say this reading is normal for the pt.- well, the nurses know their patients well].

4. Administer medications and check for any side effects 5 minutes later.

5. Start preparing for the bed bath.

6. Do a quick assessment while giving the bed bath---note any abnormal findings on the skin, any bleeding on the dressings etc.

7. If there's time, go back and complete the neuro assessment (or other assessment related to the patient's diagnosis). Usually there's not enough time to do a complete assessment so, I just check the orientation and alertness, listen to chest, lung and bowel sounds.

I try to stick to this routine, but sometimes it gets disturbed when I have to help my groupmates with turning, holding, repositioning or bathing heavy clients.

Do you have health assessment pathways? If you practice doing a priority assessment with the help of the pathways, it may help you be better at doing an assessment on your own, later on.

well, this is an advice from a third semster practical nursing student..hope it helps :)

You will begin to get a better feeling for the routine and what works best for you as you get more experience. During clinical I try to follow the same pattern, as I have found that it works pretty well, but I can't always do this. This is how my morning usually goes:

• I recieve patient assignment and listen to report on the patient that I will be taking care of for the day.
  
• I go into my patient's room, introduce myself, and take morning vital signs. While introducing myself and conversing with the patient I assess LOC, orientation, and determine whether the patient is awake, alert, oriented, confused, etc.
  
• After introducing myself and obtaining vitals, I go to the computer, look my patient up, and chart the vitals that I just took. I make sure the vitals aren't a departure from the patient's baseline before I do anything else. If the vitals are normal, I review the patient's history, their admitting diagnosis, the lab work they have had done, the medications they are getting and the times they must be administered, any tests they are having today, and the orders for the patient.
  
• Med pass at the hospital I'm currently at begins at 9 AM. When I look my patient up in the computer, I write down every medicine they are getting for the 12 hours that I am there. I write down the time, dose, route, both names, why they are getting it, etc. If I have to give meds at nine, I remove the meds from the system and prepare to give them. If the patient doesn't have meds due until ten or eleven I go into the patient's room and complete my head to toe assessment.
  
• By the time the 9 AM med pass and the head to toe assessments are done, breakfast has made it's way to the floor which we are doing clinicals on. Unless my patient needs help eating, I try to give them a break and let them eat in peace. I take the time they are eating breakfast to chart my head to toe assessment and the medication that I gave at 9 AM (if I gave meds then).
  
• After breakfast, I clean up my patient's tray and make a note about how much food they ate and how many mls they drank. I then prepare to give the patient a bath. During the bath I do a total skin assessment (more in depth than I did for the head to toe) and if I missed anything, I make a note so that I can go back and add things in the computer.
  
• After the bath is complete, and I've helped my patient change clothes, I leave the room and chart how much breakfast they ate, and chart the bath that I've given. I take this time to also chart any other pertinent information. For example, if I gave a pain med at 9 and reassessed pain at 9:20 but didn't have time to input it into the computer, I use this time to chart that the patient's pain had decreased and the medication had worked as it was intended to, etc.
  
• After this is done, it is usually time to give the 11 AM meds. If my patient is getting meds at 11, I prepare them, give them, and do follow up if it is necessary. I then chart everything that I've done.
  
• After all of this is done, things tend to slow down just a bit. Vital signs are done every four hours on a schedule of 8, 12, 4, and 8. Meds are given every two hours, unless it's a PRN or ATC med, on a schedule of 9, 11, 1, 3, 5, 7, 9, and 11. After the 11 AM med, the bath, breakfast, and the first set of vitals I generally have a bit of time to breathe.
  
• At 12 I take the next set of vitals, make sure that my patient doesn't need anything urgently, and leave the room to chart. If the patient doesn't need further vitals, PRN meds, or a procedure done, there is usually a few minutes to sit down at this point in the day.
  
• At around 12:30, lunch comes. At this time I take the patient their lunch, assess them and make sure they don't need anything, and leave them to eat. When lunch is done, I take the tray, total up how much they've had to eat and drink, and chart this.
  

The day continues in this fashion, with different procedures, meds, and assessments being done throughout the day. In addition to the routine things, unexpected things happen. The patient needs a new IV put in, they soil themselves and need another bath, they begin to vomit and need a new med, they need to be started on different IV fluids, they go to the bathroom and have to have strict I&O done, so you have to measure their output every time they go, etc. Clinical is all about finding a routine that works for you. Once you find it, things get a lot easier. Good luck!

I was like you in clinical. Now I am developing a routine, giving thorough assessments and becoming better at the CNA type stuff like turning and positioning etc. It just takes some of us more time. Don't give up.

I'm very thankful that you asked this question as I am in my last semester of nursing school and find myself scattered and unorganized in my patients' care. I had a routine down when I was given one patient but now I am given three patients and just can't seem to find a good routine. Thanks for asking and thanks for all the informative replies!