Share your ED assessment tips, tricks and routines!

[RNcDreams]

Hi all!

I'm in my 4th week off orientation in the ED.. so far so good.

One of my goals right now is to improve upon my assessments-- i.e., make them thorough and concise without being excessive, yet without missing important clues.

What are some of your routines?

What are some nifty tricks you've learned throughout the years?

Do you give everyone the same once over, or are you generally just

doing focused system/chief c/o- oriented assessments? (with the exception of those train wreck pts who end up being septic and hypotensive and swollen and have fluid in the lungs, wounds, etc)

I'm finding I haven't gotten into a groove yet. I either over-assess or under-assess.

Share your thoughts!

[ERRNTraveler, RN]

In the ER, you should be doing focused assessments. Example: If a patient complains of chest pain, you would assess their rhythm, ask when the pain started, ask them to describe the pain, where it is, does it radiate anywhere? What's their color like, are they diaphoretic? Are they also SOB, having N/V? Listen to heart & lung sounds. If they sound wet, or have a history of CHF, you'll want to peek at their lower extremities to check for edema.

For abdominal pain, ask where the pain is located, what it feels like, what and when they last ate, are the having N/V, diarrhea? LBM? For females, LMP? Then listen to bowel sounds. If it's upper abd pain, it could be cardiac, so you might want to get them on the monitor just to peek at their rhythm.

You'll develop your own routine after a while- it's something you get better at the longer you do it!

[scrubsnhugsRN]

I learned this from an experienced ER nurse, you can look inside the lower aspect of the eyelid and if it is not pink it will give you an indication of a very low H and H....it really works!

[LeashRN]

Now granted, I'm a cardiac tele nurse and for the most part I do focused assessments. But I still like to get a look from head to toe and besides vs/rhythm, check mental status, heart sounds/apical pulse, lungs sounds, bowel sounds/last BM, peripheral pulses/edema, skin/wound and pain assessments. I can introduce myself and do an entire assessment (all things mentioned above) in 5 mins, 10 if the pt is one of those 'train wrecks'. I want to transfer to the ED soon and let me know if I'm wrong, but I would like to maintain this mode of practice when I change specialties. I understand that if working with a trauma pt the entire focus changes, ie; ABC's (foley always first, however).

Later all, Leash

[ERRNTraveler, RN]

Leash- While most trauma patients will get a Foley shortly after arrival- the Foley NEVER comes before your ABC's.....

When you do switch to ER, you'll want to do a more abbreviated version of the assessment you described above. Doing a "quick head to toe" is not doing a focused assessment. You'll want to focus on the areas involved in the patient's chief complaint.....

[scattycarrot, BSN, RN]

Leash- While most trauma patients will get a Foley shortly after arrival- the Foley NEVER comes before your ABC's.........

Absoutely! No point having a Foley if you don't have an airway!

[LeashRN]

Thanks for the advice - will have to modify my practice some. It may be awhile before I get to the ED there are just no ER jobs in my area!

ARRRGH!

[LeashRN]

FOLEY....AIRWAY, BREATHING, CIRCULATION! was a joke that I read in another thread on this site! Come on guys, cardiac nurses are ACLS certified and RUN codes every once in awhile!

[ERRNTraveler, RN]

FOLEY....AIRWAY, BREATHING, CIRCULATION! was a joke that I read in another thread on this site! Come on guys, cardiac nurses are ACLS certified and RUN codes every once in awhile!

It wasn't clear from your other post that you were joking.... you just never know.....

[LilgirlRN, ADN, RN]

I suppose the best tip I could give you is this... treat the patient, not the monitor, treat the patient using their history as a guide but remember not everything is set in stone. Don't rush to judgement when drug seekers come in, sometimes they are actually sick and have real pain. Never turn down the opportunity to be kind to someone, you never know when the roles will be reversed. The ER is overused for primary care and we all know this, it used to really frustrate me until I walked a mile in their shoes... when I first got a divorce, I didn't have insurance because it was through tthe hubby. My doc wanted money upfront that I didn't have, so I went to the ER. Cost more in the long run, but when you're sick any port in the storm will do. I also used to judge patients by how clean they were, I thought surely to goodness they can buy a bar of soap, then I realized it wasn't the soap they couldn't afford, it was the water.

As far as assesment tips go... make yourself a routine of questions you ask and ask them in the same order that way it becomes routine and you don't forget to ask anything. Same with doing the assesment itself, start at the top and work your way down. Think horses when you hear hoof beats not zebras. Remember it's always OK to ask questions of your co-workers with more experience than you have, that means even the techs, secretary etc. They all know more about the protocols just because they've been there longer. Good luck, hope you like the ER!