What does your Head to Toe really consist of?

[mykg]

I'm a 2nd semester nursing student on an acute care clinical rotation, I was told by my instructor to do a Head-to-toe assessment on a patient. This took about 15 minutes to do.

The nurse I was with's only comments were that in real life you are not going to go through the whole thing on the floor. What would your priority list as far as head-to-toe assessment be in such a setting thoughts?

[LadyFree28, BSN, LPN, RN]

To add to Mr. Murse's post: once you get the habit of learning to "cluster" your assessment, your time will be less; for example, when you are listening to the quality of a heart beat, you can count respirations, for example., along with the other examples that have been stated.

[NurseSpeedy, ADN, LPN, RN]

You always to a head to toe assessment. This is required. It won't take 15 minutes, as you become more experienced you will get faster. Always be thorough. Remember ABCs and Moslow's hierarchy for priority level.

[mykg]

Thanks everybody! Great answers! I think I'm going to figure out a "script" for myself where I'm clustering multiple things together and practice it out on my wife in order to get the time down.

[bagface]

Honestly a head to toe takes me less than 10 minutes, usually around 8 minutes give or take depending on the patient severity. When I did med surg in school we would have 4 patients assigned to us and their full care was ours and ours alone. I always did a focused assessment first, did my med pass, and then went back and did a head to toe. A lot of people say they do head to toe first, which is practical when you have 1-2 patients. Not so much when you have a full section though. When doctors start rounding I didn't want to be the one that had no clue why or when patient in 421 had strayed from his baseline, and I didn't want to not know what I was facing when the doctor was coming around.

It'll get easier. Practice practice practice. You'll go far :)

[OneDuckyRN]

I agree with anh06005's first reply.

One thing I also found is that while I was in school, I was having to verbalize my entire assessment while being "checked off" on physical assessment. This probably tripled the time I spent doing an assessment. Over the last year and a half I've been working on a step-down unit, I've been able to cut down a head-to-toe shift assessment to around 5 or 6 minutes. A lot of it is observation while I'm also checking vitals. Of course, an admission head-to-toe assessment will take longer, but I can still knock it out in 15 minutes or less, including a full skin check with another nurse (we get a lot of patients from ECFs or are generally not very mobile, so we see people who are at greater risk for skin issues).

I found that having an idea of how your assessment charting is set up (whether you are paper or EMR) also can help you remember what you need to look at.

[akulahawkRN, ADN, RN, EMT-P]

I've spent much of my life learning various assessment techniques and like the others have indicated, it just takes time and practice. I first started learning this stuff as an athletic trainer and expanded that some as a paramedic. When I was working in the field, I learned to do a very rapid exam that's primarily geared toward trauma within about a minute or so. Add in doing vitals and that comes in right about 2 minutes, but well within that first minute, I know if there's a problem that requires immediate transport and what I'll likely have to do along the way. Now then, a more complete exam takes me about 5 minutes. Like the others have said, a lot of that has to do with multitasking while you're checking one area, you look for whatever you can in that same area. The first time I did a full-on exam the way my school wanted it done, I think it took me something like 20 minutes or so. As they got comfortable with my ability to do physical assessments, I could begin the multitask way to do it. It's much faster that way...