It has been way too long since I wrote last. Over the last couple weeks, I lost my confidence. I received a poor grade on my pathophysiology exam (the one I described in my last post) and it shook me up pretty bad. I started to question if this was the right path for me. I am working on having confidence in myself because I know this is my right path when I am in the hospital and I have a strong feeling that a lot of this is second nature for me.
This semester has been very difficult for me and my fellow students. However, we are all getting though this difficult time together and have each other to lean on when we need it. There were a few days I went to class when I felt like I couldn’t do it anymore and thanks to a few women in my class I made it through the week without completely losing my mind. This goes both ways, I have had a few friends come to me and tell me the same times I’ve told them before. We all need a little reminder that we can do it, we can make it though this hard time.
Organization and Study Time
So, as I just said we all need a little reminder that we can do this; if you’re feeling like you can’t do it, questioning if this is the right path, this is me reminding you, you can do it, you can make it through this. It’s going to be difficult and stressful but we can learn together how to manage that stress together. Writing these blogs and helping other people to not feel stressed helps me to destress.
A head to Toe assessment is a little intimidating. I created a skit that covers everything (on our checklist, make sure to customize this to your own checklist or liking). I organized mine in a head to toe direction.
I start by introducing myself to my patient, I wash my hands, educate them on what I’m there to do, I provide them privacy, ask them their two identifiers, if or what they are allergic to, make sure the bed is locked, and move it up to my working height.
Then I assess their LOC by asking the patient if they are oriented to who they are, the time, where they are, their purpose, and speech. I assess their central nerve VII by asking them to make facial expressions such as raise their eyebrows, squint, scrunch their forehead (to assess upper aspects of the face) and smile, bare their teeth, pucker their lips (to assess lower aspects of the face)
While they’re doing this I am assessing their skin on their face for: color, contour, symmetry, moisture, turgor, lesions, rash, bruising, trauma, or piercings.
I’ll check their eyes, by using the acronym PERRLA (Pupils are Equal Round, Reactive too Light, and Accommodation.
Lay the patient flat on the bed (remove all pillows) in supine position. You should be able to see their interior and exterior jugular veins with a pen light. Start to raise the bed until you can no longer see the veins and note at what degree of the bed they disappear (should be between 30-45 degrees)
Again, I’m going to inspect the skin: color, contour, symmetry, moisture, turgor, lesions, rash, bruising, trauma, or piercings.
I’m going to auscultate (listen) to the valves of the heart starting at the aortic valve (right of the sternum, 2nd intercostal), pulmonic valve (left of the sternum, 2nd intercostal), tricuspid valve (left of the sternum, 4th intercostal), and the mitral valve (mid-clavicular, 5th intercostal). I’m listening for the rate and the rhythm. I will also asses S1 (heard louder at the apex of the heart mid-clavicular, 5th intercostal) and S2 (heard louder at the base of the heart (second intercostal)
I’m going to inspect the abdomen just by looking at it at eye level, looking at: contour (flat, round, protuberant, or scaphoid), AP:T ratio (should be 1:2 or 5:7). Inspect the aorta just left of the xiphoid process for heaves, lifts, or pulsations. Then switch my stethoscope to the bell and listen for any bruits or thrills happening in the aorta.
I’m going to listen to the abdomen in all 4 quadrants, I want to be able to hear bowel sounds in all 4 quadrants. I will then percuss the abdomen for tympany (dullness over visceral organs, i.e liver).
In total for the lungs I’m going to listen to 14 places, 6 on the posterior, 6 on the anterior, and 2 lateral. I’m listening for resonance in the lungs.
Again, I’m inspecting the skin: color, contour, symmetry, moisture, turgor, lesions, rash, bruising, trauma, or piercings.
I’m going to assess the CRT of their fingers and toes (should be less than 2 seconds). I’m also palpating the pedis & posterior tibial pulse, the symmetry of the radial and ulnar pulse. Assess the strength, symmetry, & any edema in the limbs in addition, hair distribution.
If the patient as any tubes, lines, or drains, I will inspect them and make sure they are clean, dry, and intact.
Lastly, I will asses their gait. I will have them walk their normal gait, then walk heal to toe.
Exiting the Room
The patient has their call light
They don’t have any questions for me
They have their call light
Their bed is lowered and locked