Depending on your learning style and the amount of
time you have to invest in preparation for your weekly check-off (CO), you may
find it useful to write out a script for your CO. Depending on the organization
of the CO sheet, you may be able to order the steps in your script to match the
order of assessment elements on your CO sheet.
When you’re writing your script, remember IPPA
(inspection, palpation, percussion, auscultation) is always the order in which
you perform your assessment, with the exception of assessment of the abdomen (Seidel, et
al., 2011).
As you proceed through your assessment, assess your patient from head-to-toe.
This helps you stay organized and move in a methodical manner. For example,
when you’re assessing the integument, start at the head, noting any blemishes
such as macules, papules, or pustules (Seidel, et al., 2011). Tell your evaluator
what you see: location, size, shape, color, texture, and distribution. Is it
raised or flat? Is it the size of a pencil tip or pencil eraser?
When you’re writing your script, keep in mind that
you will be performing your assessment as if the evaluator (either an upper
classman nursing student or clinical instructor) is not in the room. Talk to
your patient; they are the ones you are evaluating. At the same time, remember
that your evaluator cannot read your mind. If you’re inspecting a patient’s
skin, tell the patient, “Now I’m going to inspect your skin. I see that you
have a small papule on your left cheek that is light brown, raised,
well-circumscribed, and less than six millimeters (mm).” This point would be a
good opportunity to explain the ABCDs of melanoma. Tell your patient, “A is for
asymmetry; B is for border; C is for color, and D is for diameter. An ideal
papule or macule is symmetrical, has a clearly defined border, is uniformly
colored, and is less than six mm in diameter.” If a papule or macule is
asymmetrical, has a border that is blurred, has two different colors, or is
greater than 6 mm in diameter then you should advise your patient to see their
physician because these might be signs of melanoma and they should have their
papule or macule examined by someone trained in identifying melanoma. Even if
your patient’s macule or papule does not show signs of melanoma, it’s important
to remind them to watch any moles for changes in size and color, asymmetry, or
indistinguishable borders (Seidel, et al., 2011).
You may find it helpful to include pictures in your
script such as diagrams of the locations to place your stethoscope when
listening to lung sounds, heart sounds (S1-S4), etc. You will not be able to
refer to your script or CO sheet during your CO, so come to the Nursing Lab
prepared to CO on your assessment for the week. The goal is for you to remember
what you should be assessing in each system so that when you get to the
hospital, you’re not carrying around a million papers containing the list of
things you should be assessing on your patient. This is why I suggest you
initially memorize what you need to assess in each system so that you can,
first of all, pass your COs and, most importantly, know what you need to be
paying attention to when you assess your real-life patients.
When you perform your assessment, remember that for
anything that you perform on one side, you must also perform on the other
UNLESS you say, “I would do the same thing on the other side.” For example, if
you percuss for diaphragmatic excursion on the left side, you must say that you
would do the same thing on the right side otherwise you will either receive
half credit or no credit at all because you professor can deem the skill
incomplete. It’s a good idea to include the statement, “I would the same thing
on the other side,” in your script so that you remember to say it when you CO.
References
Seidel,
H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart,
R. W. (2011). Mosby's guide to physical examination
(7th ed.). St. Louis, MO: Mosby.
