Saturday, August 18, 2012

Writing a Script for Health Assessment Check-Offs

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.

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.

No comments:

Post a Comment