Posted in LiFe, Nursing School, organizing, Stress Prevention

Well… Graduation happened. I’ve definitely been feeling the post graduation anxiety👩🏼‍🎓😓

It feels so crazy that it finally happened!! but I did it. I graduated from nursing school. So, now I’ve started the next step, the NCLEX. I’ve started the application process and the studying process. I bought, downloaded, printed, and page protected a wonderful nurses study guide for the NCLEX:

I’ve also purchased UWorld for 60 days. My goal is to study and to take the NCLEX in a month and a half I have a busy summer with 6 total weddings, one being my own.

One thing at a time, the NCLEX is the next item on my list.

Let’s see how this goes…🤞🏻

Well, evidentially things in life change. I ended up not taking my NCLEX until September instead on in June. I was so stressed and so overwhelmed with trying to celebrate graduation, turning 30, and planning weddings. I burnt myself out trying to complete the 75 questions a day on top of all those things listed above, looking for nursing jobs, all while still working as a bartender.

I BEAT MYSELF UP!! I made myself feel awful for not taking my exam when I originally planned. All my friends were doing it so who couldn’t I?! What was wrong with me why didn’t I have a nursing job lined up right out of school, why couldn’t I complete all the questions from UWorld that I had planned on doing, why did I feel so far behind?

If you’re feeling like this…STOP IT!!!

I was so stuck in my head about all of the things I felt like I wasn’t doing, I completely neglected giving myself credit for all the things I had done. Such as, going back to college at a later age (which was terrifying) and graduating with my BSN which is said to be one of the most difficult under grad programs one can get. I was forgetting to celebrate and enjoy the planning of my own wedding and being thankful so many people wanted me to stand up with them at theirs. None of my nursing friends were experiencing the same events in their lives so how could I compare myself to them.

Unfortunately, that is easier said than done. And that is true about everything in life. I am awful about comparing myself to other people around me. I have to constantly remind myself that we are all our own people, going through our own issues and experiences. No two people are expected live their lives the same way. So why do we do it? Why do we make ourselves feel small or less capable compared to other people? Is it societal pressures, parental pressures, community pressures? I believe it’s all of those aspects, it’s all of the aspects that help shape us into the humans we are today and that’s why we compare, we care. I personally never want to let anyone down or want anyone to think less of me. However, I CAN ONLY BE THE PERSON I AM. I will only be able to do what I can.

One thing that helps me remember this is reminding myself,

I can’t give 100%, 100% of the time. It’s not realistically feasible.

If that is what is expected of my then those are unrealistic expectations. I write these words to remind myself and to hopefully help others that may be feeling the same way.

The pressures after graduation are no different than the pressures people feel on a daily basis. The pressure of “I’m supposed to have this all figured out,” unfortunately for those thoughts, the reality is no one has it all figured out at least not 100% of the time.

So, I remind myself and others feeling this way (as my husband continuously reminds me); take it day by day, do what you can each day and don’t expect yourself to do it all in that one day. As the very true and valid cliché says, “Rome was not built in a day.”

Therefore, today I took a little self care and hung out with my best friend while getting our nails done, I’m writing this blog posts to remind myself of the aspects above, I’m going to do some yoga because I can feel my body needs it, I’m going to go to work and do my best that I can despite the dreams I had last night of feeling overwhelmed and insufficient, and maybe tomorrow I’ll work more on nursing sheets. One day at a time.

Check out the nursing sheets that are completed, more to come.

I CAN DO THIS!

And so can others that may be feeling the same way.

You got this!

Posted in LiFe, Nursing School, organizing, Stress Prevention

NCLEX Studying and When is it the “Perfect” Time to Take it?

There’s not a “Perfect” Time to Take the NCLEX

Taking notes the way that helps me best

I graduated in May of 2021 in the midst of a pandemic. My goal/plan was to take my NCLEX in the middle of June after graduation. Well, my sister’s wedding was at the end of June and I was a bridesmaid; I too am getting married in the year of 2021. The main reason I had planned on taking the NCLEX in the middle of June was because I had seen so many blog posts, Instagram posts, and Pinterest posts saying I should take my exam a month after graduation so I didn’t forget any information and I wanted to get my exam done before all four of the weddings I was in in 2021. Well, if I’m being honest, life happened and I had a lot on my plate with all the weddings. My goal blew up in my face, or so I thought at the time. With my sister’s wedding scheduled right after I had planned on taking my exam, I started to get behind on my UWorld questions (that I had originally purchased for 2 months), there’s roughly 2200 questions to get through. 

Along with the posts saying to take my exam a month after graduation, I saw posts that said to complete 75 questions a day to be ready and get through the questions in a month for the NCLEX. So, graduation was on a Saturday and starting the following Monday I planned on completing my 75 questions a day. Well, Monday came rolling around, I was able to complete 25 questions in about 2+ hrs. After those two hours, I was EXHAUSTED! While taking those 25 questions I was writing down notes from the questions that I couldn’t remember from nursing school. 

Writing things down was my lifesaver throughout nursing school. It was also my crutch. That being said, that’s when I realized there’s no one perfect way to study for the NCLEX (different ideas for studying to come). When I realized how long it was taking me to get through the questions and feel like I was truly getting out of them what I felt I needed; I started contemplating taking my exam later than mid June. I received the email saying my subscription to UWorld was about to expire towards the end of June and I knew I wouldn’t be able to finish all of the questions before that time. So, I didn’t schedule my exam and I purchased UWorld for 2 more months. I felt awful about pushing back my exam. I felt like I was letting myself down, my family down, and my future job down. I felt like I was getting behind each and every day because I wasn’t getting 75 questions done a day. I continuously thought I could be doing better, completing more questions, studying more, and doing less wedding things. Below is the link to one of the study guides I used to study, check out this wonderful nurse! 

As time went on, I realized that was the best decision I could have made for myself at the time. I had an aunt at my sister’s wedding tell me this, “these are the memories you’re not going to get back. You’re at that time in your life that numerous people are getting married and you’re never going to get to experience this again.” Those were some of the most inspirational words I needed to hear at the time. I had been feeling guilty about missing out on wedding events with my friends that were getting married due to studying or doing things for the NCLEX. 

If I’ve learned anything from this experience, it’s to not give myself such a hard time when it comes to not meeting a specific goal that evidently wasn’t right for me. Let’s be honest, life happens and it throws a wrench in your plans. There is not a “perfect” time to take the NCLEX and no one can tell you when it is your perfect time. For me, my perfect time is 4 and a half months after graduation, after 2 of the weddings I was a bridesmaid in, and before my wedding. I’ve used my past notes, UWorld, and other nurses study guides I’ve found online. There’s many resources to choose from that are best for each individual’s personal type of learning. And god forbid if other life events came up, I could reschedule my exam. 

Everything has to be a balance

My mental health is the most important when it comes to my life. Making sure I’m not putting my test before eating healthy, or getting exercise and fresh air. I’ve come up with systems to give myself breaks. For example, I’ll watch a roughly 45 minute TV show to give myself a quick break from taking questions and it gives me plenty of time to eat some fruit or veggie straws that I may otherwise “forget” (studying and not listening to my stomach) to eat. More on strategies to check in with one’s mental health to come. Please check out my ‘Mental Health’ post to check out which books have helped me thus far. The beautifully wonderful author, Rupi Kaur has words of wisdom that touched my soul specifally when I needed it.

Posted in LiFe, Nursing School, organizing, Stress Prevention

Clinical Readiness

Clinical bags/bag Essentials

Clinical stress! No matter how many clinical’s I’ve been to in nursing school I get worried and nervous every time. Something that helps me calm down and relax a little, in general, is making a list. I make a list for everything! Chores, groceries, todo lists; if I can put it on a list to cross it off or check mark it so I know that it’s completed, I do it. So, clinical is nothing different. This way I know I’m not forgetting anything. I’ll admit, Amazon is my best friend with these items. So, I’ve become and Amazon Associate so I could attach the links in this blog. And just to be up front and honest, I do receive a small amount from Amazon when people use these links.

Create Your Own List

My Capstone Check List

Each clinical is going to require a few different materials. For instance, in the list above, I’ve included my pediatric pocketbook for my clinical placement on the pediatric floor. I have also included a few different nursing brains that I’ve accumulated from past clinical placements to see which I feel best fits my clinical needs in this particular placement.

Everyone’s Brain is Different!

I mean this literally and figuratively. The Nurse Brains I use may not be the best for every individual person and that is why I HIGHLY recommend acquiring as many Nurse Brains throughout nursing school as clinical placements. By seeing how each department or hospital uses their Nurse Brains I’ve STARTED to figure out which ones work best for me.

Nurse Brains Coming Soon


Clinical Essentials

NurseIQ Info Badges, Stethoscope, Bandage Scissors, Pocket Drug Guide, Nurse Info Clipboard, Pen Light, Pens, and Essential Oil Retractable Badge Holder
I chose 5 Info cards to hold on to that I felt I needed the most for this specific clinical; head to toe, nursing basics, pediatrics, code blue, and medication calculations

NurseIQ Info Badges: Thank you to a wonderful nurse that has made it her goal to help nursing students and other nurses. I was feeling quite intimidated going into my senior practicum/capstone (final clinical before graduation) due to missing my hands on pediatric clinical. Which was missed due to COVID-19, my cohort and I were unable to complete our pediatric clinical hands on, we had to complete it virtually. So, I started looking at resources when I found this beautiful nurse and her amazing aspirations. Additionally, the best thing about these badges are they’re not only for pediatrics! They cover ALL of the basics that students need and nurses may need reminding of.

Essential Oil Retractable Badge Holder: This is what holds my ID badge and my Info Badges together. I chose the essential oil one because let’s be honest, there’s so many smells in the hospital. It comes with different felt disks so you can keep different smells on different disks. I don’t think I’ve changed out the purple felt disk on mine because it’s my lavender one. If the lavender helps me to not stress as much or if it helps a patient to not stress as much, I say, “why the heck not!” I have gotten so many compliments on it and this is one item that I’ve had from the very beginning.

Pocket Drug Guide: To be fully prepared when dispensing medications. This is one of my most necessary items in my bag. I do not know every med out there, not many do. And one should never administer something they don’t know what its indicatios are or possible side effects to look out for. This book has probably 95% of the medications that I’ve looked up and it fits right in my pocket. For my clinical prep I would mark all of the medications my patient was on. When I would have more than 1 patient I would mark on the tabs, “1” or “2” or even “both” so I know which med goes to which patient and I have the possible side effects, nursing implications, and dosages marked before I go to give the patient their meds. I’ve attached the newest version here.

Bandage Scissors: This was an item I wish I had from the beginning. There had been multiple times that nurses had asked me if I had scissors on me and I always felt behind or forgetful when I had to embarrassingly say, “No.” I will admit that this is not an item I use on a daily basis, however, having them on me when they’re needed is more of a, “HECK YES! I have a pair of scissors!” Instead of feeling any type of disappointment. This particular pair can cut through a penny and can be put in an autoclave. Now, I was not looking for the strongest pair out there. What I was looking for was a sturdy and lasting pair of scissors and after two 12 hour shifts they’re holding up great :).

Pediatric Pocket Book: This item is one that comes in handy more than you’d think. During down time, I look it over and if there’s anything that I don’t remember from the class I highlight it or write it down. I was naive to think that I would remember everything from each course. I would love to be able to remember everything that I’ve learned but unfortunately, that’s not very realistic. I have to remind, reiterate, and rewrite topics to be able to remember them. I’ve also seen that they have these pocket books for other courses. I personally have not used them but if they have as much information (I would assume they would) as this particular pocket book, it’s a great resource. So, I put links to others that I’ve thought about getting, just in case.

A Couple Pen Lights: While performing assessments as a nursing student it’s hard to remember everything you’re supposed to check. There’s so many things running though your mind that it feels like it’s about to explode. One of the assessments I forget most is checking pupils PERRLA (Pupils are Equal, Round, Reactive to Light and Accommodating). With the pen light in my pocket and my nursing basics info badge it makes it easier to remember this assessment. Also, on the pen light they have pupil sizes so you can measure (nice little perk).

Nursing Clipboard: This was another item I unfortunately waited to get until my senior practicum. There were many times I’d try writing on the wall when I needed to add information to my nurse brains. This is another great resource for things such as lab values, pupil measurements, injection sites, all things that when I was in class I thought, “Oh I know this, I understand this,” but then when I’m in the setting I second guess myself and this is an amazing reassurance or double check.

Stethoscope: Now I’ll be honest, I’ve had my stethoscope since I first became a Vet Tech in 2010, so I wont preach about which one is the best because that is something I’m still figuring out. One thing I have figured out is to not spend the most amount of money on my first stethoscope. This is an item that I think is a perfect graduation present for a nursing student. In nursing school your stethoscope gets passed around, taken, moved, tossed, you name it and that’s why I don’t recommend getting your “perfect” stethoscope from the get go.

Posted in Nursing School, organizing, Stress Prevention

Management of the Older Adult Two: Medical Surgical “Med Surg” Two

Well, 2020 has been a bit difficult for just about everyone. Probably a bit more difficult than this course is. So, that means we could all use a little help. I have attached my study guides from my Med Surg 2 class. There’s a Doc available for each exam for download. I recommended adding whatever one feels is necessary from their own lecture. I’ve also attached PDF photos of my own additions to my study guide I added during my actually studying for the exam when I was answering questions on the additional question study guide that is attached. As I’ve mentioned before in other posts, everyone studies and learns differently and that is likely to change from course to course. Being able to adapt ones studying techniques to the course is going to aid in excelling and understanding in the course.

Exam 1 Gastrointestinal & Renal

Exam 1 Additional Notes page 1
Exam 1 Additional Notes page 2
Exam 1 Additional Notes page 3
Exam 1 Additional Notes page 4

Exam Two Endocrine & Cardiovascular

Exam 2 Additional Notes page 1
Exam 2 Additional Notes page 2
Exam 2 Additional Notes page 3
Exam 2 Additional Notes page 4
Exam 2 Additional Notes page 5
Exam 2 Additional Notes page 6

Exam 3 Immune & Neurology

Exam 3 Additional Notes page 1
Exam 3 Additional Notes page 2
Exam 3 Additional Notes page 3
Exam 3 Additional Notes page 4
Exam 3 Additional Notes page 5
Exam 3 Additional Notes page 6

Exam 4 Shock & Burns

Exam 4 Additional Notes page 1
Exam 4 Additional Notes page 2
Exam 4 Additional Notes page 3
Exam 4 Additional Notes page 4
Exam 4 Additional Notes page 5
Exam 4 Additional Notes page 5
Posted in LiFe, Nursing School, organizing, Stress Prevention

Management of the Older Adult

Med Surg 1 is a very in depth course where you pull in pathophysiology and health assessment and apply it. It can be very intimidating. At least I was EXTREMELY intimidated with this course. Still, I MADE IT!

I have attached a few study guides that helped me throughout this course. Each one organized slightly different for people that study differently.

GOOD LUCK!

Study Guides for Exam 1

Respiratory & Peri-operative

Assessment & Pneumothorax
Tension Pneumothorax
Tuberculosis (TB)
Peri-operative
Intra-operative
Discharge Criteria

Study Guides for Exam 2

Coronary Artery Disease (CAD)
Acute Coronary Syndrome
STEMI vs NSTEMI
Coronary Artery Bypass Graft (CABG)
Need to Know Drugs

Study Guides for Exam 3

GI & Musculoskeletal

GI & Musculoskeletal

Final Exam Review

Inflammatory & Structural Disorders
Peripheral Arterial Disease (PAD)
Acute Arterial Ischemic Disorder
Valvular Heart Disorder
Posted in LiFe, Nursing School, organizing, Stress Prevention

Maternal Newborn

Alright, I’m so excited! I received a request for a maternal newborn post so I scavenged up some of my study guides to help gear studying.

I too had a difficult time with the course. Not because of a quarantine but because of a couple snow days caused me to miss class. And if anyone knows anything about nursing school it’s the fact that missing a couple classes puts you pretty far behind. So, I will help as much as I possibly can! I passed the course with a B so here it goes 🤓. I have also attached a downloadable document of my study guides. In addition, I added an extra little study aid for the exams.

TIPS:

  • Adapt to your class
    • There’s some classes I’ve taken and I didn’t have time to rewrite my notes. So I had to come up with other idea (more to come).
  • Highlight!!! Honestly, the more color (sensible color) the better I remember what I wrote.
  • Underline – if something helps your member a term or a concept, underline it. If that’s not enough put it into it’s own separate HIGHLIGHTED box.
  • I sometimes have a difficult time remember the “umbrella concept.” So, I make sure to underline the main subject so that clicks in my mind instead of getting confused later down the road
  • TAKE BREAKS!
    • My fiancé has to remind me after 2 hours to take a break. Set a timer, ANYTHING. Your brain is not going to take in anymore information after that amount of time.
  • Go back over notes 2-3 times before exam.

Exam 1 Study Guide

Another Study Aid/Guide: Exam 1

Study Guide Exam 2

Another Study Aid/Guide: Exam 2

I hope even a small amount of this information helps someone. It helped me.

Final Exam

My final exam was cumulative, so I recommend going back over the previous study guides. However, I have also attached a full final exam study guide.

Know How to Calculate an Apgar Score

GOOD LUCK!!

Posted in Nursing School, organizing, Stress Prevention

Holiday Stress Pick Me Up

We all know the holidays are stressful. We all know schools is stressful, especially nursing school. So, juggling the two together can be a bit overwhelming. Just like juggling work, family, and the holidays. No mater what the combination, the holidays add an additional stress on to our plate. If we let it. I know, so much easier said than done. I am completely guilty of thinking this as well. But, for someone like me who is obsessed with the holidays and everything having to do with the holidays, I don’t want to let anyone or any stress ruin that for me. The holidays are something I look forward to every year. Yes, they may be stressful, if that’s the mind set.

Unfortunately, society has created this chaos about the holidays. Many people, including myself have lost the truth behind the holidays. I’m realizing this at the beginning of the holidays and I plan on changing my perspective. The holidays are a time for believing and having faith. It’s about spending time with people that care about us that we love.

Let’s Make it to Break!

Alright, it’s finals time and holiday time. Talk about stress! Well, one thing at a time. I will be continuing to add onto this post as I get through finals and the holidays myself. In the mean time, I had a fellow student ask me about some of the pictures I sent her to remember HELLP for preeclampsia. So, I wanted to make this study tool is accessible to people that need it. I recently received a book I bought on Amazon and I think this is my new “study bible” if you know what I mean. It has everything I could think of to help me focus my studying.

Illustrated Study Guide for the NCLEX-RN Exam
An “Inside” Look

Made it Through the Semester!

Holiday time means holiday stress, am I right? NO! I am not right! Yes, the holiday’s CAN be stressful. however, they don’t HAVE to be. I’ll admit, there’s been times that I I’ve felt stressed out either about family drama, presents, traffic, or people’s attitudes. Then I have to do something to work through the stress so it doesn’t ruin my holiday spirit. I’ve been creating Mandala’s to put onto my blog to help other people who also need a little “alone” or “me time” (let’s be honest, we ALL need “alone” or “me time”) whether it’s the holidays or not.

Create Your Own Creation

De Stress with Yoga

Yoga for holiday relaxation! Let yourself have that time that is very much needed to recoup and recharge. There will be more relaxation tips to come throughout the holidays!

Posted in Nursing School, organizing, Stress Prevention

Don’t Forget to Take Care of Yourself

We live in a society where we go, go, go, and then we go some more. We forget to check in on ourselves. I say this because I am also 100% guilty of this. Unfortunately, I tend to realize how little I’ve checked in when it seems too late and I’m having a break down. I’ll admit it, I’m human and can emotionally only take so much. Let me say that again, I’m human, we’re all human, we’re aloud to have emotions. We are aloud to express our emotions. However, society has made it difficult to acceptably express our emotions. So, with this in mind we have to check in and figure out what helps release those emotions. Some activities that I have come to realize have been helping me are:

Mandala Colorings

When it comes to drawing, I am not the best. Coloring on the other hand, is something that I very much enjoy. It makes me feel like a little kid again and when I say that I mean, I feel like I have no worries, except maybe staying in the lines. The only “worries” are which colors to use, staying in the lines, and what do I want this to look like. There have been plenty of studies that have shown how coloring can relax the fear center of the brain. This is just one small, easy way to take the mind off anything that keeps playing of repeat over and over in the mind.

Mandala Coloring Book For Adults With Thick Artist Quality Paper, Hardback Covers, and Spiral Binding by ColorIt

Yoga

Yoga is another activity that I didn’t believe in at first. I have been doing yoga for a few years now, never religiously, just when I could. Yoga works if it’s done every day or if it’s done it once a month. Giving myself even the small amount of 20 minutes to stretch and focus just on me, relieves a ridiculous amount of stress. This video has been one of the best stress relievers that I have found. Take the time to relief stress and tension.

Breathing

Breathing and meditation are something that I feel like many people have said, “You should really try this! It really helps!” and yet for some reason, in my mind, I thought, “Yea, ok, yea right” However, my thoughts were completely wrong. I didn’t believe that meditation and breathing would honestly help me to relax and focus my energy. Even though, that’s exactly what it’s designed for. I still didn’t or couldn’t believe it. It took me until I saw first hand how it could help someone.

My fiancé started following the Wim How method. I would hear him breathing in the shower in the mornings. Then when he would come home from work, he’d head down stairs and I could hear him doing the breathing exercises again. At first I was thinking again, “I’m not sure this is really going to help,” and “I’m not so sure I believe in it.” After awhile my fiancé would come up stairs after meditating and breathing and he would have the biggest smile on his face and almost seemed as though he was a completely new person. I could feel how relaxed and at ease he felt. It was electrifying and contagious. So, I thought I’d give it a try. I didn’t think I felt different after the first time so my fiancé said that’s normal and it’ll take a few times to feel the effects. He was very encouraging. And let’s be honest, nothing happens in one day or after one time. I have done the Wim Hof breathing for a couple weeks now and I can definitely feel the effects. This is something that is free, easy, and it works. I highly recommend giving it a shot, and giving it your all. The only person being suffering is you. The first couple times I tried it, I didn’t let myself give it my all and that’s why it didn’t work. Then, I realized the only person I’m not helping is myself.

Meditating

While doing some of the breathing exercises I also listen to a meditation. My fiancé had the amazing idea that we combine the Wim Hof breathing method with a guided meditation. I found one meditation that is all about grounding and accepting. When combining the meditation with the breathing I was able to feel like I was floating. I felt like I was able to ground myself and feel free at the same time. For someone who was so against meditating and breathing and didn’t believe in either, I have become a strong believer. I didn’t realize how disconnected from myself I had become, and honestly, still am. Yet, I am and will continue to work on it, to work on my, work on finding myself and grounding myself. So, for anyone who is hesitant to give any of this a try, YOU ARE NOT ALONE! But, think about it who will it hurt? The only thing it can do is either help, or not do anything. Either way there’s nothing lost.

Posted in Nursing School, Stress Prevention, Wedding Planning

Feeling Disconnected?

Some times I feel as though I’m off balance or I feel like I’ve lost myself a little. It’s almost as though I’m standing over my own body because I feel so disconnected. This yoga video is quick reconnecter. A quick 12 minute video that truly helps you reconnect with yourself. Whether you’re feeling disconnected because of work, school, wedding planning or social life, just about anything; try this video to reconnect.

Posted in Nursing School, organizing, Stress Prevention

Confidence

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

Head to Toe Assessment

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.

Assessment

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.

Vital Signs

Assess:

Pain Level

Temperature

Heart Rate

Blood Pressure

SpO2

Respirations

Head

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)

Skin

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.

Eyes

I’ll check their eyes, by using the acronym PERRLA (Pupils are Equal Round, Reactive too Light, and Accommodation.

Neck

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)

Thoracic

Skin

Again, I’m going to inspect the skin: color, contour, symmetry, moisture, turgor, lesions, rash, bruising, trauma, or piercings.

Cardiac

All Patients Take Medication

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)

Abdomen

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).

Lungs

Auscultation Positions

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.

Peripheral Assessment

Skin

Again, I’m inspecting the skin: color, contour, symmetry, moisture, turgor, lesions, rash, bruising, trauma, or piercings.

Palpate

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.

Other Assessments

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

End Assessment