One of the major tasks of the Advanced Nurse Practitioner is to examine their patients.
This is not just the critical care patient, but may also be the patients out on other departments who may need review or admission by the critical care team. It is important therefore that the practitioner is competent to carry out all the examinations in full.
It maybe that they are never fully performed, but if learned in their entirety then those parts of the examination which are considered relevant for the patient being examined can be easily utilised.
The pages here cover all the major systems as well as the many resources available on the internet generally and You Tube more specifically.
The respiratory, cardiovascular and abdominal examination all start with the same process which can be summed up on this page.
All examinations should begin with the same process, whether you are examining the respiratory system or the musculo-skeletal system.
If you are in an OSCE situation points are valuable and there are some easy points to be earned if you firstly wash your hands and secondly introduce yourself to the patient, explaining who you are and what you are about to do. This is not only the courteous thing to do but also helps in getting the patients trust and co-operation and gains their consent for some of the procedures you are about to put them through.
I make an assumption here that the patient is either lying on an examination couch or, as is more likely in the role of the critical care practitioner, in a hospital bed. If you find yourself in a slightly different situation then you may have to make some adaptations to your approach. The general principles should always apply however.
Having made the introductions then, the first thing you should do is go to the end of the bed and observe the patient from a distance. At this point you are observing both the patient and the environment in which you find them.
When teaching this subject I always get people to imagine that the patients environment is surrounded by a big bubble and you are working from the outside in to elicit any useful information which may provide you with some clues as to their current status. The main point to note here is that the assessment does not start by immediately going to the patient and putting your hands/stethoscope on them.
So what clues may you get from the patients environment? There will be many, but some of the more obvious ones will be:
We can then go on to look at the patient within their environment. Again this is from a distance and we are yet to actually put our hands on the patient.
Having read the guidelines I made these infographics. They are FREE. Just click on the button below.
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