How to Study Health Assessment in Nursing School

Assessment is one of the skills that set you apart from a lot of other medical careers. CNA’s, MA’s, Techs, and other UAP’s do not have the assessment skills that registered nurses have. It is one of those skills that is pounded in nursing school, but never truly mastered until years and years of practice. This guide will hopefully give you a better idea of how to study Assessment in Nursing School and answer HESI and NCLEX style questions.

Your textbook may be different, but we used Jarvis’s Physical Examination and Health Assessment, 7th ed.💎

Anatomy & Physiology

Most programs in the United States require A&P I and II. I’ve rarely seen some programs squish all of that in one class. You need to be a master at your anatomy and physiology. Review cardiopulmonary, abdomen, and neuro anatomy before school starts. You will need to be able to pretty much label and/or draw from memory most of your body systems. A lot of people in my class had trouble with Assessment most likely because they were weak in anatomy. I personally had trouble with the cardiovascular system for this very reason.

Vocabulary

There will be a lot of big medical terms that you’ll need to know! Hopefully you’ve picked up a lot from A&P, Patho, and your other Biology classes. When you study, make flashcards of all of the terms you do not know and study them every single day. These words WILL be on your exams, HESI, and NCLEX. Learn them now.

Normal vs. Abnormal

Assessment is all about knowing what you are supposed to be seeing, hearing, and feeling (namely inspecting, auscultating, and palpating). Establishing this foundation is very important! I took notes in two columns. One side was “normal” findings, and the other side was “abnormal” findings.

In your practice, you should be able to tell when something is wrong. You may not know 100% what is going on, but you should be able to tell your doctor over the phone what your findings are.

Study Habits + Repetition

Assessment is a tough subject. It is a lot to chew, especially with your other classes. You need to establish excellent study habits. This means no more going out every weekend, no more binge watching TV. You gotta get up earlier and go to bed later. Check out my Top 10 Study Tips to get some more tips on how to establish excellent study habits!⬇️

Repetition is key with Assessment. I probably studied each set of material more than ten times. I rewrote notes, drew pictures, and answered plenty of practice questions. I made it a goal to know the material inside and out. I probably spent the most amount of time studying for the class during my first semester.

Practice

As much fun reading out of a book is, nursing isn’t all about reading a patient’s chart. You need to practice! Practice on everyone that will let you. Friends, family, strangers (JK, that might be weird). Get used to going through your full head to toe on different people. Talk through your assessment, even if the other person has no idea what you’re saying!

Patience

These skills will come to you. Like I said in the beginning, you will not master these skills until you’ve been in practice for a long time. Don’t be too hard on yourself and don’t be afraid to seek help! As always, I am here to answer your questions!



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FIVE Things I Wish I Knew Before I Started Nursing School

1) Straight-A …Student

If you are/were a straight-A student, get ready to get knocked down a notch or two. I don’t know anybody in my class of about 100 people who have gotten all A’s. I know there were maybe two in the class ahead of us? Point is, get ready for that not to happen.

I came in head-strong thinking, “I know everyone has been saying this but I can do it. I get can all A’s.”

The first round of exams went through and I thought, “Okay. That’s doable.” But then the second and third round came and eventually I was just doing everything I could to stay afloat.

My advice is this: do your best, do not compare yourself to your classmates, and ask for help when you need it. Your grades are not reflective of your capabilities as a nurse.

2) Mental Health > Study Time

“Don’t pound yourself into the ground with studying because self-care is just as important.”

My mentee

Don’t get me wrong, you need to study hard and make it a good habit. But you also need to realize that if you wear yourself out, no amount of studying is going to help you.

Make a study schedule and stick to it. Study every day, schedule breaks and rewards, and do not study outside of your allotted time. I stop studying around 8-9pm every night, and I always get my 7-9 hours of sleep.

3) Roll with the Punches

I had an expectation that nursing school would be organized, the instructions would be clear, and that there would always be a strict schedule. Boy oh boy was I wrong!!

You will have to learn to “roll with the punches.” Don’t sweat the small details. Be ready to adjust and readjust your schedule. Nursing school is very fluid!

I remember one week last semester where they said, “Oh by the way, this small group of people needs to put together a project and present it at this location. And you have five days.” I remember thinking, you want me to do that and my million other things I have going on?

I go to class every day expecting that something else will be thrown our way. That way, I’m not surprised.

4) Nurse-Administrator

The administrative/paperwork stuff added another level of stress to nursing school. The beginning was extra stressful because you have to submit a lot of paperwork to the state board of nursing. It helps to become ultra-organized with your vaccine records, identification documents, health insurance, CPR certifications, background check documents, drug screen, etc. There are 32 separate documents I have submitted JUST to be eligible to register for classes.

You will most likely also submit additional paperwork for each of your clinical sites. You will also be expected to keep up with your resume and portfolio.

If your school tells you to start working on paperwork before school starts, DO IT RIGHT AWAY. If you wait until school starts, you will be stressed out about the administrative stuff and that will cut into your study time.

5) Tick-tick-tick-DONE

When I got my acceptance letter for school, I thought that the two years would take forever, and I questioned whether or not I wanted to commit to two years of my life.

Now I’ll be starting my last semester of school and I cannot believe how fast time has gone by! When did I get here? I feel like I just woke up and now it’s time for me to apply for big girl jobs!

Nursing school keeps you so busy that time passes by really fast. Each week is so jam-packed that seven days don’t seem like enough time.

Don’t forget to enjoy life in those little moments!



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FIVE Things I’ve Learned Working in the Emergency Department

1. Staying on Task

The first few months of working as an intern, I found myself just running around with my head cut off with no sense of direction. I have (mostly) learned the art of writing things down and setting alarms on my watch. I no longer hesitate to delegate to our awesome, amazing, wonderful tech’s. I can methodically organize tasks by patient priority. It feels less chaotic for me! I try to go through four “steps” for each patient:

  1. Initial assessment/ABC’s/Intake
  2. Orders
  3. Maintenance/Repeat Labs/Comfort
  4. Discharge/Transport

I like to write the word “comfort” near the middle of my chicken scratch report sheet. Although not a priority in the emergency room, sometimes getting that patient an extra warm blanket can ease them up and give you time to handle another patient.

2. Using SBAR to Talk to Doctors

Before this job, I had never actually done this. They teach it to us all the time in school but I have always been afraid to do it. My tip? I write down my talking points. Each phone call has gotten smoother, and I usually get what I need for my patients!

An example of my talking points:

S- Mr. X, the 80 y/o male in room 16 who is here for respiratory distress now has an O2 sat of 87% 30 min after the breathing treatment

B- He has a history of HTN and type 2 diabetes

A- BP 142/88, RR 30, HR 94, SpO2 87% on 6LNC, no temp. bibasilar crackles

R- I recommend another breathing treatment and a stat chest x-ray

In school, I felt like they teach us to include everything in our SBAR. There are a lot of situations that would warrant a more thorough SBAR (like giving report to the floor nurse). But when something is needed very quickly in the emergency department, you have to just grab the basics (ABC’s) and run with it.

3. Hospice/Palliative care.

Some of you might be wondering why this is happening in the emergency department. Well you know what. The situation warranted it. We are often on saturation, which means no where else for this family to go for several hours to days. I’ve cried with the families that are waiting for a room somewhere else. I sat with them and ignored the noise and chaos down the hall. I took extra time with the extremely uncomfortable patient to make sure the bed was made perfectly, all trash was picked up, and that the family always had fresh ice water. 

When that family makes a decision for their loved one to be DNR, and we cannot get them a room upstairs, the emergency department becomes the place where the family must start the process of grieving.

4. Confidently Asking for Help

Instead of saying, “I don’t know what I’m doing,” or, “I’m really sucking today,” I say, “Hey, it’s time for morphine, could you pull that for me please?” and “Could you please page respiratory?” My preceptor knows my limits, and I am finally feeling like a real nurse.

Negative self-talk can really hinder your day. I don’t know what I’m doing all the time. But I already know that and I don’t need to bring myself down because of it. I also use statements like, “Could we review this process? I think I misunderstood something.”

ALL. NURSES. NEED. HELP.

If your preceptor says they never ask for help, they are doing their job wrong.

5. Targeted Patient Education.

How often have I ever stopped to thoroughly explain something to a patient? Never in my clinicals, honestly. My preceptor usually does it. And in the ED, it isn’t at the top of the priority list. Patient education does not have to be some crazy 30 minute presentation! I can explain insulin and blood sugar during times of illness. I can explain a sliding scale. And I can do it in about three minutes. So yes, that sounds so simple, but I’ve always been afraid to take that initiative!


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My First Code.

I am still processing my first full code experience. I had previously been involved in a “chemical” code in which the family chose no intubation and no compressions. The patient did not survive, but he was in his 90’s and probably ready to go. I had another code called during seizures, but the patient’s heart never stopped. This was my first full on ER code blue experience. There are some potentially gross details in this story. Read at your own risk. Portions of this story (i.e. room numbers, times, names, etc.) are adjusted and no private information is given in this scenario.

All Emergency Departments have that phone. Some are red, some are white, all of them are loud enough to pierce through the chaos of a busy shift. There’s a phrase that makes everyone stop what they’re doing and prepare for the worst–“CPR in progress, ETA 10 minutes.

Room 1? Room 1. Let’s go.

In our city, ETA 10 minutes via EMS usually turns into 15-20 minutes. Our preparation was like clockwork. The intubation box was set up and opened. Crash cart plastic ripped off. Body bag placed under the sheets. We didn’t want to use it, but EMS reported asystole and 4 rounds of epi at the scene. I grabbed a handful of gloves, pocketed my stethoscope and badge, tightened the drawstring on my scrubs, and set up the stool. I was set to begin compressions upon arrival.

Upon arrival EMS is vigorously performing CPR on Mr. X. He is easily twice my size and no more than 10 years older than me. “Who else is rotating compressions?” I ask. I have help. We transfer the patient and I immediately begin compressions. It’s a whirlwind. Something came over me. I’m pushing as hard and as fast as I can. I’m exhausted after a minute. But I kept going and had excellent quality compressions.

My team is organized. Methodical. Everyone has a job and knows their job. Hands and arms are working around me, placing stickers and pads, getting lines and blood. The patient’s torso is wet from whatever he vomited before arresting.

Two minutes! Time for a pulse check!” Our recorder says assertively.

I stop compressions and check a carotid pulse while other team members check for radial and femoral pulses. Nothing. The code leader calls for another round of epi. My colleague knows I need to switch out. Five seconds later, compressions are resumed and I snap out of “compression mode.”

This guy is laying here and we don’t know anything about him. We have little to no history. We don’t even know his name.

I look at each person in the room. Everyone is hyperfocused on their task at hand. One nurse is documenting. Another nurse is keeping track of time with that person and giving medications. Another nurse is at the crash cart drawing up everything imaginable. Respiratory is bagging the patient. Another tech is standing near the door. The doctor is setting up the ultrasound and attempting to get a gown on. Two minutes goes by faster when you’re not the one doing compressions. It’s already time for another pulse check. Nothing.

I’m resuming compressions and I notice that the second time around is much harder. My upper body is already exhausted from the first round. I readjusted my position so that I was nearly on the bed. I need as much leverage as I can get. The doctor says that at the next pulse check he will check for movement with the ultrasound. This requires that three of us move our position, one person takes the front pad off, and another person squirts the ultrasound jelly on the patient’s chest. We only have 15 seconds to coordinate.

Two minutes! Time for another pulse check!

To me our movements seem choreographed. To an onlooker it probably looks chaotic. But the job gets done. No heart movement. More medications are pushed. My colleague is resuming compressions and the team gets ready for rapid sequence intubation. “This should have been done at the scene,” I thought.

Two minutes. Time for a pulse check and more epi.

Mr. X is having PEA. It’s not really a rhythm. It’s not shockable. It’s my turn for compressions again.

By the third round, I feel like my whole body is going to give out. My hands are slipping around everywhere because of the vomit and ultrasound jelly.

I can’t continue compressions!” I yell.

Do you need to switch?

No, I need friction!

I lift my hands up for half a second and someone geniously throws a towel over the patient’s chest. Perfect. This is perfect. My compressions are now high quality again. Everyone is ready for intubation. A mask. I need a mask. This guy probably aspirated and I don’t want whatever that was all over my face, too.

Can someone please put a mask and shield on me?

I continue my compressions as my colleague places a mask on me. He did a great job considering I was half on the stool, half on the bed, hair astray, and using all of my body strength to try to bring this guy back. I’m exhausted. I’m thinking to myself, “How much longer can I do this?” It isn’t about me. Everyone in this room is busting their ass for this patient. I’m not going to be the one to give out.

Two minutes. Pulse check!

Asystole. No pulses. No sign of life. Intubation is done and there is a significant amount of fluid coming out. CO2 monitor said 7 but now there are just dashes. No movement on the ultrasound. The doctor wants to resume compressions but he says it will probably be our last round. It has been a total of 45 minutes counting EMS time.

My colleague resumes compressions. He and I are both dripping in sweat.

We have given everything we can. H’s and T’s are checked. Bicarb, calcium, D50, fluids, etc. We have exhausted everything. As a team we were thinking massive pulmonary embolism which is very hard to come back from, if not impossible. I don’t think he was really moving any air.

Are there any objections? Does anyone have any other ideas?” The doctor asks the room.

We all look at each other and realize there is nothing else we can do for Mr. X.

Time of death 1148.


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Emergency Room Essentials

I know what you’re thinking – there’s no such thing as a “typical” day in the ED. In fact, the only thing you can rely on is that your day will be unpredictable. As a nurse intern in a busy adult ED, I have quickly figured out which items are essential during my shift, and which ones I really do not need. I do not currently work in a trauma center–we see most of the city’s STEMI’s, CVA’s, and transplant patients. We also see minor fractures, lacerations, dislocations, etc.

Our ED is divided into “Stations,” and each station has somewhat of a different category of patients. The “front rooms” are the most critical, we have a special room for eye trauma, and we have about 40 beds.

My job as a student intern involves shadowing/helping an Emergency Room RN. I’ve gotten to the point now where I am a helpful partner to my preceptor. When we get a new patient, I know exactly what my role is!

My first day, I showed up with a pocket full of extra supplies that only weighed me down throughout the day. I’ve narrowed down my everyday essentials to just 7 items!

  1. Stethoscope. My beautiful Littman III Classic in matte black is my closest friend in the ED. When assessing ABC’s, lung sounds can give you a clue as to what someone’s respiratory status is. It also isn’t uncommon to uncover distant heart sounds indicating cardiac tamponade.
  2. Retractable badge Sharpie. This is my second most used item! It takes out the possibility of setting your pen/marker down somewhere and losing it forever. I use it to label lines, specimen tags, patient belongings, sign EMS handoff, write down vitals on my glove, and the list goes on.
  3. Pen light. Neuro checks are important for ANY type of patient. If a patient comes in with a sprained ankle, I still do a neuro check. No matter what the patient tells you, they could be making something up because they don’t remember what happened. I also use my pen light for Foley placements and quick airway checks.
  4. Trauma shears. Mine can cut through thick leather! Although we are not a trauma center, I have still cut my fair share of clothing. It is also useful for cutting tape, medication packaging, and during wound care.
  5. Saline flushes. Not something you bring from home, but I always grab a handful at the beginning of my shift. You’ll find that you always need one or two when your hands are already full doing something else.
  6. White board marker. Our rooms are supposed to have their own whiteboard markers. We all know this doesn’t happen. Updating the boards aren’t necessarily the top priority, but I try to update them when I can. It helps patients feel more comfortable if they know the names of their care team.
  7. Black pen. This is probably my least used item, and I often lose it, but it’s good to have!

I hope this can help some of my fellow students. I was so nervous on my first ED shift and I had no idea what I would need! I ended up filling my pockets with 4 pens, a small notebook, and all of my other regular clinical supplies. It was just too much.



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The Ultimate Guide to Surviving Nursing School!

Congratulations for getting into nursing school! I put together a list of supplies you may need. There are also a few tips for surviving that no one else will really tell you until you’ve been through it. Keep in mind that every one’s experience is different. What applies to me may not apply to you.

MUST HAVES:

  • Blood pressure cuff (was provided to me through school via lab fees)
  • Compression stockings/socks
  • Bandage/dressing scissors
  • Drug handbook (pocket size – Lippincott💎 is a great way to go!)
  • Lab coat (ordered through the school)
  • NCLEX-RN Study guide (Saunders💎 or Kaplan💎)
  • Tote bag for clinical/hospital/lab (separate from your lecture backpack!)
  • Nursing shoes
  • Watch – simple, waterproof, inexpensive!
  • Penlight (was provided to me through school via lab fees, but I purchased extra)
  • Scrubs (ordered through the school)
  • Stethoscope
  • Retractable badge holder
  • Nursing care plan book (we were given a specific one to order, this one saved me time and time again!💎)
  • Clipboard and BLACK pens
  • Extra hair clips/bobby pins, hair ties
  • Medical dictionary💎

Lecture Supplies!

  • Binders
  • Looseleaf notebook paper
  • Black pens (or colored if you are the type to color-code notes)
  • Highlighters
  • Drug guide (App available if lecturer allows electronic devices)
  • Textbook (IF you need it)

Tips for Surviving LECTURE:

  • Read the assigned text BEFORE class. I don’t mean skim. Understand it. Make this mandatory in your homework routine.
  • Come to class with questions. Mark down the answers as the lecture goes on. If there are unanswered ones, get them answered before class ends. If you don’t understand something, don’t be afraid to raise your hand and ask. Chances are that there is someone else with the same question.
  • Star, highlight, underline, circle, etc. any topic that the professor repeats. I usually put a star down for each time it is said. I can’t tell you how many times they put this information on exams.
  • Avoid using electronic devices. I always use pen and paper. I have e-textbooks, but I only pull my tablet out when I absolutely need to. Silence your cellphone and only use it during breaks or emergencies.
  • Keep your energy up. Eat a high-protein breakfast and drink plenty of water. Snack on nuts or other nutrient dense food. I usually eat almonds and/or apples with peanut butter.
  • Be courteous to your neighbors. Avoid opening loud snack packaging, using your phone, talking, or doing another classes’ work during lecture. Anything abnormal that you do during lecture is a distraction to others around you. Don’t be afraid to move seats during break if you can’t concentrate.
  • Wear comfortable clothes. Nursing school is not a fashion show. I wear sweats most days because I am sitting for 6+ hours at a time. I usually have a jacket because I get cold very easily.
  • If you are given a break, USE IT! Go walk around, go outside, walk up and down some stairs, etc. Just get your blood flowing.


Tips for Surviving LAB:

  • Lab is for PRACTICING skills, not learning. Usually you will be assigned a video or reading assignment that explains how to perform the skill. The professor will demonstrate the skill, but you are more than likely expected to already know the steps. Don’t make a fool out of yourself by not preparing. We were given step by step instructions for most skills. If your school doesn’t provide these, then make your own.
  • Come to lab in uniform and with all of your supplies. Make sure you wash your hands before beginning.
  • Try performing the skill on your own before asking too many questions. You will learn more by making mistakes than by avoiding them.
  • Don’t overthink anything. You are practicing skills to perform them on a human being. Put yourself in their shoes. Practice compassion. Talk to your mannequin as if it were a real person. It will feel silly at first, but it will help you in clinical.
  • Explain every step out loud in lab. This will not only help you, but it will help your lab partner and others around you. It is also easier to catch mistakes this way.
  • Take advantage of open lab hours if your school provides it. Get together with a study buddy and spend an extra hour or so each week practicing.

Tips for Surviving CLINICAL:

  • Congrats, you’ve made it to clinical! You will probably be nervous, but that’s okay. I was nervous AND excited. That is normal. Take some deep breaths and go with it!
  • Eat a high-protein breakfast. You will probably have to wake up at an hour you’ve never been awake for. If you’re like me, I can barely eat in the mornings to begin with. Force yourself to eat. Don’t go for a high-carb breakfast. You will crash before 9am. Bring snacks for the commute. I usually eat egg/bacon/potato breakfast burritos and I bring an apple to eat on the way.
  • Be prepared. Your school will have different requirements for pre-clinical. If you are assigned a patient the day before, make sure you know which drugs they are getting and WHY.
  • Stay busy. If there is a lull in the day, ask your nurse if there is anything you can do. If he/she says no, then that’s the perfect time to go talk to your patients.
  • Ask to perform skills you have already learned. Already learned how to put in a Foley? Ask your nurse if you can do the next one. Injections? IV starts? ASK!!! You will never learn if you don’t ask. The worst they can say is no.
  • Talk to your patients. You will learn more about them through conversation than by reading a chart.
  • Don’t think of yourself as a shadow. You are a student nurse who is there to help, not follow. Although you will be “shadowing” a nurse, your confidence will give your nurse more confidence in letting you take the reign!
  • When it’s time for lunch, eat something healthy. You already know how high-carb/high-fat meals make you feel. Plan accordingly. Take the full break. If you get 30 minutes, try to sit and rest for that full amount of time. Make sure you wash your hands before and after, and use the restroom before going back.
  • Enjoy yourself! This is what you’ve been working hard towards, right??
  • We always had a debrief with our instructor after clinical. It was an open “round-table” discussion about our day. Be honest about how your day went. Not every clinical day is unicorns and rainbows. Other students will appreciate your honesty.

Tips for READING your textbooks (BEFORE lecture):

  • Turn off your phone, TV, etc. I have a classical music station that I listen to when I study.
  • Skim the chapter and pay attention to titles/subtitles. Count how many pages you have to read and allow yourself enough time accordingly.
  • Start reading from the beginning. Look up any words that you don’t know. Read slowly and carefully.
  • Take breaks every 30-50 minutes.
  • Write down any questions or unclear topics.

Tips for STUDYING material (after lecture):

  • Review the lecture notes from each class when you get home that day. Make sure everything is organized to make studying easier.
  • Go through the assigned reading again and highlight or underline the main topic/sentence of each section. This will make it easier to find information.
  • If you have a homework assignment for this chapter, do it now.
  • The next day, review your notes and skim through the book again. Look for different sources of information for main topics. I like to find YouTube videos that explain topics.
  • Rewrite important information on notecards or in a notebook.
  • If you can, on a different day, get together with a study buddy or group to discuss the information. Don’t do the homework together unless there’s a question that you couldn’t answer on your own. Study groups are not for learning, they are for discussing and solidifying concepts.
  • Notice that now you have reviewed/heard the material 5 times.

Tips for studying for an EXAM:

  • Although I study every day, I usually start my “exam” studying a week before the test.
  • Practice NCLEX-style questions.💎
  • Answer the questions at the back of the chapter.
  • Get any unclear topic resolved at least 48 hours before an exam.

I hope that this information is useful! Feel free to reblog and add anything I may have missed. Also feel free to message me with any questions!


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