tips on how to prepare self for assessment

1. PREPARING FOR
ASSESSMENT

2. Review the client’s record, if available
• Know the client’s basic biographical data
• Medical diagnoses and progress notes
• Review client’s status with other health care
team members who have taken care of or
interacted with him
Maria Carmela L. Domocmat, RN, MSN

3. Remember to keep an open mind and to avoid
premature judgments that may alter your
ability to collect accurate data
Educate self about client’s diagnoses or tests
performed and their implications
Maria Carmela L. Domocmat, RN, MSN

4. Other cases that require more reflection time are
those involving:
STDs
Terminal illnesses
Amputation
HIV infection or AIDS
abortion
Maria Carmela L. Domocmat, RN, MSN

5. Reflect on your feelings regarding your initial
encounter with the client
Be as objective as possible
Maria Carmela L. Domocmat, RN, MSN

6. Obtain and organize materials that you will
need for the assessment
Maria Carmela L. Domocmat, RN, MSN

7. Reflect on your approach
to the client
• When first examining patients,
feelings of insecurity are
inevitable – but these will soon
diminish with experience
• Be straightforward
Maria Carmela L. Domocmat, RN, MSN

8. • Identify yourself as student
• Try to appear calm, organized and
competent
• Avoid interpreting findings
• Always avoid showing distaste,
alarm, or other negative
reactions
Maria Carmela L. Domocmat, RN, MSN

9. Make the patient
comfortable
• Provide privacy
• Drape wit gown or draw sheet
• Visualize one area at a time
• Be sensitive to patient’s
feelings
• Watch facial expression
Maria Carmela L. Domocmat, RN, MSN

10. Choose the sequence of
examination
The key to a thorough and accurate PE
is developing a systematic sequence
and accurate examination
Maria Carmela L. Domocmat, RN, MSN

11. • 3 goals
1)Maximize the patient’s comfort
2)Avoid unnecessary changes in
position
3)Enhance clinical efficiency
Maria Carmela L. Domocmat, RN, MSN