When Performing A Reassessment Of Your Patient You Should First

When Performing a Reassessment of Your Patient, You Should First…Prioritize!

Reassessing a patient is a crucial aspect of providing safe and effective healthcare. It's not simply a repetition of the initial assessment; it's a dynamic process that requires clinical judgment, prioritization, and a keen eye for subtle changes. When performing a reassessment, your actions should be guided by the urgency of the situation and the patient's evolving needs. This article will delve into the systematic approach to patient reassessment, emphasizing the critical first steps and the ongoing process of monitoring and adapting care.

The ABCDEs (and Beyond) of Prioritization

Before diving into specifics, remember the core principle: prioritization. You need to rapidly assess the patient's overall condition and identify any immediate threats to life. This is where the ABCDE approach, while not universally accepted in every setting, provides a valuable framework:

A - Airway:

• First, assess for patency. Is the airway open and clear? Look for signs of obstruction, such as stridor, gurgling, or difficulty breathing. Any significant compromise requires immediate intervention. This might involve suctioning, repositioning the head and neck (carefully, considering potential cervical spine injury), or insertion of an airway adjunct.
• Consider the need for advanced airway management. If the airway is severely compromised, you may need to utilize more advanced techniques, depending on your scope of practice and the available resources.

B - Breathing:

• Assess respiratory rate, rhythm, and depth. Observe the chest for symmetrical rise and fall, listen for breath sounds, and note the use of accessory muscles. Cyanosis, tachypnea, or bradypnea are all warning signs.
• Check oxygen saturation (SpO2). This provides valuable information about the patient's oxygenation status. Low SpO2 warrants immediate attention, including supplemental oxygen administration.

C - Circulation:

• Assess heart rate and rhythm. Check for the presence of a palpable pulse, noting its rate, rhythm, and strength. Palpate major peripheral pulses, checking for symmetry.
• Assess blood pressure. Hypotension or hypertension can indicate significant problems.
• Assess skin temperature, color, and moisture. Changes in skin color (pallor, cyanosis), temperature (cool, clammy), or moisture (diaphoresis) can provide valuable clues about the patient's circulatory status.
• Consider bleeding. Look for obvious signs of bleeding and address any significant blood loss immediately.

D - Disability (Neurological Status):

• Assess level of consciousness. Use the AVPU scale (Alert, Verbal, Pain, Unresponsive) or Glasgow Coma Scale (GCS) to quickly assess the patient's neurological status. Any deterioration requires immediate attention.
• Assess pupillary response. Note pupil size, shape, and reactivity to light. Unequal pupils can indicate neurological damage.
• Assess motor function. Check for any weakness, paralysis, or abnormal movements.

E - Exposure:

• Completely expose the patient to allow a thorough physical examination. This involves removing clothing to assess for injuries, rashes, or other abnormalities. Remember to maintain patient privacy and warmth as much as possible. This step often gets overlooked in the initial rush to attend to more obvious life-threatening concerns, but is a critical element of a full reassessment.

Beyond the ABCDEs: A Holistic Approach

While the ABCDEs provide a crucial framework, reassessment requires a holistic approach that considers the patient’s overall condition, including:

Pain Assessment:

• Use a standardized pain scale (e.g., numerical rating scale, visual analog scale) to assess the patient's pain level. Pain is a subjective experience, and its management is crucial for patient comfort and recovery. Changes in pain levels should always trigger a reassessment of the underlying cause and the effectiveness of pain management strategies.

Medication Review:

• Review the patient's medication regimen and ensure that all medications are being administered correctly and effectively. Check for potential drug interactions and side effects. Observe for expected therapeutic effects and any unexpected responses.

Fluid Balance:

• Monitor input and output (I&O). Assess for signs of dehydration or fluid overload. Pay close attention to urine output as a key indicator of hydration status.

Wound Assessment:

• Regularly assess any wounds for signs of infection (e.g., increased pain, swelling, redness, purulent drainage) or complications (e.g., dehiscence).

Psychological Assessment:

• Assess the patient's emotional state and look for signs of anxiety, depression, or other psychological distress. Remember that a holistic approach to patient care includes addressing psychological needs alongside physical concerns. Changes in mental state might be a result of physical issues, medication side effects, or environmental factors.

Family and Social Support:

• Consider the patient’s family and social support systems and their role in their recovery and care. A supportive environment can significantly impact a patient's healing process. Changes in the support system can directly impact their progress and will need to be carefully monitored during reassessment.

Documenting Your Reassessment

Thorough documentation is essential. Your reassessment notes should include:

• Time and date of the reassessment. This establishes a clear timeline of events.
• Specific findings from each component of the assessment (ABCDEs and beyond). Use precise language and quantifiable data whenever possible. For example, instead of saying "blood pressure high," note "blood pressure 180/110 mmHg."
• Comparison to previous assessments. Highlight any changes in the patient's condition. Emphasize significant deviations or concerning trends.
• Interventions performed. Detail all actions taken to address any problems identified during the reassessment.
• Response to interventions. Note the patient's response to treatment. Was the intervention effective? Did it alleviate the problem, or were other interventions required?
• Changes in the care plan (if any). If changes in the treatment plan were made based on the reassessment, clearly document these changes and the rationale behind them.

The Ongoing Nature of Reassessment

Reassessment is not a one-time event. The frequency of reassessment depends on the patient's condition and stability. A critically ill patient may require frequent reassessments (e.g., every 15 minutes or more), while a stable patient may only need a reassessment every few hours or even less frequently. The key is to remain vigilant and adapt your approach based on the patient's changing needs.

Continuously monitoring vital signs, reviewing lab results, and maintaining open communication with the patient and their family are integral to the ongoing reassessment process. Trust your instincts, and if something feels amiss, perform another focused assessment to identify and address the issue promptly.

Conclusion: Prioritize, Assess, Adapt

When performing a reassessment, your first and foremost action should be to prioritize. Identify and address immediate life threats using the ABCDE approach. Then, systematically assess other vital aspects of the patient's condition, including pain, medications, fluid balance, wounds, and psychological status. Remember that reassessment is an ongoing process. Your ability to effectively reassess, adapt your treatment plan as needed, and proactively address evolving needs significantly impacts patient safety and outcomes. Regular reassessment represents a commitment to quality, patient-centered care. By following a systematic approach and continuously monitoring your patients, you can provide the best possible care and improve overall patient outcomes.