In today's video, I'm going to share with you my tips for getting through health assessment and advanced health assessment in nursing and NP school. The main things we'll be focusing on are mastering the physical exam and how to do that, as well as how to take a really good HPI or history of presenting illness, as these are the two main components of health assessment. Now, since we are kind of covering two topics, but they're so similar, I thought we would just combine them into one video. I'll talk to you about my tips for surviving advanced health assessment, because that's also how I survived regular health assessment.
in the day for nursing school so if something isn't quite applicable to you because you're not doing the advanced class just ignore that part it'll be fine but most of it is applicable to everything you're just going to do a bigger deep dive if you're in advanced health assessment obviously if you're new here welcome i'm liz i'm a family nurse practitioner so i have survived health assessment twice once in nursing school and once in np school i thought this class was kind of fun it's where you start to get your feet wet and actually do what you're interested in hopefully you guys feel the same way and if you're struggling a bit then maybe these tips can help you So obviously a huge part of health assessment is the physical exam. You're going to need to know what type of exam you need to do, how to do it, and how to interpret the findings that you get. Now the easiest way I found to do this is to make a script for yourself. You're going to have to do this for every single body system and you're going to want to base your script off of the rubric. that your professor gave you.
That shows you what you need to know for each system and you're going to obviously study and base your exam to that. If your program is like mine, you will have assessment check-offs for every single body system. However, you may not have been given all of the information on how to do all the physical exams, what they all mean, all of that.
Some of that was expected that you would go out and find that information yourself. And that can be really overwhelming if you aren't sure what wording to go with, what order to put things in. all of that i also felt overwhelmed and worried about this but you'll be okay guys you really will so i built my scripts based on two main things my health assessment textbook and youtube videos i used my health assessment textbook first and then when i felt like i either wasn't it wasn't clear or i just wasn't understanding or i didn't i needed verbiage to put with it like how do i say what i'm doing here that's when i would turn to youtube now when you're going to youtube to look for all these health assessment videos search very specific if you want to find something that does the cranial nerves search just cranial nerve videos make sure it's by a reputable source a lot of schools put these out and I will link a few of the ones I found helpful down below, but just make sure you know when you're going through. It's not some 12-year-old that was like goofing around being like, oh, look at this. That's not very helpful.
And I also kind of like to watch a couple different videos, even on the same assessment. That way I could see how different people phrased things, what the different techniques were. And while you're doing this, make sure you're putting everything in your own language. You're making it really comfortable for yourself because you're going to be practicing this over and over.
And it's something you're going to have to be comfortable with for your practice anyway. So make sure you're just kind of incorporating everything and making it your own. Now, I will tell you up front, this takes forever.
So do this at the beginning of your module. Trust me, I learned the hard way. I would wait until the end sometimes, and you were just, it's really hard to memorize something like this when you're hysterically sobbing. So don't be me, friends. Just suck it up.
Do it at the beginning of the module. It takes a really long time. If you can imagine.
looking in your book and then trying to go to YouTube and like finding all the different methods and putting it into your own words. This is not one of those things that can be rushed. You need to give it the time it needs as with so many things in nursing school.
Now, in terms of how I actually made my script, you can obviously do this whatever way you want, but the way I found to be super effective is I would take a sheet of paper or your iPad, whatever you use to take notes and make four columns in it. Column number one, I would put the rubric requirement. So for example, Extra ocular eye movements. Now in the second column, I would put the exact words I was going to use and say when I was doing the physical exam and instructing the patient to help me along with these motions.
I would write it down exactly how I wanted to say it. For example, Now I'm going to examine your extraocular eye movements. This examines the muscles around your eye.
I don't remember what they are anymore, but I had to know like for health assessment. So you could say that there. You could say it also examines cranial nerve 3, 4, and 6. Please follow. my finger with your eyes without moving your head in all these directions. Now your school might be different.
In my school I had to explain what I was doing, what it was assessing, and the muscles and nerves and everything that it was interacting with. Yours might not be like that, but if it is, I highly recommend writing everything that you plan on speaking out loud in the second column. Third column would be notes to myself on how to perform the physical exam. So you know, take your finger, what we have in front of their face, have them hold their head still.
um follow your eyeballs that way you could remember what you actually need to do and in the final column you need to put what the expected outcome is and sometimes i would put the verbiage for abnormal findings so say in this one you could do like nystagmus would be if it shakes otherwise you would say you know you expect fluid eye movement without any twitching i don't know however you want to phrase that so it's But in my programs as well, you needed to be able to verbalize the outcome. So don't forget that part. It's important.
I feel like that's the part I always would forget. And I was like, oh, I'm doing this, but I don't really know what I'm looking for. So don't forget that fourth column.
It's huge. And those are my four columns. I would do that for every single.
single thing on the grading rubric. Do you see why it took forever? But that had everything in one place for you.
I never needed to know like, oh my gosh, I don't remember quite how to do this valgus varus thing when it comes to the musculoskeletal assessment or like what that's even looking for. Everything, it was all right there. Such a lifesaver.
And it was really helpful going later on down the road to when I needed to look back on it. Excellent source of notes when you're actually in clinical and you're trying to do these assessments. So take the time.
I know it's a pain. Well worth it though. Now in terms of actually memorizing all of this stuff and getting through it, guys, it's just straight memorization. I wish there was some easy, wonderful hack.
You're just going to want to read through it over and over and over again. When you're at the gym, when you're drinking your coffee in the morning, you know, over and over. And do it slowly.
Again, don't be me. A lot of times I would wait until the end and cram until I learned my hysteria was preventable and like I should probably learn to just procrastinate less. you're gonna absorb it so much better and i learned so much more from the modules when i actually started doing this on time rather than at the very end so just reading it through reading it through practicing what you're gonna say practice on whatever you have your dog your boyfriend your girlfriend your mom your make a pillow human on your couch and do that you're just going to want to practice so much that you don't even have to think about the movements you want to get to the comfort level point where you're saying it and it all just sort of tumbles out of your mouth without you having to sit there and rack your brain for every step of the way because you're going to be nervous checkoffs make you nervous no matter what i never got over that i don't know if you have tips for how to get over being nervous during checkoffs other than just being wildly prepared please share them down below.
But yeah, you just got to repeat, repeat, repeat, practice, practice, practice. So it's second nature and start early guys, because trust me, panic sobbing does not lead to excellent retention and good grades. Now we've kind of covered the physical exam, let's talk about taking a history.
This is the other huge component of the class and is honestly, sort of in my opinion, more important when you get out into the real world, is being able to take an excellent history. In this portion of the class, you need to learn what questions you need to ask. to ask people when they feed you little nuggets of information in order to gain a better understanding of what is going on with them. And this portion is definitely going to be more in-depth in terms of advanced health assessment. But I remember you had to do this in traditional health assessment too.
It's just not quite too... to the extreme degree. In advanced, you're obviously trying to lead to a diagnosis, whereas in nursing school, it's an assessment to help you be able to better understand the patient and see what you should do next.
It's important, I think, to understand here that this is going to come with time. Learning how to do a good HPI is something that takes a great deal of time and experience and exposure to a ton of different diagnoses and patients, and it will come in time. You will get it. Just be patient. Don't expect yourself to know every question you should have asked.
out of the gate because you just you haven't seen enough yet and that's fine. I still haven't seen enough and don't always know the questions I should ask and I'm a year into this and I like to think that's fine. You're okay if you don't know all the questions to ask. The class really just wants to make sure that you are safe.
As with all things in nursing school, Safety, safety, safety. So that means you're going to want to memorize the red flags and the things that should prompt you to ask about the red flags. So each body system as you go through it, your book, I promise you will have a section and your teacher will talk about it and they will call them red flags.
you definitely do not want to miss. You're going to want to memorize these red flags and what they indicate. So for example, let's say you are talking to your patient and they're reporting that they're having this dull, achy chest pain and this pain going down their left arm. They can't stop sweating, which should hit you as a red flag and should prompt you to ask them, do you feel like you're short of breath?
And when they say yes, all of the alarm bells that were kind of already going off should really go off in your head. and you should be able to identify that this patient may be having a heart attack. And that's what I mean by red flags, guys.
Just know things like chest pain, shortness of breath, pain down my left arm, crushing elephant on my chest. You're gonna wanna know those phrases and know what else to ask in conjunction with them, their friend red flags, and know what it means. Now let's say you're talking to your patient and you have determined that there are no red flags, really, that you can find surrounding what they're talking to you about.
You're gonna wanna start. asking them questions about all the other things that are in this body system that you are already talking about that was the presenting complaint. So let's say you're talking to a patient and their chief complaint was that they had a sore throat.
You know throat is in your head and your neck kind of, so we're looking at the head ears eyes nose throat body system so you're gonna ask some other questions about are you congested do your ears hurt are you dizzy are you blowing a bunch of gunk out of your nose all of that fun stuff that goes with the head and then once you've kind of ruled in or out all the other head symptoms you're gonna go and try to get a little bit creative here and think about what else might be affected or could cause issues with the throat. Now the easiest way to usually do this are look at the neighbors. So this is a throat problem.
So we're probably going to want to look one down and near. So we'll ask about their gut, right? Because their stomach is right here. Maybe this is acid reflux, something like that. So we'll ask them a bunch of GI questions.
We'll ask them respiratory questions because your throat's kind of by your lungs. We'll ask them some, you know, are you breathing? How are you breathing? Are you wheezing? Are you coughing?
Heck, we could ask them some cardiac questions because that's kind of... of in the neighborhood too and once you've asked about those other systems that are neighbors and could be related don't forget you always always want to ask about their general symptoms how are you feeling overall have you had a fever chills body aches super tired every single person really should kind of get that at least general overview you can do it in the beginning or the very end sometimes i wait until the very end just to get a general picture of kind of like what i'm looking at but that's totally up to you and that's pretty much the basis of it so quick review when you're going through the body systems ask them about red flags about their chief complaint or the body system that it has to do with ask them all their questions about the body system that this involves move to then move to neighboring body systems and then your questions about your general overall well-being now let's talk about some general tips for your history of presenting illness biggest one here is just practice open ended questions which sounds so much easier than it actually is i feel like it's our natural i don't know i'm at least naturally inclined to ask questions that are not necessarily open-ended and all open-ended means is the answer answer cannot be yes or no. Instead of saying, have you been tired? Ask them, how are your energy levels? Something where they can't just say yes or no.
Again, this will come with time and practice. It's actually a lot harder than you would think. All right, last but not least, I wanted to talk about shadow health really quick, which seems oddly specific, but if you have dealt with Tina and shadow health, then this might be helpful for you.
So shadow health is a online simulation for health assessment where you type into the computer and the, you know. Tina, the person in the computer, talks back at you and you're trying to elicit all this health assessment information for you and it's teaching you kind of how to get in physical, but she's also the most impossible human to work with ever. You'll ask her very straightforward questions like, hey, Tina, what are your hobbies?
And she's like, no. I don't wear socks outside and you're like that's not at all what I asked you but it's fine in order to survive shadow health You have a few options in my program. I was allowed to do each module twice So I would do the first one I would try most of the time I was almost every time I would fail because I just couldn't elicit all the information out of Tina That I apparently needed to when you go to review your first attempt You can go to the transcript where it grades you and it will show you everything you missed Print that out put it next to your computer and when you talk to Tina again now you know all the points you need to talk about with Tina I also have heard that there are corners of the internet where you can just kind of go on and it might help you guide your conversation with Tina but I did it the first way I learned a lot this program overall is infuriating but it does teach you the related questions to ask about a body system especially when you look over that review at the end and you're like oh either I shouldn't have asked that at all like it doesn't matter or this is something that's good to ask if someone comes in with a sore throat or if they have chest pain or they can't breathe. It's really annoying, I know, but you will get through it.
And Tina, you do some great work with Tina, so just be proud of yourself. Okay, that wraps up all of my tips, I think, for health assessment. Remember, repetition is key.
Get on that train early. Do not be mean. Do not wait. You will cry.
It won't be pretty. You won't learn a lot. Bad day.
Hopefully, this was helpful for you. You absolutely can tackle this class. I know it seems pretty overwhelming, and depending on what they pair it with in school, it kind of feels like you're drowning.
You will get through it one day at a time, I promise. promise, hang in there. Now, if this video was helpful for you, I do have videos on how to survive patho and pharmacology. And both of those are the same where it covers advanced patho and advanced farm, all kind of twisted into one. So if you haven't taken those classes yet, or you're in them now, that could be helpful for you.
I will leave the links to them at the end of this video and down in the description box below. And if you want to see more videos like this in general, I make content videos on Tuesdays that are usually on nursing and NP things. And on Saturdays, I have a weekly vlog where I just talk.
take you through my life as a family nurse practitioner in and out of work. So if that sounds interesting to you, I'd love to have you on my journey. Consider subscribing below and head over to Instagram where I post things I'm learning at work all the time, new assessment skills I'm learning, all the good things and cute pictures of my kid. It's a great place to message me and we can chat as well. For our question of the day, who are you going to practice your physical exam on?
I practice mine on my dog, Holly. At the very end, right before my exam, I would go and I would do a dress rehearsal. I called it like my dress rehearsal. I'm like, it's the final run. And I would make my husband be my physical assessment model, but mostly my dog, occasionally a pillow.
Excited to hear who you guys are practicing all of this on. Hope you have a fabulous rest of your week and I'll see you next time. Bye.