Week 16. LPAT = Leveled Physical Assessment Tool

Approach a patient during the head-to-toe physical assessment with no preconceptions, no assumptions, no judgement. Also, with kindness, patience, and respect.

Please allow me to take your temperature, pulse, respiration, blood pressure, and O2 saturation. What is your pain level on a scale of 0-10? How did you sleep last night?

What is your full name? Do you know where you are and what brought you here? What time/day is it?

If you don't mind, I will check your head for lumps and bumps and run gloved fingers through your hair. I see your eyebrows, nice lashes, the whites of your eyes a bit bloodshot. My, what big eyes you have. Do you wear contacts or need glasses? Can you hear this? How about this? Sniff for me through one nostril, then the other. Thank you. Please open up wide so I can see your tongue, mucous membranes, and teeth/dentures. Swallow for me. Say something. Okay, no aphasia, but I'm going to pretend you didn't just say that.

You're breathing a little hard. Let me listen to your lung sounds from six sites, front and back. I see you're also coughing. Any sputum? Has the oxygen helped with shortness of breath?

You look flushed, and your skin feels hot and moist. Let me test for turgor under your clavicle to see if there's tenting when pinched. We'll also have a look at your skin overall, check for intactness, any rashes, bruises, wounds. Yes, I know the restraints are uncomfortable, and I'm sorry. Next, inspect the fingernails & toenails. If a nail is squeezed for a second, how long does it take for capillaries to return blood & color? Less than 3 seconds? Now, counting 1, 2, 3, 4, 5 intercostal spaces down from the left clavicle, I will listen to the apex of your heart for one full minute. Next, radial pulse at wrists, pedal pulse at insteps. I see you have an IV for the antibiotics.

Your abdomen feels round and hard. Do you have any pain? Let me trace your digestive tract with the diaphragm of my stethoscope, listening for bowel sounds in all 4 quadrants. We're looking for bubbles and gurgles, and must listen for five minutes if things are all still. How has your appetite been since they took out the nasogastric tube? Fluid intake? When was your last bowel movement and what did it look like? Yes, we're still doing a culture to rule out C. diff.

I see the urine in the catheter bag is tinged pink and cloudy. I need to document that, and also, reduced output. Have you noticed any discharge from your vagina/penis? That was a medical question, not sexual harassment...

Shall we continue? Hold my hands and squeeze. Ow, not that hard. Let's try foot pushes. Just a little push; no kicking, please. Inspecting joints and range of motion. When the physical therapist aides came, were you able to walk with their assistance?

Thank you for cooperating during the assessment; I will chart here that you have been mostly pleasant. Do you have family that might visit? We can take your restraints off while family's present, in addition to the half hour range-of-motion every 2 hours.

I understand you don't like the restraints, but they're doctor's orders.
We just don't want you to pull out your IV or hurt a nurse again.
Because you can be so very pleasant when you don't.