Chapter 1: Assessment of Critically Ill Patients and Their Families

INTRODUCTION

The assessment of critically ill patients and their families is an essential competency for critical care nurses. Information obtained from an assessment identifies the immediate and future needs of the patient and family so a plan of care can be initiated and revised to address or resolve these needs.

Traditional approaches to patient assessment include a complete evaluation of the patient’s history and a comprehensive physical examination of all body systems. This approach, although ideal, rarely is possible in critical care as clinicians struggle with life-threatening problems during admission and must balance the need to gather data while simultaneously prioritizing and providing care. Traditional approaches and techniques for assessment must be modified in critical care to balance the need for information, while considering the critical nature of the patient and family’s situation.

This chapter outlines an assessment approach that recognizes the emergent and dynamic nature of a critical illness. This approach emphasizes the collection of assessment data in phases consistent with patient care priorities, and can be used as a generic template for assessing most critically ill patients and families. The assessment can then be individualized to address specific aspects of the patient diagnosis. The components of the assessment appropriate to particular disease states are identified in subsequent chapters.

Crucial to developing competence in assessing critically ill patients and their families is a consistent and systematic approach. Without this approach, it would be easy to miss subtle signs or details that may identify an actual or potential problem and also indicate a patient’s changing status. Assessments focus first on the patient, then on the technology. The patient is the focal point of the critical care practitioner’s attention, with technology augmenting the information obtained from the direct assessment.

There are two standard approaches to assessing patients: the head-to-toe approach and the body systems approach. Most critical care nurses use a combination, a systems approach applied in a “top-to-bottom” manner. The admission and ongoing assessment sections of this chapter are presented with this combined approach in mind.

ASSESSMENT FRAMEWORK

Assessing the critically ill patient and family begins from the moment the nurse is made aware of the pending admission of the patient and continues until transitioning to the next phase of care. The assessment process can be viewed as four distinct stages: (1) prearrival, (2) admission quick check (“just the basics”), (3) comprehensive initial, and (4) ongoing assessment.

Prearrival Assessment

A prearrival assessment begins the moment the information is ...