Chapter 1: Assessment of Progressive Care Patients and Their Families

INTRODUCTION

The assessment of acutely ill patients and their families is an essential competency for progressive 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 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 is ideal, though progressive care clinicians must balance the need to gather data while simultaneously prioritizing and providing care to acutely ill patients. Traditional approaches and techniques for assessment are modified in progressive care to balance the need for information, while considering the acute nature of the patient and family’s situation.

This chapter outlines an assessment approach that recognizes the dynamic nature of an acute illness. This approach emphasizes the collection of assessment data in a phased or staged manner consistent with patient care priorities. The components of the assessment can be used as a generic template for assessing most progressive care patients and families. The assessment can then be individualized based on the patient’s diagnosis. These specific components of the assessment are identified in subsequent chapters.

Crucial to developing competence in assessing progressive care 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 progressive 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 progressive 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 progressive care patient and family begins from the moment the nurse is aware of the pending admission or transfer and continues until transitioning to the next phase of care. The assessment process can be viewed as four distinct stages: (1) prearrival, (2) arrival quick check (“just the basics”), (3) comprehensive initial assessment, and (4) ongoing assessment.

Prearrival Assessment

Patients admitted to a progressive care unit may be transitioning from a critical care unit, as they become more stable and improve in ...