 Welcome to Nursing School Explained and this video on head-to-toe versus focus assessment. This is something that I find in the clinical setting that students have a lot of trouble with really understanding the difference and also the similarities between the two. So I'm hoping that in this video I can actually clear up some of these confusions. The head-to-toe fashion, we always want to stick with a certain methodical approach so that we don't forget anything and focusing from the head down to the toe is really an easy flow of the assessment plus it allows us to kind of talk to the patient first, engage with them, build some rapport and then move on to expose some other maybe more sensitive areas that we need to. Where a focused assessment is more focused on whatever problem the patient is currently having and in the hospital setting that might be a variety of problems but you can also encounter patients in the clinical setting, let's say in an outpatient clinic, if you're working in the community, those kind of things. But the gist of it is that we always need to assess certain things whenever we assess a patient from head to toe which are just like basic orientation and I'll go into that here in a little bit. But then when it comes to the focused assessment, when the patient has a particular problem with a particular body part or body system then we need to tune into that a little bit more and get into more of the details of that so that we can make sure that they're okay and progressing accordingly so that they can heal and get better. So first of all, in any kind of assessment we need our basic tools generally that means our pen light and stethoscope and then of course any PPE that applies to your patient care scenario. And then over here I have outlined the things that we will always, always, always assess. You cannot skip any of these parts and again here we have our patients and we always focus on the head to toe so we start on the top and work our way down. And so in the head when it comes to the head assessment we talk to them, ask them the basic orientation questions to assess their basic neural status and see how they're overall doing. And then we always need to assess their mucus membranes to determine their hydration status and also the color of the mucus membranes that may be pointing us into the direction of anemia or see any kind of other abnormalities in there. But really for the head that's it. That's all we have to do there. Of course if there are any obvious injuries or stitches or surgeries then that applies more to the focus assessment that I'll be going with. But at the minimum these are the two things that we need to do on assess on the head. And then when it comes to the torso here or the upper body so in the chest we always need to listen to the heart as well as the lungs and that's both anteriorly and posteriorly. And if we or when we do listen to the patient's lungs in the back whether that is having them sitting up or roll onto their sides it's also a good opportunity to assess the back and specifically the skin on their back to see if anything's going on there. As you know patients especially in the hospital setting might be prone to pressure injuries so when they roll over it might also be a good opportunity to take a look at their buttocks and their sacrum to assess for any of those pressure injuries there. And then another part in the torso is the abdomen. We always focus on inspection, auscultation and then I put in parentheses her percussion because many times we don't do that but we also palpate. We ask about the last bowel movement and then assess their bladder for distention. And this is mostly for the patients in the inpatient setting where you know a lot of times they lay in bed and we need to make sure that they're not getting urinary retention. And then for the extremities and that's really the same for upper and lower extremities we always need to assess their muscle strength and their circulation and the circulation is always assessed by their pulses as well as the cab refill. And so when we assess the pulses we always want to check them equally or on both sides at the same time to check at their equal, what's their amplitude, are they bounding or are they just very faint as well as their regularity. And then in the lower extremities we also check for edema and then the upper extremities in the inpatient setting this is a good opportunity to assess the patient's IV site. And then as we go we assess the patient's skin because when we look at their front and their back we can assess their skin as we go so there's not any particular skin assessment or we don't have to start from head to toe again to just assess their skin. So really basic neural mucus membranes, heart, lungs, abdomen, back, extremities and skin these are the minimum things that we always need to do. Now if the patient is therefore a particular focused problem which most of them will be and that doesn't matter if you're in the inpatient or outpatient setting then we're going to focus in or tune in more into the problem area that they are there for. So when we have a focused assessment, so if this is a neurological problem, a patient and these are just some examples, a stroke, head injury, patient with sepsis because they might be have altered mental status and some other issues neurologically or any kind of neuromuscular disorder, Mycenae gravis, Guillain-Barre syndrome any of those that you can think of. Now if they are therefore any of these problems then we need to focus more on the neurologic system by also in addition to these basic things assessing their cranial nerves their cerebellum function, motor and sensory systems. Now if they are therefore a cardiovascular problem and examples here include patient with hypertension, hyperlipidemia, any kind of cardiac issues or peripheral vascular disorders such as peripheral vascular disease, problems with circulation then we assess all pulses, not just the distal ones so that's anything brachial, radial, carotids, femoral, popliteal as well as the distal pulses and then also assess for breweries, so in particularly in the carotid arteries maybe over their abdominal aorta and their renal arteries and then for JVD especially if they have cardiac issues to see if their fluid volume overloaded. Now patients with a focused respiratory problem and examples here include pneumonia, pulmonary hypertension or chronic issues such as asthma. Now in addition to listening to their tests like we did that we talked about in the basic things that we always need to do we might want to percuss and also palpate their chest because for example if this patient had some sort of surgery or pneumothorax they might have subcutaneous emphysema and so if you don't palpate you're not going to feel this emphysema and you're going to miss out on something and then we might also want to check the patient's chest excursion to focus more into their respiratory system. Now if they are there for an abdominal problem, examples, bowel obstruction, GI, GU surgery or any kind of patient with a feeding tube and that might be particularly so in the skilled nursing facility where patients might have a G-tube or a J-tube or any patient in the inpatient setting with an NG-tube then we need to focus on their abdomen more and that not only pertains to IAP and this is where the P here is in parentheses so this then we would maybe also want to percuss their abdomen to see if there are any underlying things going on there. Now a patient with a musculoskeletal problem such as somebody with a fracture any kind of extremity injury or any kind of musculoskeletal surgery, hip replacement, knee replacement, whatever it might be in addition to assessing all those things that we talked about here in the extremities we also want to assess their 5Ps, pain, pallor, pulse, peristasia as well as paralysis and the range of motion if it's indicated for the injured or maybe even the not injured extremities so we can compare left to right. And then the other thing is for skin so this is focused assessment on the skin if the patient is therefore some sort of injury or maybe a burn patient or somebody who has pressure source or any kind of rashes then we need to focus on into their skin more and that also pertains to surgical wounds to assess their reed. And let me add that here and that is redness, erythema, achemosis, drainage and approximation. So in summary here we always want to focus in a head to toe fashion so that we don't miss anything then we always want to assess these things here because these are just the very basics and this should really with practice take you less than 10 minutes to get through and then if they are therefore a particular problem then we want to focus on whatever body system is affected and to the additional assessments that I've outlined here in the black boxes to really see how they are doing to determine any changes assess them basic interventions on these assessment findings and hopefully get the patient better so that they can go home and recover fully. Now I do have videos where I actually demonstrate the focused assessments of the neurocardiovascular respiratory abdomen and musculoskeletal systems so that way you can see what it actually looks like when we combine these basic things with the most focused assessment and what that looks like especially in these boxes these additional things that we always assess. So thank you for watching this video I hope this has helped you clear up any confusion about head to toe versus focused assessments and how we can really combine the two to really assess the patient well and make sure that they get better. Please give me a thumbs up if you've enjoyed the video and also check out my Instagram page and I'll see you soon right here on Nursing School Explained Thanks for watching.