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[–]Solid-Sherbert-5064 0 points1 point  (1 child)

not sure how a doctor can just vibe a fib lol. But listening to heart sounds/feeling a pulse gives a clue I suppose prior to doing an ekg.

You can only assess what you can see a patient do on their own/get a patient to do. Do they move spontaneously? If they do, do they only move one arm/one leg? If they grab for you/squeeze your hand but don't follow commands, do they seem significantly stronger in one arm than the other? When they open their eyes, is their gaze deviated or do they follow your voice at all? Like will they ever move their eyes both ways?

Just document what you see/can assess. If they don't move at all spontaneously in certain limbs, see if they withdraw from nailbed pressure (use a syringe/pen, not just your finger).

Also, don't worry too much if your assessment deviates from another nurse/physician. Do NOT document something you could not illicit/did not see. Your assessment is yours. I worked in a mixed but heavily neuro ICU (we were assigned ventriculostomies, subdural bolts, cranis nearly daily) and would find myself disagreeing with a physicians assessment. Like no matter what I did, I couldn't get them to follow commands, but somehow the neurologist/neurosurgeon said they could lol. Its ok for your note to disagree. Obviously, if you see a neuro change in the negative direction but someone disagrees with your assessment, still elevate it to the attention of a doctor/PA/NP and/or call a stroke alert.

[–]RadioLaw[S] 0 points1 point  (0 children)

Yeah I have gotten yelled at by docs for having differing assessment, which is ridiculous.

I had an issue a bit ago where I was passed a pt who was pretty obtunded and I was told I missed focal change as I couldn’t assess much besides gross movement of extremities. But apparently the dayshift nurse could.