Comprehensive Vs Focused Assessment in Nursing

Assessment is one of the essential nursing practices while providing healthcare. It’s a crucial process for planning and evaluating patient-centered and family-centered care. Comprehensive health assessment includes patients’ history, physical examination, and vital signs. On the other hand, focused health assessment involves examining a specific body system where the patient exhibits a concern, problem, or disorder.

A comprehensive assessment gives a clear picture of the patient’s condition, while focused assessments provide quick information on the patient’s specific condition, especially in emergencies. This article will teach you what comprehensive vs focused assessment in nursing entails.

Health Assessment in Nursing

A health assessment is one of the essential tasks a nurse performs. It involves a patient overview which includes subjective and non-subjective findings. The importance of a health assessment is identified in preventative care and in times of critical and acute services. There are two types of health assessment, i.e., comprehensive and focused.

Comprehensive Health Assessment

A comprehensive health assessment includes the patient’s history, physical examination, and vital signs. This assessment is carried out at the beginning of a shift, during admission, and when evaluating for unrecognized illness. When a patient visits a new hospital with new staff, they don’t know their current health status during admission, so there is a need to conduct a head-to-toe examination.

While assessing the patient, you should include the patient surgical and medical history. At this point, you should also discuss any medication the patient is taking. You should also find out about the family and social history of the patient. To know the general survey of the patient, you should include the patient’s age, gait, weight, posture, height, and hygiene.

Comprehensive health assessment help nurses to obtain information about patients’ physical condition. Always remember to have enough time for a full assessment.

The following is an example of normal findings of a health assessment;

• Head: do not have lumps of masses
• Eyes: the pupil is equal, round, and reactive
• Ears: have normal hearing, and the auditory canal is clear
• Throat: have no dental caries and redness
• Neck: do not have lymph node swelling and jugular venous distention
• Cardiac: have regular rate and rhythm, no gallops, capillaries refill less than two seconds, and warm with the appropriate color.
• Lungs: have no clear auscultation, have typical breathing sound with no wheezing, and have regular respiratory rate.
• Abdomen: is non-tender, and bowel sound is present in all four quadrants.
• Urogenital: genitals are developed, and the patient has no difficulty urinating
• Extremities: have a normal gait, no swelling, and each extremity has a full range of motion.
• Neurovascular: cranial nerves are intact, and reflex 2+ have average strength and sensation.
• Skin: is normal for ethnicity without lesions.
• Psychiatric: is non-suicidal and oriented to place, persons, and time.

Vital signs are assessments that show how the body functions, revealing many medical conditions. Children and the elderly have different vital signs that may be considered normal. Let’s have a look at vital signs and normal findings for adults;

• Temperature: 97.8-99.0 degrees Fahrenheit
• Pulse: 60-100 beats per minute
• Respiratory rate: 12-16 breathes per minute
• Blood pressure: 120/180
• Oxygen saturation: 96-100%

Focused Health Assessment

A focused assessment examines a specific body system where the patient exhibits a concern, problem, or disorder. This procedure is usually done in an emergency room with insufficient time for a detailed full-body assessment. The focused assessment aims to identify and work out a single problem instead of looking into every factor affecting the patient.

Nurses present the assessment finding to doctors and other healthcare professionals, encouraging teamwork while providing better healthcare. They use their best clinical judgment to decide which assessment will apply to their patients. A focused assessment is done when a patient complains of a particular problem or disease affecting a specific body system.

This assessment is helpful in an emergency room where the patient has severe symptoms and has little time to save their life. In such a situation, the nurse’s primary focus is the body system causing the emergency rather than other areas. The nurse may also inquire about the patient’s medical background as it may relate to that particular body system. Focused assessment is life-saving for the patient.

Nurses can do focused assessments in any of the following areas;

• Neurological assessment: inspect sensory functions, fine and gross motor skills, growth and development, neurological observations, and seizure.
• Respiratory assessment: monitor oxygen saturations, symmetry and shape of the chest, respiratory rate, and color.
• Musculoskeletal assessment: inspect a joint range of motion, redness and swelling in joints, posture, movement, and body symmetry.
• Cardiovascular assessment: inspect the presence of edema, hydration status, circulation and hydration status, and capillary refill time.
• Eye assessment: inspect visual fields and bilateral symmetry, test for red eye reflex, presence of tears, the color of the sclera, and visual acuity.
• Skin assessment: inspect color, bruises, moles, and hair, and examine high-risk areas.
• Renal assessment: inspect hydration status, urinary pattern, growth and feeding, urinalysis, skin condition, and urine output.
• Gastrointestinal assessment: inspect the contour of the abdomen, stoma site, distension, umbilicus, and visible peristalsis.
• Ears, Nose, and Throat (ENT) assessment: inspect nose and ear for symmetry, gingival tissue, teeth condition, and external trauma. Look for excessive fluid, and inspect lips.

Key Points to Consider While Undertaking Focused Assessment

The following are essential points to consider while writing a focused assessment in nursing;

• It would be best if you introduced yourself to the patient
• You should wash your hands before attending to any patient
• You need to have a safety concern
• You should confirm the patient’s identity using two patients’ identifiers.
• You must be systematic and orderly in your evaluation
• Explain what you are doing to the patient
• Pay attention to the patient’s signs
• Use appropriate attention and questioning techniques
• You must respect the patient’s privacy and dignity
• You should assess vital signs
• Complete any required specialized assessment
• Assess ABCCS, sanction, oxygen, and safety

Guidelines for Conducting Health Assessment

In both assessments, patient history is considered. Patient history may include relevant information related to the current condition and past medical issues. To remember significant parts of patient history, we use SAMPLE.

S- Signs/symptoms

A- allergies

M- medication

P- past medical history

L- last oral intake

E- event leading to illness

The following guidelines are essential to both comprehensive and focused assessment in nursing;

1. Non-verbal cues

It would be best to watch for non-verbal cues such as a patient avoiding eye contact or being reluctant to answer questions that can enlighten on other issues and patients’ histories.

2. Physical signs to watch

Examining the skin is an excellent test for an individual’s overall wellness. Take note of the following;

• Any unusual colouring on the patients’ skin
• Any lesions, abrasions, or rushes
• Whether it’s cold, hot, clammy, or dry throughout the examination

Make a note of any unusual asymmetry when examining a patient. Physical signs to check for bilateral symmetry patients are;

• One side being limper than the other
• One side of the body is weak
• Limited range of motion

3. Building rapport

Build trust and respect while beginning an assessment. For example, avoiding unnecessary touching during assessment makes a patient comfortable. You should note non-verbal cues and your patient’s overall manners during assessment. You might also want to be aware of the following aspects of your patient;

• Respiratory rate
• Level of alertness
• Engagement, for example, is your patient making eye contact
• State of health, comfort, or distress. (How does your patient come in looking)

4. Bookkeeping

During the assessment, you should document all the findings and abnormalities noted to avoid the risk of forgetting. Record keeping varies depending on the unit you are conducting an assessment. For example, in an ICU, assessments are run more often than in other units since monitoring their vital is essential for their care.

5. Communicating throughout

It would be best if you communicate with your patient throughout the assessment. Ask before touching your patient, and explain everything that you are doing. It would help if you also asked them what they feel because they are the experts on their bodies.

The amount of time required to complete an assessment depends on the patient’s health status and the assessment type. It would be best to take your time while assessing and not rush the process. Accurate record-keeping is crucial during assessment since it helps avoid forgetting vital information.

Bottom line

In this article, you learned comprehensive vs. focused health assessment in nursing. For comprehensive health assessment, medical history and physical examination are performed during admission of a patient or the first time a patient visits a doctor. At the same time, focused assessment involves examining a specific body system where the patient exhibits a concern, problem, or disorder.

The primary duty of a nurse is to conduct patient health assessment irrespective of its type and form. After completing a health assessment, they apply knowledge, critical thinking, and solving capabilities. Write a good health assessment today using the knowledge you have gathered in this article.