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You will be expected to know how to perform a patient assessment in clinicals as a Respiratory Therapy student.

So let’s go through the process so that there is no guesswork work in the equation. After reading this article, you will know and understand the exact how to perform a patient assessment the proper way (i.e. the way the NBRC wants us to do it).

First things first, the Respiratory Therapy student must be able to interpret, recognize, and perform the right patient assessment procedures that will lead to the appropriate care for the patient. They will also need to be able to make therapeutic recommendations such as administering therapy in an effective manner. Moreover, they must evaluate the patient’s progress, as well as recognize adverse reactions to any therapy that they provide.

Sound like a lot, huh? It’s not so bad once we break it all down. So let’s take a look at the steps for how to perform a patient assessment as a Respiratory Therapy student:

1. Check for the doctor’s order.

This applies to pretty much anything you will do as a student or Respiratory Therapist. You should always verify the doctor’s order before you proceed.

As a student, before entering the room, you should be able to accurately locate the patient’s chart and obtain and interpret all the information that is relative to the case.

2. Enter the room.

Obvisouly, you want to knock before going in. Wash your hands, then proceed to introduce yourself to the patient.

3. Gather any subjective information from the patient.

This is the information that you gather that the patient tells you through communication. It is not measurable.

For example, the patient says, “I’m having trouble breathing.”

This is subjective information.

4. Gather any objective information from the patient.

Objective information, on the other hand, is measurable. It includes all the vital signs that you will measure during your assessment. “Measure” is the key word here.

These are a few that you should obtain on every patient:

  • Heart rate
  • Oxygen saturation
  • Respirations
  • Breath sounds

Each of these vital signs can be classified as objective information and are very important for your patient assessment.

5. Use the information that you have obtained from the patient to interpret and develop an analysis on the patient.

Now it’s time to put what you learned to the test. How were the patient’s vital signs? Was their heart rate in the normal range? How about their oxygen saturation? Were they breathing too fast or too slow? Did you hear in wheezing in their breath sounds?

This is all stuff you should take into consideration to form your analysis for the patient.

6. Use the information for your assessment to develop a plan for the patient.

Now it’s time to make a plan for the patient. Do you see all the questions we asked in step 5? Now is the time to answer those questions in order to help make a plan for the patient. 

Was their oxygen level low? If so, now would be the time to provide the patient with a higher FiO2. Was the patient wheezing? If so, you can administer a short-acting bronchodilator via small-volume nebulizer, in this case.

Use everything you gathered in your assessment to help develop a proper action plan to treat the patient most effectively. 

Final Thoughts

Now you know how to perform a patient assessment the right way as a Respiratory Therapy student. Hopefully, you can take what you learned from this article to be more confident each and every time you assess a patient, now and forever.

Thank you for reading and Happy Respiratory!