As a critical care nurse in a hospital, i've done thousands of assessments. in hospital, the nurse exam is often a lot more extensive than the doctors. In an acute care setting, doctors have more patients than the nurses do. Doctors at our hospital have about 15 patients and spend about 15 minutes with the patient per day, i spend 12 hours between three patients per day. Health care in a hospital setting is very much a team effort.
As a nurse, i do a ton of interventions, but that is different and separate from the exam/assessment. i've observed that a lot of med kinksters looking for 'realistic' med play aren't really looking for "real." For example, i have never given an enema during an exam, it's not part of the process. And temperature? Oral, tympanic, temporal, axillary, even foley, but have never taken a rectal temp of a patient.
For those interested, here's my typical exam: It starts with hand off from the prior nurse, just a quick snap shot of emergent info, what i am walking into, but it's also info i glean from my exam, so it's purposely redundant. Next, i look at the patient information from a computer, in a medical records program called "Epic." i look at the name, age, gender (or gender variant), code status and allergies. i look at consults, there can be many and they add to the picture (e.g., cardio, PT, OT, ST, RT, SW, psych, etc.). i look at diagnosis (i.e., the reason they were admitted), and medical history (in a critical care unit, it is rare to have just one diagnosis, there are usually several "co-morbidities" to consider and manage. Next i check the Medication Administration Record (MAR), medications tell me a ton about the patient. Next i check the most recent recorded vital signs, we take the every 4 hours if they are stable, or may have them 'hard wired' for more frequent depending on their status or meds we may be giving. For instance, with a nitro drip i might get a BP every 5 minutes, but i check current and recent past to establish a baseline. Next i go to the labs section and look at blood work. i get to work at 7 am, labs are usually done at 4 or 5. i look at all of them, again, there is a ton of info there, but looking for labs that are not WDL (within defined limits). So, before i even walk through the door and introduce myself, i have "examined" the patient in great detail and already know a great deal about them.
When i go into the room and introduce myself, i ask the patient what they like to called and usually try to relax them with a little humor, telling them i am there to ask a lot of stupid questions, look them over, then ply them with drugs, which usually gets a laugh, but pretty much summarizes what comes next. My assessment (i say "my" because everyones assessment is different, mine tends to involve a lot more than my peers) starts with a series of questions to determine if the patient is alert and oriented.
Next, i ask when their last bowel movement was, with a series of connected questions like issues of constipation or diarrhea, irregularity, hemorrhoids, etc. I ask the patient if they are feeling pain, then explain the pain scale to them. i then examine and flush their IV. Next, i assess their face. Interwoven is a neuro check for nerve connections 2-12 (don't typically assess olfactory) to determine if they are grossly intact. i have done this so many times, i combine several assessments at a time, like skin (wounds, spots, abnormalities, color, temp, dry/clammy, etc), as i am looking at other things. i'm leaving out a lot of detail here, just giving the surface. i look in the mouth, looking at teeth, mucous membrane mouth/throat, opening at the back of the throat (assessing for potential sleep apnea), asking if they have any issues chewing or swallowing. Eyes, pupils (with light), ears, nose, neck. radial pulses, grip. Lung auscultation, front and back, axillary, take a deep breath and cough please, smoking history? rec drugs? alcohol?. heart: listening at the valve locations second space right side of sternum for aortic, second space left side for pulmonic, third space left sternal for tricuspid, fifth space mid clavicular for mitral. Regurg? (murmur), regularity? Clicks (valve replacements), etc.. Then on to the ab with the stethoscope, four quadrants, palpation. Any numbness, tingling or pain in arms or hands? legs or feet? Down to the legs/feet, checking skin, checking for edema, vascular (varicosities?) post tibial and pedal pulses, dorsal and planter nerve response, thumb gets run across the bottom of the length of the foot watching the toes respond.
Assess for falls, bleed risk, suicide, nutrition. It's a long list.