Focused Assessment
A focused assessment gathers targeted findings about a specific complaint, body system or change in condition. It may be the first assessment of a new concern or a reassessment after care.
Exam Tip
LPN/VN assessment responsibilities depend on state law; the RN leads comprehensive nursing judgment. Use PQRST for pain assessment. Report findings to the RN. Always reassess after interventions to evaluate effectiveness.
What Is a Focused Assessment?
A focused assessment is a targeted, in-depth evaluation of a specific body system, symptom, or complaint. Unlike a head-to-toe (comprehensive) assessment that evaluates all body systems, a focused assessment zeroes in on relevant areas based on the patient's presenting problem or changes in condition.
Focused vs. Comprehensive Assessment
| Feature | Focused Assessment | Comprehensive Assessment |
|---|---|---|
| Scope | Relevant systems and findings for the complaint | Broad review of health history and body systems |
| When performed | At presentation or when following a specific concern | On admission or at set intervals |
| Duration | Brief and targeted | Thorough, takes longer |
| Performed by | LPN or RN | RN (initial); LPN can collect data |
| Example | Assessing pain after medication | Full head-to-toe admission assessment |
Common Focused Assessments
| Complaint/Condition | What to Assess |
|---|---|
| Chest pain | VS, heart sounds, lung sounds, pain characteristics (PQRST), O2 saturation, skin color |
| Shortness of breath | Respiratory rate, lung sounds, O2 sat, accessory muscle use, position of comfort |
| Abdominal pain | Bowel sounds, tenderness, distention, last BM, nausea/vomiting |
| Fall | Check responsiveness and breathing, activate help as needed, and assess for pain, bleeding and possible head or spinal injury. Follow the post-fall protocol before moving the patient. |
| Post-surgical | Incision site, VS, pain level, I&O, drainage, circulation distal to site |
| Diabetic concern | Blood glucose, LOC, skin moisture, tremors, vision changes |
PQRST Pain Assessment
| Letter | Meaning |
|---|---|
| P | Provokes/Palliates: What makes it better or worse? |
| Q | Quality: What does it feel like? (sharp, dull, burning) |
| R | Region/Radiation: Where is it? Does it radiate? |
| S | Severity: Rate on 0-10 scale |
| T | Timing: When did it start? Constant or intermittent? |
LPN/LVN Role in Assessment
- LPNs perform focused assessments and collect data within their jurisdiction's authorized scope
- The RN generally leads the initial comprehensive nursing assessment; LPN/VN responsibilities depend on state law and setting
- LPNs report findings to the RN for interpretation and care plan changes
- LPNs identify changes from baseline and report immediately
Exam Alert
Focused assessment questions appear in multiple NCLEX-PN categories. Know when to perform a focused assessment (change in condition, specific complaint, post-intervention monitoring). LPNs collect data through focused assessments but report findings to the RN. Use PQRST for pain assessment.
CNAs collect authorized observations such as vital signs and report changes; they do not perform an independent nursing assessment. Sudden chest pain, breathing difficulty or neurological changes require help without delaying for a full data set. Official guidance.
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Vital Signs
Vital signs are the fundamental measurements of basic body functions: temperature, pulse (heart rate), respirations (breathing rate), blood pressure, and pain (often called the "5th vital sign"). They provide critical data about a patient's physiological status and are assessed by all levels of nursing staff.
Nursing Process
The nursing process is a cyclical framework for planning, delivering and evaluating patient-centered care. ADPIE is a common way to remember assessment, diagnosis, planning, implementation and evaluation.
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) describes level of consciousness through eye opening (1-4), verbal response (1-5) and motor response (1-6). When all three can be tested, their sum ranges from 3 to 15.
Scope of Practice (Nursing)
Scope of practice defines what a healthcare professional is legally authorized to do. LPN/LVN practice depends on the jurisdiction's nursing laws, the setting, required supervision and the nurse's competence.
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