The Neuro Assessment Kelsey Mayer Afraid of neuro

The Neuro Assessment Kelsey Mayer

“Afraid of neuro patients because you don’t trust your neuro judgement? The truth is, neuro is one of the simplest systems that we have. Unfortunately, it’s often taught in such a difficult way that people are intimidated. ” -Judith Lower, American Journal of Nursing 5

LOC Glasgow Coma Scale 1 Painful Stimuli 5 1. Central a. Trapezius squeeze a. Supraorbital pressure a. Sternal rub

Orientation Person Place Time - What is your full name? - Where are we? - What month is it? - What is your middle name? - What city? - What day of the week is this? - What state? - What holiday was just celebrated? - Which hospital? - What year is it? Are we in a school? Remember. . . Patients lose orientation to time (1), then (2) and finally person (3)4 Are we place at the park? AND Patients may be memorizing the correct answers to your questions - mix it up!5

Attention, Language & Memory Attention Language a. Hold up a watch and ask what it is. If the patient says “It tells time” don’t assume they know it is a watch. Memory 1. Long-term a. What is your date of birth? 2. Short-term a. Who is the president of the United States?

Vital Signs Specific changes in vital signs can demonstrate increased intracranial pressure Cushing’s Triad 3 - Increased systolic blood pressure with widening pulse pressure - Bradycardia - Irregular breathing patterns Hypertension, hypotension and loss of thermal control can also indicate increased ICP 3

Cranial Nerves

Cranial Nerves the Breakdown II: Optic ● What are you watching on TV? Can you see that sign? III, IV & VI: Oculomotor, Trochlear, Abducens ● Walk from one side of the bed to the other during your assessment, bend to empty the foley, reach above the patient V: Trigeminal ● Chewing, facial sensation VII: Facial ● Tell a joke and watch the smile, raise your own eye brows and see if they do as well VIII: Auditory IX & X: Glossopharyngeal, Vagus ● Swallow XI: Accessory ● Shrug your shoulders XII: Hypoglossal ● Stick out your tongue, watch for patient licking lips

Motor

Pupils http: //pocketdentistry. com/8 -neurologic-evaluation-and-management/

“Get in the habit of approaching all patients from the neuro perspective. The med-surg population is aging, and older patients are as much as risk for neurological events as are neuro patients, especially postoperatively 4. ”

To summarize. . . There are many parts to the neurological exam. . . Baseline, baseline Adequate stimulation Mix it up! Cranial nerves. . . why are there so many!? If you aren’t seeing what had been previously charted, get help Don’t leave the room when PT/OT/Physicians/Speech Therapy see your

References Bajaj L. , Kaushal R. K. , & Kaur S. (2014). Nurses’ Knowledge and Practice of using GCS in a Tertiary Level Hospital. Research & Reviews: A Journal of Neuroscience. 2014; 4(3): 9 -13. Couret D, Boumaza D, Grisotto C, et al. Reliability of standard pupillometry practice in neurocritical care: an observational, double-blinded study. Crit Care. 2016 Mar 13; 20(1): 99. Crimlisk JT, Grande MM. Neurologic assessment skills for the acute medical surgical nurse. Orthop Nurs. 2004 Jan-Feb; 23(1): 3 -9. Lower J. Facing neuro assessment fearlessly. Nursing. 2002 Feb; 32(2): 58 -64. Lower J. Rapid neuro assessment. AM J Nurs. 1992 Jun; 92(6): 38 -45.