![]() Be aware that a temporary decline in neurologic status caused by insufficient oxygenation or circulation still represents a neurologic change-and leads to permanent neurologic loss unless the underlying problem is corrected. Ideally, you should conduct the neuro exam when the patient’s blood pressure, temperature, heart rate, and heart rhythm are normal. To appropriately assess the patient’s peak neurologic status, be sure to evaluate oxygenation and circulation. Next, check vital signs: Are her respirations adequate? Are her vital signs stable? Is her blood pressure high enough to perfuse the brain and other vital organs? Be aware that current or progressive injury to the brain and brain stem may make vital signs unstable, but this situation can be complex: Although unstable vital signs can reduce neurologic response, brain injury itself may cause unstable vital signs. Ask yourself: Is the airway patent? If so, is the patient able to maintain it? First step: Evaluate ABCs and vital signsĪs with any patient, give top priority to assessing the ABCs-airway, breathing, and circulation. Yet despite the relative brevity of this type of exam, it can yield a significant amount of information. If your patient can’t follow commands, you’ll be able to assess only the pupils, eye opening, motor response, and some of the cranial nerves. If she can, your exam can be more comprehensive and should include evaluation of: The type of neuro exam you conduct depends on whether your patient can follow commands. Once you’ve completed the initial assessment, subsequent assessments can be either basic or more in-depth. Performing it early is crucial because this helps you establish a baseline for later comparison.įor accurate interpretation of assessment findings, nurses on the offgoing and oncoming shifts should evaluate the patient’s neurologic status together during shift changes or care transfers (as well as with the medical team on rounds). It starts the moment you meet the patient. The neuro exam can be conducted quickly and is easy to integrate into your daily assessment. One reason may be that, unlike CT scans and other diagnostic tools, its results come in shades of gray, not black and white. Although it’s still an integral assessment component for critically ill patients, many bedside nurses overlook or underuse it. ![]() Subtle changes in findings may indicate the need for further testing.īefore the advent of computed tomography (CT) in the 1970s, the neurologic examination was the main tool used to monitor a patient’s neurologic condition. But once you become proficient in performing this exam, you’ll be able to detect early significant changes in a patient’s condition-in some cases, even before these show up on more advanced diagnostic tests. Assessing the neurologic status of unconscious or comatose patients can be a challenge because they can’t cooperate actively with your examination.
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