neurologic assessment

neurologic assessment

[-loj′ik]

Etymology: Gk, neuron + logos, science; L, icus, like, adsidere, to approximate

an evaluation of the patient's neurologic status and symptoms.

method If alert and oriented, the patient is asked about instances of weakness, numbness, headaches, pain, tremors, nervousness, irritability, or drowsiness. Information is elicited regarding loss of memory, periods of confusion, hallucinations, and episodes of loss of consciousness. The patient's general appearance, facial expression, attention span, responses to verbal and painful stimuli, emotional status, coordination, balance, cognition, and ability to follow commands are noted. Assessment of cranial nerves and deep tendon reflexes is included. If the patient is disoriented, stuporous, or comatose, demonstrated signs of these states are recorded. Observations are made of skin color and temperature; pupillary size, equality, dilation, and reactions to light; respiratory rate, rhythm, and quality; and chest movements and breath sounds. The pulse is checked; ears and nose are examined for possible drainage; strength of the handgrip is tested; and the extremities' sensations and voluntary and involuntary motions are assessed. Urinary output is determined for evidence of polyuria, and the patient's speech is evaluated for signs of slurring and aphasia. Included in the record are concurrent diseases such as hypertension, cancer, and coarctation of the aorta; past illnesses associated with head trauma; seizures; motor, sensory, or emotional disturbances; loss of consciousness; and neurologic, medical, or surgical procedures. Pertinent to the assessment are the patient's sleep pattern; medication; personality changes; relationships with family and friends; and a family history of seizures, stroke, mental illness, tumors, or sudden death. Diagnostic aids that may be required for a complete evaluation include a lumbar puncture, complete blood count, myelogram, magnetic resonance imaging, echoencephalogram, brain scan, computerized tomogram, and determinations of glucose, fluid, and electrolyte levels.

interventions The nurse may conduct the interview to obtain subjective data, examines the patient, and assembles the pertinent background information and results of the diagnostic tests.

outcome criteria A careful neurologic assessment is an important aid to the neurologist in establishing a diagnosis and the course of treatment.

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neurologic assessment 

evaluation of the health status of a patient with a nervous system disorder or dysfunction. Purposes of the assessment include establishing a medical diagnosis to guide the physician in prescribing medical and surgical treatments, and a nursing diagnosis to guide the nurse in planning and implementing nursing measures to help the patient cope effectively with daily living activities.

Important parts of the neurologic assessment include a general physical examination and a detailed neurologic examination; these may be conducted by either a physician or a nurse practitioner. A neurologic history must also be obtained, as well as any necessary special neurologic diagnostic studies. The neurologic physical examination involves evaluation of the patient's level of consciousness, mood, orientation, speech, content of thought, and memory; gait while walking and ability to stand quietly with feet together; physical status of the head, neck, and spine as determined by palpation, inspection, and auscultation; function of the cranial nerves; sensory and motor function; and reflex activity.

Nursing assessment of a patient's neurologic status is concerned with identifying functional disabilities that interfere with the person's self-care ability and ability to lead an active life. A functionally oriented nursing assessment includes: (1) consciousness, (2) mentation, (3) motor function, and (4) sensory function. Evaluation of these functions gives the nurse information about the patient's ability to perform everyday activities such as thinking, remembering, seeing, eating, speaking, moving, smelling, feeling, and hearing. Some patients should also be assessed for signs of hallucinations, delusions, delirium, and convulsive seizures.

A patient with an acute and life-threatening alteration in neurologic function is evaluated and monitored in four general areas: (1) level of consciousness, (2) sensory and motor function, (3) pupillary changes and extraocular movements, and (4) vital signs and pattern of respiration. (See also intracranial pressure.) In many institutions a checklist for “neuro checks” is available to the nursing staff to be used as a guide for objective assessment of a patient with an altered level of consciousness such as coma.