Assessment of the Neurological System1 Paper
This week’s graded discussion topic relates to the following Course Outcomes (COs). CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities.Assessment of the Neurological System1 Paper (PO 1) CO2 Recognize the influence that developmental stages have on physical, psycho social, cultural, and spiritual functioning. (PO 1) CO3 Utilize effective communication when performing a health assessment. (PO 3) Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident.
Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq.Assessment of the Neurological System1 Paper The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist. Based on the above please discuss the following. Pathophysiology of concussive injuries and treatment Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling) Current best practices associated with post-traumatic stress disorder (PTSD) Nursing interventions you would include in this patient’s plan of care Assessment of the Neurological System1 Paper
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient’s medical history, but not deeper investigation such as neuroimaging.
A neurological assessment is an evaluation of a person’s nervous system, which includes the brain, spinal cord, and the nerves that connect these areas to other parts of the body. A neurological exam is done to assess for any abnormalities in the nervous system that can cause problems with daily functioning. A complete exam includes evaluation of an individual’s speech, awareness of environment, motor function and balance (walking ability, muscle strength, and tone), sensation, reflexes, coordination, and the 12 cranial nerves of the brain. These nerves are involved in smell, vision, pupil activity, eye movement, taste, hearing, swallowing, and movement of the face, neck, and shoulders. The health provider will use tools such as lights and reflex hammers to test these various functions of the body; the typical neurological exam will also include a general physical examination and discussion of symptoms and medical history to put any neurological abnormalities into context.
The neurological examination that is performed by many nurses today includes only a gross examination of the patient, Most chronic and acute medical and surgical nurses have no need for a detailed exam. However, this course deals with an exam for nurses who are involved with very special nursing situations in which a more detailed neurological examination is necessary.
It will be assumed in this course that you have a basic understanding of the anatomy and physiology of the nervous system. If you need to refresh yourself, you may use any basic anatomy and physiology textbook as a reference. This course will present the nurse with a quick and thorough technique for performing a neurological exam. It will also describe in detail some special nursing situations which are common to the acute care med/surg nurse and the critical care nurse. As you begin your general physical assessment, you may notice some symptoms that will reveal the need for a more detailed neuro examination. This text will provide a step-by-step procedure for performing the exam.Assessment of the Neurological System1 Paper
GENERAL NEUROLOGICAL EXAMINATION
Patient History
A detailed history is always important before starting the examination. If this exam is the first one given to a patient, such as the admission assessment, the nurse will usually complete a general form or questionnaire stating the history of the patient. If any of the questions suggest a neurological problem, the nurse will then ask questions more pertinent to the neuro status of the person. As always, the nurse must intervene if there is an emergency discovered during the examination. However, for this course, we will assume that the patient is “THE AVERAGE PATIENT.”
Some specific items to include in the history are: syncope, pain, bladder or bowel incontinence, seizures, diplopia and others. Often the relatives can give a better history, especially if the patient’s level of coherence is diminished.
In summary, the neurological history is often part of the general medical history. The nurse must be careful to intervene should there be a potentially life-threatening problem encountered. Otherwise, the nurse will continue to assess the neurological status of the patient, while obtaining the general medical history of the patient. After the general questions are asked and answered, the nurse can more carefully assess the neuro status of the patient.
Following, there is a list of items to be included in the medical and neuro exam of the patient. Remember that this is only a partial list. Some items can be excluded if the answers were already obtained at an earlier time; there may be other items which the nurse may wish to add to the list, due to specific patient problems or responses to questions.
The fundamental processes of the brain and nervous system are the key to understanding why nurses perform a focused neurological assessment. If there is a disruption to any of these processes, the whole body suffers. The neurological history and exam allows the examiner to pinpoint various areas of the brain or nervous system that may be dysfunctional. Assessment of the Neurological System1 Paper
Specific signs and symptoms manifested by your patient are associated with specific areas of the brain. Nurses observe for signs and symptoms that may be abnormal and link them to general areas of the nervous system that may be causing the disturbance. Nurses must also recognize when further neurological injury is manifesting, intervene appropriately, and notify the physician for a change in plans for the patient.
Components of the neurological history should be integrated with the steps taken during the complete physical examination. It may not be necessary to perform the entire neurological exam on a patient with no suspicion of neurological disorders. Nurses should perform a complete, baseline neurological examination on any patient that has verbalized neurological concerns in their history. The neurological exam should be rechecked at periodic intervals with any patient that has a neurological deficit (Jarvis, 2016; Wilson & Giddens, 2017).
History of the patient requires questions about injury, neurological or mental health disorders, deficits, headaches, syncope, and vertigo. Speech, swallowing, and coordination should also be assessed. Inquiry about exposure to environmental hazards is also a consideration. Important components of the neurological examination include assessment of mental status and testing cranial nerves (Jarvis, 2016; Malik, 2017).
Neurological procedures can lead to significant postoperative deficits. It is necessary for physicians to assess nervous system function intraoperatively so that any deficits can be remedied before they become permanent. The oldest way of assessing spinal-cord function is to use the Stagnara wake up test where individuals are awoken in the middle of medical procedures in order to evaluate motor function(1). Once the nerve status with the patient is definitely evaluated, the person would be reanesthetized and the surgery would continue. The awaken test is limited in that that only gives a brief examination of engine function. It fails to discover ischemia and sensory function(2). Now, intraoperative neurophysiological monitoring with motor evoked possibilities (MEPs), somatosensory evoked possibilities (SEPs), electromyography (EMG), electrocorticography (ECoG), and cortical mapping has become the new standard of care. It allows physicians to examine the nervous program function with no waking the patient. It has become an essential intraoperative device to improve safety in surgical procedures and aiding minimize postoperative deficits. It has allowed surgeons to accept high-risk patients whom might have been normally denied for the surgical procedure. There are plenty of intraoperative monitoring modalities accustomed to assess diverse part of mind, spinal cord, as well as the peripheral nervous system. The strength of each technique is able to offset the limitations of other monitoring modalities, and once combined with each other, they provide an extensive picture on the complex spine function.Assessment of the Neurological System1 Paper
Motor Evoked Potentials (MEPs)
Motor evoked potentials (MEPs) have common use to diagnose and assess the functional honesty of the descending motor way…
… to get assessing postoperative sensory function.
It is important to note some of the strong points and limits of SEPs. The talents of SEPs are that it allows for continuous monitoring, offers excellent specificity, and can be used with neuromuscular blocking agents(11). A limitation of SEPs is that it requires temporal summation of neural indicators that your spinal cord. Recorded data are based on calculated uses, so it may take several minutes after an acute offend for it to show up on the information. Studies have demostrated that the average wait time of SEPs is 18 minutes after MEPs and this SEPs is often as delayed intended for as long as thirty-three minutes(19). Additional limitations of SEPs are that it does not directly keep an eye on the corticospinal tract, offers low level of sensitivity for electric motor deficits, and its particular recording may remain unchanged in sufferers with anterior spinal artery injury(11). Assessment of the Neurological System1 Paper