NURS 6512 wk 9 Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.NURS 6512 wk 9 Assessing Neurological Symptoms
In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
Case 1: Headaches
A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.
Case 2: Numbness and Pain
A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.
Case 3: Drooping of Face
A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.
A focused neurological assessment of your patient can make a difference between life and death, permanent disability or complete recovery. It is a key standard of care for all patients. Yet many nurses fear the neuro exam unnecessarily. RN.com offers you an easy and manageable guide to performing a neurological exam with ease!
The purpose of a neurological assessment is to detect neurological disease or injury in your patient, monitor its progression to determine the type of care you’ll provide, and gauge the patient’s response to your interventions (Noah, 2004). Performing a neurological assessment early is important in establishing a baseline for later comparison (Anness & Tirone, 2009).
The initial evaluation is usually a comprehensive examination covering several critical areas of assessment, including level of consciousness (LOC), orientation, speech, facial symmetry, motor and sensory function and reflex activity. Assessment of cranial nerve function, cerebellar function and reflex activity are covered in a comprehensive neurological assessment.
Before beginning a focused neurological assessment, evaluation of the patient’s vital signs should be conducted, as current or progressive injury to the brain and brain stem may make vital signs unstable, which could reduce neurologic responses. It is best to conduct the neuro assessment at a time when vital signs are relatively stable (Anness & Tirone, 2009).
Evaluation of LOC is the most important part of the neuro exam, as a change is usually the first indication of a declining status (Noah, 2004). The Glasgow Coma Scale (GCS) is a valuable tool for recording the conscious state of a person, and is based on three patient responses: Eye opening, motor and verbal response. The total score will range from 3 (coma) to 15 (fully conscious, alert and oriented). A score of 8 or lower usually indicates coma (CDC, 2013). Although the GCS was initially used to assess LOC after head injury, it was not designed to be used for patients who are intubated, as the verbal component of the score cannot be accurately assessed. In documenting the GCS score for intubated patients, a notation of the patient’s intubation can be included as a narrative note to facilitate accurate interpretation of the GCS scores (Matis & Birbilis, 2008).NURS 6512 wk 9 Assessing Neurological Symptoms
In addition to performing the GCS, assessment of your patient’s pupil size, shape and equality before and after exposure to light is an integral part of a neurological exam. The PERRLA (Pupils Equal, Round, React to Light and Accommodation) acronym is a useful tool to use. A change in pupillary response, such as unequal or dilated pupils can provide a warning sign of increasing intracranial pressure (ICP) (Anness & Tirone, 2009).
A bedside neuro assessment almost always includes an evaluation of motor and sensory function, but requires the patient to be cooperative and oriented. To assess motor response in a comatose patient, apply a painful or other noxious stimulus to a central part of the body, such as trapezius muscle squeezing, or application of supraorbital pressure. Then observe for specific motor responses, as specified in the GCS, such as flexion (decorticate posturing) or extension motor responses (decerebrate posturing) (Anness & Tirone, 2009).
The Focused Neurological Assessment course is a part of the Assessment Series on RN.com. The course provides a comprehensive review of additional motor and sensory function tests, as well as cranial nerve testing.
Once an initial, thorough assessment is conducted (on admission or at the beginning of each shift), subsequent assessments should be problem-focused, zeroing-in on the parts of the nervous system affected by the patient’s condition (Noah, 2004).
Although the comprehensive neurological exam can be complex, it is essential to the diagnosis and treatment of a wide variety of neurological conditions. With practice and repetition you will hone this essential, life-saving skill (Anness & Tirone, 2009).
Diagnostic tests and procedures are vital tools that help physicians confirm or rule out a neurological disorder or other medical condition. A century ago, the only way to make a definite diagnosis for many neurological disorders was to perform an autopsy after someone had died. Today, new instruments and techniques allow scientists to assess the living brain and monitor nervous system activity as it occurs. Doctors now have powerful and accurate tools to better diagnose disease and to test how well a particular therapy may be working.NURS 6512 wk 9 Assessing Neurological Symptoms
Perhaps the most significant changes during the past 10 years have occurred in genetic testing and diagnostic imaging. Much has been learned from sequencing the human genome (the complete set of a person’s genes) and developing new technologies that detect genetic mutations. Improved imaging techniques provide high-resolution images that allow physicians to view the structure of the brain. Specialized imaging methods can visualize changes in brain activity or the amounts of particular brain chemicals. Scientists continue to improve these methods to provide more detailed diagnostic information.
Researchers and physicians use a variety of diagnostic imaging techniques and chemical and metabolic tests to detect, manage, and treat neurological disease. Many tests can be performed in a physician’s office or at an outpatient testing facility, with little if any risk to the person. Some procedures are performed in specialized settings to determine particular disorders or abnormalities. Depending on the type of test, results may be immediate or may take time to process.NURS 6512 wk 9 Assessing Neurological Symptoms