Many nurses (and even physicians!) are uneasy when performing neurological assessment. Often, it is difficult to remember which test goes with which symptoms, so neurological assessments—when performed outside of a specialty area—often offer vague assistance with diagnosis.
Knowing how to match the assessment to the potential issue, however, and understanding how, why, and when to perform specific neurological assessments will help you gather valuable information about a patient’s condition and specific needs. When a neurological injury has occurred (or is in the process of occurring), proper assessment is critical!
One easy pointer to start you off with: The test should match the area of the brain that is involved. For example, the Glasgow Coma Scale is not much use for a spinal cord injury.
6 Neuroassessment Steps
Follow these steps to simplify and standardize your neuroassessment process:
1. Remember that every patient is a potential neurological patient.
Anyone can have an unexpected acute neurological event, regardless of their age, gender, health, or setting.
While an elderly patient with hypertension and diabetes might seem like an obvious candidate for a neuroassessment, think also of teenage football players, expecting mothers—and even healthy-looking visitors to your unit with no immediately apparent issues.
2. Know the basic assessments for the neurological system.
For example, if your patient has or is suspected of having an injury to the occipital lobe, which assessments should be done? Basic assessments for the occipital lobe focus on vision and include:
- Visual fields
- Identifying the color of objects
- Naming objects
- Facial recognition
Practice these assessments on your patients over and over, and take the time to teach them to your peers.
3. Memorize the BE FAST assessment for potential stroke.
What issues do you need to watch for in people who may be having, or have had, a stroke?
- Balance: Has their balance recently changed?
- Eyes: Has their vision changed? Is the room tilting?
- Facial drooping: Ask the person to smile and show you their teeth. Is the smile symmetrical?
- Arm drift (or pronator drift): Are they showing signs of damage in the motor strip such as weakness in the shoulders and hands?
- Speech difficulty: Can they repeat a phrase after you? This one part of the assessment gives you insight into the function of multiple parts of their brain.
- Time is of the essence! Determine the time since onset of symptoms, and it’s time to call 911 if any of the above are present.
4. Be ready to perform a neurological assessment if your patient, a visitor, family member, or friend exhibits any other unusual symptoms.
These might include:
- Acute memory loss
- Behavioral changes
- Complaints of severe head pain
- New swallowing difficulties or slurred speech
- Problems with balance
- New onset of urinary or bowel incontinence
- Sudden onset vomiting, often accompanied by headache
- Unusual eye symptoms such as wandering eye, pupillary changes, or drooping lids
5. Always notify the provider of any neurological changes.
An unusual or sudden headache or a pupillary change can be the earliest sign of a deadly event.
6. Work to improve your neurological assessment skills.
They could save a life!
For more information on the neurological system and to boost your neurological assessment skills and confidence, watch the MedBridge course “The Nervous System for Rehabilitation Nurses.”