Brain check: Neurological Assessment
Whenever you go to a new place, an apartment or a house perhaps what do you usually do? You check the rooms, the kitchen, the sockets, the comfort room and all other things involved around the house. What about when you buy a new gadget like a tablet? You check its screen for possible scratches, you check the charger if it functions well, you check the applications whether all of them are working, you test everything to see if all of them are working as they should.
In this kind of life that we live in, it is very common for people to check on their material things and their functionality from time to time, to check if they are still okay, if they are working on normal terms and if there are some parts of those that are damaged and need to be repaired. Same is the same with different parts of our body, which need to be checked from time to time for their status.
The brain is one of the most important organs of the body, actually, it is vital to every person’s existence. It enables us to think and controls everything that we do, from breathing to doing our favorite activities. It stores our memories and allows us to feel emotions, and so much more. Without it, we can even breathe on our own.
Neurological assessment is defined as a series of simple questions and tests that provide crucial information about the nervous system. It is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired.
Monitoring neurologic status is not only applicable to those patients admitted in the ICU, but also to patients who do not have neurologic diagnoses such as those with cases that may lead to possible neurologic changes (i.e., post operative patients who may develop neurologic deficit because of blood loss).
A thorough one may include assessing mental status, cranial nerves, motor and sensory function, pupillary response, reflexes, the cerebellum, and vital signs. Typically, however, you may not need to perform cerebellar and sensory assessment, unless you are assigned in the neuro unit.
To assess a patient’s mental status, you may need to evaluate the patient’s level of consciousness, orientation and memory. You may need the Glasgowcoma Scale (GCS) to assess the patient’s LOC since this scale is the first to change in case of neurologic injury. The patient’s response is divided into Eye opening (perfect score is 4), Verbal response (5) and motor response (6). The perfect score is 15, any score below 9 indicates sever brain injury and a GCS score of 3 indicates brain death.
For orientation, you may ask questions such as where he is, what date and time it is and his/her name. When you assess your patient’s orientation, you must also note his/her speech. Assessment of memory, on the other hand, involves asking questions assessing immediate memory (repeating numbers or words you have just mentioned), short-term memory (describing a few things that happened in the last few days), and remote memory (birthdates, wedding dates and news events).
You may assess the cranial nerves by performing some procedures depending on the nerve involved.
- CN I (Olfactory) – ask the patient to identify the smell of two different objects.
- CN II (optic) – Rosenbaum-near vision card and Snellen chart may be used
- CN III (oculomotor), CN IV (trochlear), and CN VI (abducens). Corneal light reflex test, the six cardinal positions of gaze, and the cover-uncover test may be used. You may also assess the size, shape, and symmetry of your patient’s pupils and papillary reactions to light.
- CN V (trigeminal) – You may need objects to use in testing the pain and sensory perceptions in the same three areas.
- CN VII (facial) – Sensory component may be checked by placing different items with different tastes on the anterior portion of the tongue. Motor function may be checked by assessing symmetry when smiling and frowning. By asking the patient to attempt opening his eyes, you are also checking muscle strength.
- CN VIII (acoustic) – Weber’s and Rinne’s test may be used with the use of a vibrating fork.
- CN IX (glossopharyngeal) and CN X (vagus) – You may need to listen to the patient’s voice and check the gag reflex.
- CN XI (spinal accessory) – You may assess this nerve by testing the strength of the sternocleidomastoid muscles and the upper portion of the trapezius muscle.
- CN XII (hypoglossal) – You may need to check tongue symmetry as well as tongue strength (asking the patient to push his tongue against his cheek as you are applying resistance).
To assess motor function, you may need to focus and arm and leg movement, their symmetry and muscle size, muscle tone, muscle strength, involuntary movements, posture and gait.
Some nurses, especially the newbies in the field may panic at the sight of a neurologic assessment order in the patient’s chart. However, this assessment need not be feared as it actually helps us take a look at the patient’s health and neurologic status and clues us in on what needs to be focused on and what to look out for.