A Complete Neurological Nursing Assessment Guide

• Neurological nursing assessments aid in identifying and diagnosing issues. 
• Neuro exams should be performed routinely in case anything progresses or worsens. 
• A complete understanding of why and how of neurological nursing assessments will not only help you remember all of the components of the exam, but also make you a better prepared nurse. 

A neurological exam, often called a “neuro exam” consists of an assessment or evaluation of an individual’s nervous system that is often performed by nurses, advanced practitioners, and physicians.   

The assessment can be completed using instruments, lights, and reflex hammers.   

Some may ask, “is it painful?”  It is a painless assessment that is often completed to determine if there is any alteration or issues related to the nervous system.   

If the nervous system is damaged, many physical issues may be noted along with a decline in daily functioning.   

As with any other medical issue, disease, or disorder, the key to preventing long-term complications is early identification.  Here is a complete guide on the value and correct method to complete a neurological nursing assessment. 

Indications For Performing a Neurological Nursing Assessment

A neurological nursing assessment can be conducted for various reasons anytime there is the possibility of a disruption of the nervous system due to the following factors: 

• Following a type of trauma 
• Complaints of headaches, fatigue, blurred vision, changes in behavior, changes in balance, changes in coordination, injury to the head, neck, or back, numbness or tingling of the arms and/or legs, fever, seizure activity, slurred speech, tremors, weakness, and decreased movements of the arms and legs 
• Problems with thinking clearly and memory loss 

Completing a Neurological Nursing Assessment

The nervous system consists of the brain, spinal cord, and the 12 nerves that originate in the brain.  

It can sometimes be difficult to complete the neurological assessment if one is unsure of the rationales of each area being assessed.   

Nurses, especially working with those with a possible neurological deficit, must possess keen observational skills while performing a neurological nursing assessment. It’s important not overlook an issue that may be causing a problem.   

The following areas are important to focus on when completing a neurological exam: 

Mental Status

Assesses the level of consciousness and interaction with the environment.  Many times, the nurse or healthcare professional will ask the patient about time, person, and place to determine if he/she is showing a deficit in one of these areas. 

Sensory

A sensory exam assesses the patient’s capability of feeling and understanding sensations and is often performed by using instruments such as a sharp item, dull item, alcohol swabs, and tuning forks.

Motor Function and Balance

These can be determined by having the patient to “push” and “pull” using their arms and legs to determine if there is any weakness noted.  Many times after a neurological stroke, there is weakness noted on one side of the patient versus the other.  Balance can be checked by having the patient to walk or stand.   

Reflexes

Due to the various types of reflexes noted in newborns and infants, it is important for the nurses to observe the reflexes for any abnormalities.

Evaluation of Nerves

There are 12 cranial nerves and they each serve a difference capacity and function.

Coordination Exam

This often exhibits itself when the patient begins walking abnormally or cannot do simple commands such as tapping one’s norse with eyes closed.

Five Minute Neurological Nursing Assessment

As nurses and other healthcare providers, it is imperative to attend to neurological needs quickly.  The following are important when completing the 5-minute neurological nursing assessment: 

• Mental status – nurses can tell a great deal by looking for odd movements and level of consciousness 
• Cranial nerves – assessing visual fields, pupil constriction and dilation, speech, and facial strength  
• Functional motor testing – assessing lower limbs/upper limbs for any weakness or limitations 
• Gait – ability to walk straight and to maintain balance 
• Sensory and Coordination – sensory testing is purely subjective and coordination can be caused by many things such as lesions on the brain or sensory disorders 
• Reflexes – reflex testing is purely objective and assess for asymmetries
  

Impact of Neurological Nursing Assessment

The five-minute neurological nursing assessment can quickly identify any issues, thus preventing progression and providing intervention.  

Nurses are often the first ones to notice any abnormalities and can sometimes stop something in time before it becomes too aggressive.   

One must understand that a neurological nursing assessment should be completed with accuracy, thoroughness, and complete understanding of the assessment.   

It is important that a neurological nursing assessment be performed every four hours or sooner in order to ensure continuity of care and that no adverse effects or changes have occurred.   

The neurological status of a patient can change abruptly and suddenly, so ensuring that “neuro checks” are being performed and reported helps predict the outcomes for the patient.   

It also gives reassurance to the family that the best care possible is being administered and that any subtle changes will be noted by the nurse.   

The Bottom Line

Neurological nursing assessments should not be delayed or skipped. Important and valid information can be missed or overlooked and of course, deterioration of the patient’s condition can unfortunately take place.

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