Quick Neuro Assessment?

I am not a neuro ICU nurse, so know that my answer is inadequate even as I type it.......

but for me as we all get our neuro patients and need to assess for neuro sx anyway all the time......

1) PERLA or not
2) UE equal and strong
3) LE equal and strong
4) tongue midline or not
5) any facial droop.....
6) speech-----describe.......

and past that......as I have already stated........I am not the expert here......
help others of more expertise here.........

but the ??? is something that has to be done quickly and routinely.....as we all know what reality nursing is like anywhere!!!!!!

As I *am* inordinately proud of my home page, I shall refer you to it.

I actually have a page where I describe a neuro exam, although it is written for laypeople, I think it is easier than typing the whole thing.

Also, I've written it as if the patient is somewhat lucid. Right - and how often does that happen? When I describe asking someone to hold out their arms like superman and close their eyes, I'm looking for strength and pronater drift. I don't guess I explained that in the page.

You'll love neuro. It's definitely *there* for the experience junkies among us. Be really, really careful of your back! But it's way cool (Except for the back injuries). I've done unit and floor and you just can't get that kind of experience on any other service!

Here's the page with the physical assessment:
http://members.tripod.com/~denniesim/physical.html

Love

Dennie

Hi

I've worked in Neuro ICU for the last 6 years and been nursing for 39. As you are new don't get carried away by 'quick'. Be thorough first, speed comes from experience. NurseDennie has outlined an approach that will start you on the right path. Remember also, more is missed by not looking than by not knowing.

Jonty

Ooooops - I thought my post didn't post, so I think I sent it as a PM to NeroRN as well. Sorry. (blush)

Love

Dennie

wow! nurse dennie,
your website rocks!!!

I am also a new RN on a neuro floor. I am so stressed being a new grad and today was my first real day. I felt so dumb. I felt like I new absolutely nothing at all and really that I didn't learn much in nursing school. Is this normal or am I just really behind? Thanks for the posting of the neuro website Dennie, I hope it will help a little.

I also ask the patient to state their full name, the year and month it currently is, and where they are. In addition to the other assessments listed, I have the patient hold their arms out with palms up (I tell them to hold their hands out like they are holding a pizza tray) and close their eyes (to assess drift). I ask them to squeeze my fingers and then push me away and then pull me in, to assess upper extremity strength. I have them do the same with their legs. I also make them smile at me and say "ahhh" when their tongue is sticking out.

It's amazing how quickly a patient can have a dramatic change in neuro status. I had a patient a few weeks ago who was A & O x 4 and VERY talkative during my initial assessment. A half hour later, he didn't even know his own name. Stat CT for him and a diagnosis of infarct. Scary!!

Good luck! Neuro is exciting!

Hello! I too am a new-grad (May 2008)- just passed my boards! Yeay! I started on a neuroscience unit at a major teaching hospital two months ago, and have an amazing preceptor. One of the best pieces of advice that he gave me is to try to use your time you spend with your patient to the max! While you are doing your physical assessment, talk to the patient to determine LOC, level of orientation, etc. . . while you're listening to lungs/heart have them wiggle their toes and fingers. You get the picture. Also, I tend to find that helping the PCAs with AM care is a great time to not only perform some of your neuro assessments, but also to check over their skin. Believe me, your PCA will appreciate you helping them out and it's much easier to position patients with help.

Remember to be careful of your back! Never be afraid to ask for help with T&P or moving a patient OOB to a chair or whatever. You will not only be looking out for yourself but also the patient- less likelihood of a fall.

Besides this, pay attention to the way senior nurses manage their time. Everyone has their own routine, but I've gotten better with mine by stealing their ideas! LOL

I've found neuro to be challenging but very rewarding! When a person's brain is involved, you never know exactly how things are going to manifest- and things can change dramatically very quickly!! Just be sure that no matter how you perform your neuro check, make sure it's thorough!! A slight change could signify something major! I had a patient in my second week who's pupils were equal and reactive at the begining of the shift. Four hours later, one was slightly larger than the other. Called the MD, got a CT scan and low and behold the patient had an emergent hemorrhage!

Best of luck with everything! Hope this helps a bit!