Assessment question

[Reba2084]

Hi! So I'm new to the NICU... Two weeks off orientation!! ? My question is related to a neuro assessment. I was giving report this morning to a more experiences RN who commented on my neuro assessment charting from the night. I had called a pt "arousable to pain" but she said he was actually unresponsive. He would not open eyes or follow commands but would withdraw to pain in all 4. I've had the arousable vs unresponsive debate with a few of my new RN cohorts but we get nowhere. Any experienced thoughts on this? In neuro terms, what constitutes "arousable"? Or any thoughts on a good neuro exam...

[Surprised1, MSN, RN]

I agree with your assessment. Your pt reacted to pain. Unresponsive would mean that you elicited absolutely no response to sternal rub, or whatever noxious stimulus you tried.

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[Mully]

We always had an intermediate box "withdraws to pain". "Arousable" alludes more to waking up, as in consciously. It can definitely be taken either way (depending on the attorney ) and would best be followed up with a supervisor or someone other than another floor nurse. Some of the best nurses I've worked with have been some of the worst charters, and visa versa.

[delphine22]

If it's not totally clear, I check the closest box I can find and then write a note on it. Our electronic charting lets me link the note to that particular box in the assessment, so it's clear I've written a whole narrative on that topic. Responsiveness is not always cut and dried, and sometimes the people who designed these assessments can be clueless.