ER Nsg Neuro Assessment

[S.T.A.C.E.Y, LPN]

I've been second guessing my neuro exams on ER patients, and am now wondering what kind of neuro exam others do on a patient presenting with neuro symptoms? Confusion, dizzyness, balance issues, stroke symptoms, etc.

My usual neuro exam include GCS, orientation to person-place-time, pupils, bilateral hand/foot strength, and questions about headaches, nausea, vomiting, confusion and balance. What actual other assessment do you do?

I've been observing the docs do their neuro exams which are WAY more thorough, and I wonder if my nursing assessment should include more. But, frankly, beyond charting any descrepencies, I wouldn't know what to do with the information or what it means. I found a link on the net about cranial nerve assessments that is pretty simplified, but i'm wondering is this too much?!?!

Basically, I guess the question I'm asking here is what is YOUR practice for neuro assessments? How much do you know? If you do an extensive exam, how do you find this changes your nursing practice?

[mlzmom]

I know its not much help but how about smiling or sticking out their tongue?

[Mobeeb, RN]

I thought the following article might be helpful to you-----"Facing Neuro Assessment Fearlessly". I work in a busy Level I ED and we do quick initial assessments which include each of the practices you mentioned. I find it helpful to know the distribution of the spinal nerves when I have a patient with spinal cord injuries, so that when I learn where the level of injury and if it is a complete or partial cord injury, I will be able to expect loss of specific muscle control and sensation below the area of injury. Re: documentation----I document what I observe and let the docs be more specific about their exams in their documentation.

However, I digress. Here is the link to the article about neuro assessments.

Hope it helps.

http://findarticles.com/p/articles/mi_qa3689/is_200202/ai_n9081643/pg_1?tag=artBody;col1

[Medic2RN, BSN, RN, EMT-P]

We do a quick modified NIH stroke scale initially and try to get the full NIHSS as soon as possible for baseline.

The trend I've noticed is that once we get the initial assessment, vitals, labs, BS and 12 lead, the patient is off to CT and the scale is done after (s)he gets back.

[loricatus]

Besides what you mention, using scales would help simplify charting. For instance: Negative Cinn. scale. As opposed to equal b/l smile, equal b/l arm raising without drift...

Here's a link to help you with your options

http://www.strokecenter.org/trials/scales/index.htm

[back2bRN]

I add event to the person/place/date(season), pupils, smile, stick out tongue, nausea/vomiting, h/a, gait(if mobile), have them follow my finger with eyes, visual disturbances, any numbness/ tingling or unusual feelings, behavior(normal for them?), of course VS(incl temp), GCS. It sounds like alot, but takes very little time.