How do you do your neuro checks???

[InmyblooD]

Just starting my preceptorship and was wondering what you guys do to assess neurological function?

Let's say you have to do neuro checks every 15 min.

I'm sure you're not going to get out that piece of cotton and whisp it across their face and then ckeck the same spots with the end of a sharp tongue blade.

I know the obvious is A/O x 1-3 and pupils but what else should be covered so I don't miss anything but at the same time maximizing my time with the pt. Or say I have to do those 15 min. checks..........what do you do?

Thanks in advance.

More Info on Neuro Checks...

Neuro Checks - What do I do?

[TazziRN, RN]

Depends on what you're testing for. If the pt has a head injury you test for orientation by asking questions. You can also test gait if the pt is allowed to get up and walk. Facial symmetry, speech clarity.

If you're testing for nerve function distal to an injury/surgical repair, you test the extremety on both sides to compare.

[kmoonshine, RN]

Most of the neuro checks I do are for acute events (ie stroke), so here's what I usually assess:

• Level of Consciousness
  
• A/O and compare it with their baseline
  
• Speech clarity
  
• Facial symmetry (smile)
  
• Tongue midline (stick your tongue out; doesn't deviate to one side)
  
• Grasp strength
  
• Have the patient lift their leg up as I try to push it down; compare bilaterally
  
• Pupil check (PERRLA: pupils equal, round, react to light and accomodation)

[fgoff]

I've always taken VS as part of neuro checks (like above). For closed head trauma/? Stroke I will do the "hand drift" Pt closes eye hold arm out in front of trunk palms up. If the hold even no drift. I will not which hand drift up/down. I will notify MD if anything different from basesline.

[Altra, BSN, RN]

Most of the neuro checks I do are for acute events (ie stroke), so here's what I usually assess:

• Level of Consciousness
  
• A/O and compare it with their baseline
  
• Speech clarity
  
• Facial symmetry (smile)
  
• Tongue midline (stick your tongue out; doesn't deviate to one side)
  
• Grasp strength
  
• Have the patient lift their leg up as I try to push it down; compare bilaterally
  
• Pupil check (PERRLA: pupils equal, round, react to light and accomodation)

Same here ... neuro checks in our ER are for CVA, head injury or cervical injury. The only thing I'd add to the above list is to test sensation (but just w/my hand - no cotton or sharp objects) IF the pt. is oriented enough to c/o lack of sensation in some area.

Neuro checks are hourly, unless something else happens that necessitates additional assessment.

[jjjoy, LPN]

A good reflection of the gaps between what's taught in school and what actual practice is. Of course, they can't teach everything school, but harried experienced nurses when asked about such things during nursing school clinicals tend to roll their eyes and huff about how poorly schools prepare students these days...

[tsicurn]

A bit off subject but same area... I work on on a Trauma/ Surgical ICU that receives frequent head injuries. Some of my coworkers and I were talking the other night about how there should be a GCS for intubated pts. Some of our head injury pts are with it but due to being intubated receive a lower GCS due to not being able to "vocalize". Any thoughts on this.....

[Altra, BSN, RN]

A bit off subject but same area... I work on on a Trauma/ Surgical ICU that receives frequent head injuries. Some of my coworkers and I were talking the other night about how there should be a GCS for intubated pts. Some of our head injury pts are with it but due to being intubated receive a lower GCS due to not being able to "vocalize". Any thoughts on this.....

A GCS is meaningless on an intubated pt. for the reason you mention and also because of paralytics used during RSI.