Neuro Check on awake, alert patient

[Szbeylik]

I'd like to get some feedback on this from seasoned neuro nurses, since I had an issue with this: When you have an alert and awake patient who has a stable, not fresh, smaller intracranial bleed, when you have every 2 hour neuro checks, do you, in your practice go through the whole head to toe rapid neuro assessment? The patient is alert, talking, looking right at you, joking, using a urinal, turns self, watches TV, etc., able to tell you if he is feeling any numbness, headache, etc... Or, do you use your experience and nursing judgement to deduce most of your assessment just from observing, interacting, taking care of the patient?

Your input is appreciated!

[offlabel]

An awake, apparently alert patient doesn't imply a neurologically intact patient. Can't catch something if you don't look and positive findings on a neuro exam are, by definition, new information if not surprises. If someone has the attention of a physician for a neurologic event, he is owed a thorough neuro check at the prescribed interval

[Szbeylik]

Ok. Let me clarify a little further. What if you did a full, thorough assessment initially and then you saw no change in behavior or alertness? Would you still go through EVERY single step by the book?

[offlabel]

Ok. Let me clarify a little further. What if you did a full, thorough assessment initially and then you saw no change in behavior or alertness? Would you still go through EVERY single step by the book?

Yes...that's the idea. Subtle changes in the neuro exam can be picked up early, thereby avoiding catastrophic changes an hour or 2 later. Changing the exam you do from check to check nearly guarantees you'll miss something. You're setting a baseline for the next time.

[MaxAttack, BSN, RN]

Depends on the situation. We don't have a dedicated neuro ICU so the strokes, intracranial bleeds, etc come to us. With a new admission or unstable patient, absolutely. With a patient who is awake and alert and can self report and has been stable, no.

LOC and mentation are the most sensitive indicators of ICP. If they're stable in report and stable for my initial assessment, I'm happy checking in on them frequently and doing my neuro checks every four hours. It's not proper, but I'm thinking back to the last time I caught a change and it was when I went in to hang another drip. It doesn't take a comprehensive assessment to tell me that my patient is acting different. The next q2hr neuro check wouldn't have even been for another 45 minutes or so.

[WIBound]

If your patient is alert it will make your neuro assessment much quicker. I have worked a Neuro ICU and sometimes they would keep QH near assessments as the residents were reluctant to step them down without the attending approval. At the minimum I am checking orientation, memory, having them move all arms and legs checking the face for any deviations...it can be completed is just a few minutes and if you do it often enough the patient will go thru the whole exam from memory. Better do it then miss something..