Neuro Checks - What do I do?

[gambitlizard]

Nursing student here. Hitting the neuro floor for the 1st time tomorrow. I'd like to have a head start... How do I perform a neuro check?

Thanks,

Kim

[TracyB,RN, RN]

Well, most likely you will have a checklist..... But here's a few to give you an idea:

• Pupils perrla?
• Verbal
• Responsive (appropriate) follows commands
• Hand grasps = & strong
• It alert & responsive, pt can push feet against your hands to check if strong & equal...
• Response to pain?

[geekgolightly, BSN, RN]

I do this with almost all neuro patients because you never know when a change in mentation will occur.

My routine is to first ask them their name, where they are, and what year it is (if they are elderly... If they are young, I ask them the date. The older patients seem to have a harder time with years than months if they are beginning to be confused).

Then I ask if they have a headache. Any numbness or tingling anywhere? Any pain? Blurred vision? Double vision? I look to see if they are neglecting the right or left side, or if their pupils are grossly different.

I ask them to give me a big smile to check for symmetry, and ask them to raise their eyebrows.

Then I check the pupils with a light to see if they react and guesstimate the mm of the pupils.

Then I ask them to raise their arms in the air.. Hold for ten seconds. Wiggle fingers. Touch nose with finger and then my finger. Move my finger to see if they have difficulty with following a change in space.

Then I check their grip. Both hands at one to feel for a difference.

Then I ask them to raise one leg at a time five seconds each to check for drift or tremor.

Then "push on the gas" the foot on my hand. And then put my hand on their toes and ask them to bring their "toes to their nose".

Even if they say they don't feel any numbness, I check for intact sensation in lower extremities by first giving a light pinch and a light poke explaining what I am doing, so they know the difference and then check to see if they can differentiate on their own.

I also feather touch right or left leg and ask "which leg am I touching now?"

That's the basic neuro check. If there is any change I might go into further detail... Like asking what pictures mean checking for aphasia or field cuts, or asking them to repeat words like "fifty-fifty" "tip-top" to hear any sort of dysarthria/slur/hesitancy.

[geekgolightly, BSN, RN]

http://www.strokecenter.org/trials/scales/nihss.html

[kaseysmom, LPN]

Keep in mind when doing neuro checks that if there is a board in their room (more so in a hospital setting) with the date on it - that the "what's today's date" question won't work - also, when I am doing neuro checks - and the patient answers the majority of them correctly but gets one wrong, I'll ask another similar question because sometimes they are forgetful. Another good tip is to always go head to toe otherwise you'll probably forget something if you're forgetful like me, lol.

[hypnotic_nurse]

When you check grip, give them just ONE finger to squeeze; they can't hurt you no matter how good the grip is. (probably all of you knew that, just a reminder) ?

[86toronado, BSN, RN]

I was just going to say to the OP... where I work, the GCS score is included in our neuro checks-you may want to be prepared to include one in your assessment of your neuro patients.

[Danielle lpn, LPN]

If I enter a room and observe a resident on the floor and pt has sustain injury on face. Should I care for client,complete a neuro ck, vitals, observe poss. cause of fall, then alert supv. Should I get help first, then care for client.After completing a neuro ck, what findings would I report to the physician.

Online reading to expand knowldge...pls. help new lpn.....

[katkonk, BSN, RN]

Please go back to your medical surgical nursing book and review the section that discusses patient falls. Always, and I mean ALWAYS it is C.A.B.C. Cervical spine, airway, breathing, circulation. Call for help while you are checking the patient....someone should hear you. Neuro checks will come later.

It is good of you to ask, and I am glad you want to know the important things, but this is something that they should have covered in your classes. Since they apparently didn't do that, then reviewing the book will help.