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Neuro exam, following commands vs mimicking?

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by Angelllau Angelllau (New) New

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I'm a new nurse to the ICU. I was doing a neuro exam on a trauma intubated patient the other day with a new student doctor.

When I asked the patient to show two fingers, I demonstrated it by holding out my own two fingers. Even though he was able to show two fingers, She said that he was only mimicking and does not count as following commands.

So my question is, during neuro exams do you only speak and not demonstrate the action/command you want the patient to perform? (Eg thumbs up, squeeze hand).

Does that patient not follow commands since he needs a visual to be able to perform and understand the task?

Thanks.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

1 Follower; 6,370 Posts; 65,641 Profile Views

The ability to follow commands includes the ability to mimic since that's basically what we're asking patients to do either verbally or visually. This is particularly true in an intubated trauma patient, I've had patients where just as you described the patient couldn't follow a verbal command but could follow visual commands, this turned out to be because the patient didn't speak English, couldn't hear, etc.

If they can see you holding up two fingers, cognitively process that sufficiently to know you want them to do the same and then do it, that's a clear ability to follow commands.

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Mini2544 has 1 years experience as a ASN, RN.

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The ability to follow commands includes the ability to mimic since that's basically what we're asking patients to do either verbally or visually. This is particularly true in an intubated trauma patient, I've had patients where just as you described the patient couldn't follow a verbal command but could follow visual commands, this turned out to be because the patient didn't speak English, couldn't hear, etc.

If they can see you holding up two fingers, cognitively process that sufficiently to know you want them to do the same and then do it, that's a clear ability to follow commands.

This is the only answer you need. I usually don't ask patients to squeeze my hand because that can just be a reflex.

Otherwise... it's all following commands

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