how to perform basic neuro check, not the NIH scale

[looking_foranswers]

Hello, I am a nursing student on a basic neuro floor. As a student, we are not allowed to do NIH scale neuro checks, just the basic ones. I see a mixture of both when I am on the floor and get confused as to what I should do when I perform my neuro checks. Does anyone know what the basic neuro checks are? can someone send me a check list? From what I think I know, I just check the pupils, check their grip and assess the strength in the legs.

[amzyRN]

I usually ask orientation questions. Where they are, time, situation, seeing if they are A and O x4. I look for facial symmetry and tongue deviation. I test shrug, grip, and dorsi/plantar flexion and any other noted abnormality in strength in movement. I check sensation. I check pupil reactivity to light and if it's symmetrical and also if the pupil reaction is brisk. I check ability to tract with they eyes. I check speech, any noted aphasia. Have you heard of the acronym FAST. Look it up, that's a basic neuro guideline. NIH is good too and you can get it online. The videos are a little long but there's some useful info.

[TheGooch]

NIH is good too and you can get it online. The videos are a little long but there's some useful info.

As a nursing student she isn't allowed to do NIH scale neuro checks.

[Jason Webb]

There should be no reason she can't ask the NIH SS questions for practice during clinicals if her preceptor is ok with it. She shouldn't document having done the NIH checks.

[akulahawkRN, ADN, RN, EMT-P]

On basically all patients I come into contact with, I do the following checks:

• A&O status (person, place, time, purpose)
  
• Facial symmetry (smile/frown/tongue deviation)
  
• Shoulder Shrug
  
• Hand grip
  
• Elbow flexion/extension
  
• Shoulder internal/external rotation
  
• Pronator drift
  
• Plantarflexion/Dorsiflexion
  
• Straight leg lift
  
• Ask if there's any tingling, numbness, pain, discomforts anywhere, if yes:
  
  • bilateral sensation: sharp, dull, pressure
    
  • OPQRST (useful mnemonic) the symptoms
    

I also watch the patient to see if they notice me as I come into the room and interact appropriately with me and their surroundings. While I may appear to make small-talk with the patient, I'm actually assessing the patient's mental status constantly. Someone may be able to answer the "orientation" questions appropriately but may be unable to hold a conversation. Note this is NOT the full NIHSS exam...

[looking_foranswers]

I have not been on since I posted this and I am so sorry I did not thank you all sooner! Your help is so appreciated.

[misswoosie]

Surely it depends on the individual patient? For example, the NIH(SS) is a Stroke scale, and would not be appropriate for someone with MS. FAST (Face, Arm, Speech,Time of onset) again , was specifically developed for use in the emergency assessment of suspected stroke. I would have thought the Glasgow Coma Scale would be appropriate for some patients on a neuro floor. Also need to be aware of restrictions due to pre-existing conditions eg an older patient may not be able to perform a straight leg lift, but it may not mean they have a neuro deficit. Also- how about whether they can transfer in and out of bed, feed themselves, etc etc ie Activities of Daily living (ADLs)?

[Techy214]

At a basic level you need to assess three things for a general neuro check.

Patient's GCS

Pupils

Power in all four limbs

Report ANY changes, even if they tend to fluctuate. I think people forget to report neurological changes or don't assess it properly and I've seen people in deep trouble for it. As long as you do those three things correctly and accurately first then you can worry about the more advanced stuff.

[MissyNik]

Good Stuff!!