Use Your Head: Making Neuro Assessments Simple

Every nurse has their specialty, an area of nursing with which they are most comfortable and have the most experience. One system that transcends all specialties is the neurologic system. Neurologic events occur in any patient population. Whether you work at the bedside or in an office, whether you care for adults or children, whether you work ER, ICU, psych, or any other specialty, it is vital that you know how to complete a basic neuro assessment.

Understanding how to do a neuro assessment can seem overwhelming to a nurse who is unfamiliar with it. Many nurses feel that neurology is a difficult specialty to understand and that only specially trained nurses can complete this type of assessment. However, it is important not to allow these feelings to prevent providing thorough care to your patients. Neurologic events can happen anywhere, and the best way to recognize them is by including this type of assessment in your basic care.

Early detection of neurologic changes can lead to the identification and treatment of stroke more quickly, allowing for the best possible recovery. The more time passes between the onset and treatment of stroke, the more brain is affected and the lower the chances of improvement in the stroke symptoms. The sooner symptoms are recognized, and treatment is initiated, the better the treatment can benefit the patient.

The best way to recognize neurological changes in a patient is to have a good baseline assessment. This does not have to be complicated or take a long time. Many of these assessments can be done informally while you are conversing with the patient or engaging in your assessment of other body systems.

Neuro Patient Assessment

• The first step is evaluating whether they are alert and oriented. Do they arouse or awaken easily? Do they answer simple questions correctly when you speak to them? 
• The next step is examining their speech. Are their words clear and easy to understand? Do they seem to have difficulty finding the right words to say? Along with their speech, watch their face while they are talking and note if there seems to be symmetry or if one side of the face is drooping. 
• Another step is assessing the patient's movement. If they are responsive, ask them to raise their arms, then their legs. Do they raise and lower them equally, or is one side weaker or unable to move at all? If they are ambulatory, you can observe their gait and see if one side appears to be stronger or if there is limited movement. If they are not responsive, a simple reflex test can be done by pressing on the patient's nailbeds and observing their movement. Does the patient respond to this painful stimulus equally on both sides of the body?
• A final basic assessment step is done by examining the patient's pupils' response to light. A small flashlight or the light on a smartphone can be used for this. Check to see if the pupils are the same size and if both react by constricting as the light is being shone into the eye. It may be helpful to do this in a dark room in order to see the light reaction more clearly.

Once you have completed each of these steps, you now have a baseline neurologic assessment. As you continue to encounter the patient, you can consider if the patient's response is different than their baseline. Any change in alertness, confusion, difficulty speaking, inability to move one side of the body or pupils that are unequal or do not react to light is cause for concern. 

There are many more components to a complete neurological exam, some of which can be quite complex. However, these basic steps can be done by any nurse and can be pivotal in getting patients the care that they need. Your patients will thank you for it!

References/Resources

Simplifying neurologic assessment: Nursing Made Incredibly Easy!

Neurologic Exam: National Library of Medicine

Guidelines For The Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: American Stroke Association / American Heart Association, Inc.