Podcast
Questions and Answers
In neurologic assessment, a small change is highly indicative of what?
In neurologic assessment, a small change is highly indicative of what?
- Decreased medication effectiveness
- Stabilized vital signs
- Neurologic injury (correct)
- Improved cognitive function
Changes in vital signs are typically the first indicators of a developing neurologic injury.
Changes in vital signs are typically the first indicators of a developing neurologic injury.
False (B)
What three components are included in evaluating a patient's mental status during a neurologic assessment?
What three components are included in evaluating a patient's mental status during a neurologic assessment?
Level of consciousness (LOC), orientation, and memory
A Glasgow Coma Scale score of less than 9 suggests a ___________ brain injury.
A Glasgow Coma Scale score of less than 9 suggests a ___________ brain injury.
Match each Glasgow Coma Scale category with the corresponding type of patient response:
Match each Glasgow Coma Scale category with the corresponding type of patient response:
In assessing a patient's level of consciousness (LOC), what is the first step you should take?
In assessing a patient's level of consciousness (LOC), what is the first step you should take?
When evaluating LOC, if a patient is hearing-impaired, it should be documented as it will negatively impact their Glasgow Coma Scale score.
When evaluating LOC, if a patient is hearing-impaired, it should be documented as it will negatively impact their Glasgow Coma Scale score.
List three techniques used to elicit a response in a patient who is not following commands.
List three techniques used to elicit a response in a patient who is not following commands.
Moving in response to pain, but not in a meaningful way, is referred to as ______ response.
Moving in response to pain, but not in a meaningful way, is referred to as ______ response.
Match the following posture types with their descriptions:
Match the following posture types with their descriptions:
When evaluating the date for orientation, what additional information should be asked to accurately gauge a patient's understanding?
When evaluating the date for orientation, what additional information should be asked to accurately gauge a patient's understanding?
If a patient confidently states the name of the hospital when asked where they are, it always indicates they are correctly oriented.
If a patient confidently states the name of the hospital when asked where they are, it always indicates they are correctly oriented.
Name the three types of memory that are assessed when evaluating a patient's mental status.
Name the three types of memory that are assessed when evaluating a patient's mental status.
To assess ______ memory, give your patient three unrelated words to remember, such as pencil, grape, and car.
To assess ______ memory, give your patient three unrelated words to remember, such as pencil, grape, and car.
Match the type of memory with its method of assessment:
Match the type of memory with its method of assessment:
Which cranial nerve is usually deferred during a standard neurologic assessment?
Which cranial nerve is usually deferred during a standard neurologic assessment?
When testing CN II (optic nerve), visual acuity is only tested with a Snellen chart.
When testing CN II (optic nerve), visual acuity is only tested with a Snellen chart.
What three cranial nerves are assessed together when evaluating eye movement?
What three cranial nerves are assessed together when evaluating eye movement?
Pupillary response and eye motion are controlled by cranial nerves III, IV, and ______
Pupillary response and eye motion are controlled by cranial nerves III, IV, and ______
Match each cranial nerve with its function:
Match each cranial nerve with its function:
When testing the sensory component of the trigeminal nerve (CN V), what areas of the face should be tested?
When testing the sensory component of the trigeminal nerve (CN V), what areas of the face should be tested?
Corneal reflex testing should be performed on alert patients.
Corneal reflex testing should be performed on alert patients.
Name two methods of assessing the motor function of the facial nerve (CN VII)
Name two methods of assessing the motor function of the facial nerve (CN VII)
Weber and Rinne tests are used to assess cranial nerve number ______.
Weber and Rinne tests are used to assess cranial nerve number ______.
Match each test with the cranial nerve it assesses:
Match each test with the cranial nerve it assesses:
When assessing motor function, unilateral atrophy often indicates what condition?
When assessing motor function, unilateral atrophy often indicates what condition?
If a patient can't let go of your fingers on command, it's indicative of musculoskeletal injury
If a patient can't let go of your fingers on command, it's indicative of musculoskeletal injury
What is pronator drift, and what does it indicate?
What is pronator drift, and what does it indicate?
About 15% of people normally have one pupil up to 1 mm smaller than the other; this is a normal variant known as ______.
About 15% of people normally have one pupil up to 1 mm smaller than the other; this is a normal variant known as ______.
Match the assessment component with its primary focus:
Match the assessment component with its primary focus:
In a focused neurologic assessment, what three components are typically included?
In a focused neurologic assessment, what three components are typically included?
It is necessary to perform the entire neurologic assessment, even if a patient has a known neurologic diagnosis and develops a subtle change.
It is necessary to perform the entire neurologic assessment, even if a patient has a known neurologic diagnosis and develops a subtle change.
What is the purpose of a 'cheat sheet' in performing frequent neurological assessments?
What is the purpose of a 'cheat sheet' in performing frequent neurological assessments?
Prior to beginning a neurologic assessment, you should ______ the assessment to your patient and his family to ease their anxiety.
Prior to beginning a neurologic assessment, you should ______ the assessment to your patient and his family to ease their anxiety.
Match each term from the text with its definition.
Match each term from the text with its definition.
Which of the following findings indicates a likely lesion of cranial nerve XII?
Which of the following findings indicates a likely lesion of cranial nerve XII?
It is acceptable for family members to answer questions for the patient during a neurologic assessment if the patient is struggling to respond.
It is acceptable for family members to answer questions for the patient during a neurologic assessment if the patient is struggling to respond.
What is the significance of eye motion in pupillary response assessment?
What is the significance of eye motion in pupillary response assessment?
In assessing cranial nerve function, the test that involves striking a tuning fork and placing it on the patient's forehead is known as the ______ test.
In assessing cranial nerve function, the test that involves striking a tuning fork and placing it on the patient's forehead is known as the ______ test.
Match the painful stimulus with its correct means of administration:
Match the painful stimulus with its correct means of administration:
Flashcards
Assessing Mental Status
Assessing Mental Status
Evaluates level of consciousness, orientation, and memory to gauge a patient's neurological status.
Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
Tool used to assess level of consciousness by evaluating eye-opening, motor response, and verbal response.
Eliciting Best Level of Response
Eliciting Best Level of Response
Start by speaking in a normal tone, then louder, gently shaking, and finally using painful stimuli if necessary.
Nonreactive Side Assessment
Nonreactive Side Assessment
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Purposeful response
Purposeful response
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Nonpurposeful Response
Nonpurposeful Response
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Memory Assessment
Memory Assessment
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Immediate memory assessment
Immediate memory assessment
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Short-Term Memory Assessment
Short-Term Memory Assessment
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Remote memory assessment
Remote memory assessment
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CN I (olfactory)
CN I (olfactory)
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CN II (optic)
CN II (optic)
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CN III, IV, VI
CN III, IV, VI
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CN V (trigeminal)
CN V (trigeminal)
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CN VII (facial)
CN VII (facial)
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CN VIII (acoustic)
CN VIII (acoustic)
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CN IX & X : IX (glossopharyngeal) and CN X (vagus)
CN IX & X : IX (glossopharyngeal) and CN X (vagus)
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CN XI (spinal accessory)
CN XI (spinal accessory)
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CN XII (hypoglossal)
CN XII (hypoglossal)
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Assessing Motor Function
Assessing Motor Function
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Pupil reactivity
Pupil reactivity
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Eye motion or extraocular movement (EOM)
Eye motion or extraocular movement (EOM)
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Focused assessment
Focused assessment
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Study Notes
- A neurologic assessment is valuable as small changes can indicate neurologic injury, and early intervention can prevent permanent damage.
- The article reviews how to perform a basic neurologic assessment and tailor it as needed.
Comprehensive Assessment
- A complete neurologic assessment includes mental status, cranial nerves, motor/sensory function, pupillary response, reflexes, cerebellum, and vital signs.
- In non-neuro units, sensory and cerebellar assessments aren't always needed.
- Vital sign changes usually signify end-stage neurologic injury.
- Assessment focuses on mental status, cranial nerves, motor function, and pupillary response.
Assessing Mental Status
- Mental status includes level of consciousness (LOC), orientation, and memory.
- The Glasgow Coma Scale is used to assess LOC, which is the first indicator of neurologic injury.
- First, speak the patient's name in a normal tone, then louder if needed.
- Note if the patient is hearing-impaired.
- Gently shake the patient if there's no response.
- Use painful stimuli if there's still no response.
- A decreased Glasgow Coma Scale score may indicate a neurologic crisis.
- A total score of less than 9 indicates severe brain injury.
- Eye-opening scored as: Spontaneous (4), to speech (3), to pain (2), none (1).
- Motor response scored as: Obeys (6), localizes (5), withdraws (4), abnormal flexion (3), abnormal extension (2), none (1).
- Verbal response scored as: Oriented (5), confused (4), inappropriate words (3), incomprehensible (2), none (1).
- Techniques for Painful Stimuli: Trapezius squeeze, sternal rub, supraorbital pressure can be used.
- The patient who requires painful stimuli isn't following commands; therefore, if he reacts to the painful stimuli with only one side of his body, you'll need to assess the nonreactive side.
- Assess nonreactive side by pressing a pencil into the cuticle of one of your patient's fingers.
- Responses can be purposeful (pulling away), nonpurposeful (moving without meaning), or no response at all.
- Apply painful stimuli for 15 to 30 seconds.
- Determine orientation with detailed questions about name, location, and date, being specific.
- Vary questions to avoid rote answers.
- Assessing orientation also evaluates speech.
- Memory is divided into immediate, short-term, and remote memory.
- Assess immediate memory by giving three unrelated words, having the patient repeat, then recall them after 5 minutes.
- To assess short-term memory, ask about an event from the last few days, verifying the response if possible.
- For remote memory, verify information like wedding dates or birth dates.
Assessing Cranial Nerves
- CN I (olfactory): Identify common substances like coffee and cinnamon. Often deferred.
- CN II (optic): Test visual acuity using Snellen and Rosenbaum charts.
- CN III (oculomotor), CN IV (trochlear), CN VI (abducens): Assess together using corneal light reflex, six cardinal positions of gaze, and cover-uncover test.
- Also inspect pupil size, shape, and symmetry, and reactions to light
- CN V (trigeminal): Sensory component - touch forehead, cheek, and jaw with cotton and safety pin, asking the patient to describe the sensations.
- Motor component - clench teeth while palpating temporal and masseter muscles, noting strength; if not alert, test corneal reflex with cotton wisp, looking for blinking.
- CN VII (facial): Sensory - test taste on the anterior tongue (sweet, sour, bitter).
- Motor - observe face for symmetry at rest and during facial expressions; have the patient close eyes tightly and test muscle strength by attempting to open them.
- CN VIII (acoustic): Use Weber's and Rinne tests.
- CN IX (glossopharyngeal) and CN X (vagus): Test together (innervation overlaps). Listen to voice and check gag reflex; watch for symmetrical upward movement of the soft palate and uvula.
- CN XI (spinal accessory): Test strength of sternocleidomastoid and upper trapezius muscles.
- CN XII (hypoglossal): Observe tongue for symmetry, tremors, twitching; test strength by pushing tongue against cheek with resistance.
Assessing Motor Function
- Look bilaterally for muscle asymmetry or atrophy.
- To assess upper extremities, have the patient raise arms and resist downward pressure.
- Repeat with lower extremities.
- Have the patient grasp fingers and release on command; inability to release indicates neurologic injury.
Assessing Pupillary Response
- Pupillary response, along with eye motion, is controlled by cranial nerves III, IV, and VI.
- Normal pupils are 2-6 mm, equal, and round.
- Anisocoria (unequal pupils) is normal in 15% of people.
- Check reactivity by shining light from outer canthus; both pupils should react equally and briskly.
- Medications, surgery, and blindness can affect pupil size, shape, and reactivity.
- A key sign of severe neurologic injury is a change in pupil size and reactivity.
- Eye motion is tested by tracing the letter H with a finger, checking extraocular movement (EOM); document any inability to follow.
Focused Assessment
- Only assess LOC, motor strength, and pupillary reactivity unless indicated otherwise.
Helpful Tips
- Use a cheat sheet for cranial nerve functions and deficit terminology.
- Explain the assessment process to the patient and family to ease anxiety.
- Instruct family not to answer for the patient.
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