Neuro Assessment ppt_2018.ppt - Neurological Assessment N210 1 How much of the exam to do What is the Chief Complaint What is the Physical Condition

Neuro Assessment ppt_2018.ppt - Neurological Assessment...

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Neurological Assessment N210 06/25/20 1
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How much of the exam to do? What is the Chief Complaint? What is the Physical Condition? Level of Consciousness Ability to comply Willingness to Participate & Cooperate 06/25/20 2
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Neuro Assessment Mental status / Level of Consciousness Cranial nerves Reflexes Motor function Sensory function 06/25/20 3
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Nursing History Pain Disorientation (Person, Place, Time) Speech Any loss of consciousness / memory Fainting Convulsions Trauma 06/25/20 4
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Nursing History (Continued) Numbness or Tingling Tremors or Tics Limping Paralysis Mood Swings Sensory complaints Changes or problems in vision, smell taste, touch, hearing 06/25/20 5
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Mental Status Intellect / Cognitive Emotions / Affective Language Orientation & Level of Consciousness Memory & Thought Processes Attention span & Concentration 06/25/20 6
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Languag e Aphasia = Deficit in Communication Sensory / Receptive Aphasia = Unable to comprehend oral &/or visual Motor / Expressive Aphasia = Unable to express self Usually able to assess during interview May ask client to name objects, follow commands, match pictures to words 06/25/20 7
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Orientatio n Person, place, time and situation What is your name? Where do you live? Where are you now? What day is it? What are we doing here? Level of consciousness Glasgow coma scale: applies best in head trauma, but used everywhere Eye opening: score 1 to 4 Motor response: score 1 to 6 Verbal response: score 1 to 5 06/25/20 8
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Glasgow Coma Scale 06/25/20 9
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Glasgow Coma Scale Practice Quiz The Glasgow Coma Scale provides a score in the range 3-15. Patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. 10
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11 A patient fell while rock climbing. When you apply a deep sternal rub, he extends his arms and legs and shows no other response. What is his Glasgow Coma score?
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12 What is the Glasgow Coma Score for a patient who is pulseless and apneic?
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13 A 73 year old patient looks at you when you speak to her. When you ask her the date, she says "blue." You note left-sided weakness when she grips your fingers.
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