Neurological Health Assessment - CustomNursingPapers.Com

Neurological Health Assessment
Health assessment is often the first step in identifying the patient’s problems upon seeking healthcare. The initial assessment of the patient helps to determine the nature of the problem and the most appropriate management depending on the results. Other assessments like focused health assessment, time-lapsed assessment, and emergency assessment are available to guide specific delivery of healthcare services to patients. Neurological assessment is among the many aspects addressed during health assessment by nurses and other healthcare providers. A value of solid neurological assessment can make a difference between life and death, permanent disability, or complete recovery. The main reason for neurological assessment is to detect neurological disease or injury in a patient and to monitor its progression while gauging the patient’s response to interventions (Brich et al., 2018). While neurological assessments are simple, many consider the practice daunting and in most cases sends the provider into a panic.

During my practicum experience, performing a neurological assessment was the most challenging aspect. From the beginning, I had a negative mindset that neurological assessments were only for the experienced because everybody around feared this area. I purely understood that a complete neurological exam involved the assessment of sensorium, cognition, cranial nerves, motor, sensory, cerebellar, gait, reflexes, meningeal irritation, and long tract signs. Specifically, I found it challenging to assess groups like infants, younger children, and older uncooperative adults. Initially, I had challenges in understanding what I was looking for during neurological examination. According to research, neurological examination findings can be useless if the healthcare provider does not have a purpose in mind (St-Denis et al., 2017). The examination only yields incidental findings that could otherwise cloud the picture of the healthcare provider. Consequently, the complexity of neurological examination, interpretation of results, and correlation of neuroaxis are often challenging.

The most critical aspect of neurological assessments is assessing the mental status of the patient. Assessing the level of consciousness (LOC) is often the first part because it helps to identify changes that can indicate neurological injury. I had issues with performing LOC assessment using the Glasgow Coma Scale (GCS) especially for patients with a head injury and trauma-related issues. During emergencies, I had challenges with allocating GCS scores to patients due to the quick nature of the assessment required. To counter this challenge, I kept a cheat sheet to help in remembering the scores and also during the documentation of patient data.

The Key to performing an overly detailed neurological examination is observation. Evidently, more than half of the neurological exam is performed by observing the patient (Bornkamm et al., 2019). While performing the examination, an explanation of the procedure to the patient serves to prepare them for the commands of neurological assessment. For example, I found it challenging to perform cranial nerves assessment and sensory examination in older adults because many felt uncomfortable performing the required movements. Another challenge observed was the linking of the neurological findings to the patient’s condition. I realized that performing a complete history of the patient could sometimes help in identifying the red flags that could guide a neurological examination. For instance, I had an encounter with a patient who presented with a chronic headache. Upon assessment, I thought of migraine as a benign outcome or a brain tumor at its worst. However, I noticed that the patient had an ataxic gait and had previously presented with a history of nausea and vomiting. I immediately realized that the patient could probably be having increased intracranial pressure. Recognizing the red flags can be challenging when performing a neurological examination, but increasing awareness of what constitutes a neurological exam can greatly perfect the assessment skills.

References

Bornkamm, K., Steiert, M., Rijntjes, M., & Brich, J. (2019). A novel longitudinal framework aimed at improving the teaching of the neurologic examination. Neurology, 93(24), 1046–1055. https://doi.org/10.1212/WNL.0000000000008628

Brich, J., Steiert, M., & Rijntjes, M. (2018). The essential neurological examination of the unconscious patient in the emergency room. Brain and Behavior, 8(9), e01097. https://doi.org/10.1002/brb3.1097

St-Denis, Y., Wenghofer, E., Young, N., & Ruckholm, E. (2017). Neurological assessment in the acute care practice environment of northern ontario hospitals. Diversity of Research in Health Journal, 1, 44-60.https://doi.org/10.28984/drhj.v1i0.22

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