14-09-2013, 12:52 PM
Neurological assessment
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INTRODUCTION
Nursing care of patients is holistic and patient
focused, and begins with an accurate patient
assessment. This is vital for planning and imple-
menting appropriate care to all patients, including
those with a neurological condition.
Doctors and nurses carry out neurological
assessments for different reasons. Doctors pri-
marily use the neurological assessments to find
the site of a central nervous system (CNS) prob-
lem, establish a diagnosis, or determine the
course of treatment. Nurses
WHAT IS CONSCIOUSNESS?
Consciousness is defined as a general aware-
ness of oneself and the surrounding environment
(Hickey 1997); it is a dynamic state and can,
therefore, change. One prime example of a
change in a person’s conscious level is seen
when a person wakes up from sleep. Conscious-
ness is described as having two parts to it:
■ Arousal or wakefulness – a function of the retic-
ular activating system (RAS) located in the
brainstem.
■ Cognition – a function of the cerebral hemi-
spheres.
Consciousness cannot be measured directly
and can only be assessed by observing a per-
son’s behaviour in response to different stimuli.
Assessment of consciousness is difficult because
it can only be implied by an evaluation of the
person’s appearance and behaviour by another
person (Hickey 1997).
ASSESSMENT OF MOTOR RESPONSE
Obeying commands is the best response and
scores 6. It shows that patients are aware of their
environment, have understood the observer’s
instructions, and are able to carry them out.
Examples of possible commands are ‘lift up your
arms’ or ‘hold up your thumb’. If patients are
asked to ‘squeeze my hands’, they must also be
asked to release their grip, because some
patients with a brain injury can show an involun-
tary grip response when something is placed in
the palm of their hand. This grip response does
not mean that patients have understood what has
been asked of them, rather it is a primitive reflex
which is also present in newborn babies and
patients with dementia (Lindsay et al 1991).
CONCLUSION
An accurate neurological assessment is an inte-
gral part of holistic patient assessment for patients
with a neurological condition. It is, therefore,
essential that nurses who care for these patients,
have the knowledge and skills to be able to com-
petently carry out a neurological assessment
using the Glasgow Coma Score