Correlate neurologic assessments to patient problems and diagnostic findings.
Identify indications for, complications of, and nursing management of commonly used neurodiagnostic tests.
Identify causes of increased intracranial pressure and describe strategies for management.
Compare and contrast the etiology, pathophysiology, clinical presentation, patient needs, and nursing management for:
SPECIAL ASSESSMENT TECHNIQUES, DIAGNOSTIC TESTS, AND MONITORING SYSTEMS
Although there is no single method of performing a neurologic evaluation, a systematic, orderly approach offers the best results. Knowledge of neurologic disease processes and neuroanatomy allows the critical care nurse to tailor the assessment to individual patients. Obtaining a comprehensive past medical history that includes any preexisting neurologic conditions in addition to a thorough history of the present illness or injury is essential. The time from injury to symptom onset, and identification of the mechanism of injury have important implications for diagnostic testing and treatment. The administration of any medications that may potentially alter the neurologic examination, especially sedatives and neuromuscular blockers, is also noted.
Serial assessments, coupled with accurate documentation, allow for detection of subtle changes in neurologic status. Early detection of changes permits rapid intervention and improves patient outcomes. Neurologic assessment in the critical care unit can be broken down into the following components: level of consciousness, mental status, motor examination, sensory examination, and cranial nerve examination. A baseline examination is established and subsequent assessments are compared. Whenever a patient handover of care occurs, the oncoming nurse should perform a neurological examination. This is often completed with both off-going and oncoming providers together to provide an accurate baseline for the nurse assuming care of the patient.
There are multiple components to level of consciousness including arousal, awareness, and responsiveness. Arousal refers to the state of wakefulness; awareness reflects the content and quality of interactions with the environment; and responsiveness refers to the ability to react to changes in the environment. Arousal reflects function of the reticular-activating system and brain stem, and awareness indicates functioning of the cerebral cortex. Level of consciousness is assessed on all patients unless they are pharmacologically sedated and paralyzed. A change in level of consciousness is the most important indicator of neurologic decline. Any change in the level of consciousness requires further assessment or action from the healthcare team.
Observation of the patient’s behavior, appearance, and ability to communicate is the first step in assessing level of consciousness. If the patient responds meaningfully to the examiner without the need for stimulation, then the patient is described as alert. A patient may exhibit responsiveness to auditory or physical stimuli. If stimulation is required, auditory stimuli are used first. If the patient does not rouse to auditory stimuli, tactile stimuli such as a gentle touch or shake are used, followed by painful stimuli if necessary to elicit a ...