4 Tips for your next Neuro Assessment

_{By Amanda Kammes, MSN, BSN, RN, Nurse Community Manager}

The Neuro Assessment is one that is a hard skill to pick up, but with practice, is easy to master. Picking up slight neuro changes can save a life, and many times Nurses are the ones with the skills to notice and pick up these subtle changes. After many years of working in a Neuro unit, this assessment is second nature to me. 

Tip #1– Start at the head and go to the toes.

Tip #2- Weave cranial nerves and GCS into your head to toe assessment. Do not think of them as separate things, but rather parts of your head > toe assessment. Orientation, smiling, patients gaze following you around the room, all test for cranial nerves and also satisfy parts of the GCS scale. Be observant!

Tip #3– You do not test for every part of the GCS or cranial nerve scale if patients can do certain things. Ex: If a patient is mentating appropriately, is AAOx3 (awake, alert and oriented x3), is moving all 4 limbs spontaneously and on command – you have already assessed, just by walking in and having a conversation with the patient, and asking them to perform some simple tasks, Eye Opening, Verbal and Motor. You only move down the GCS scale if there are things the patient cannot do. Ex: Your patient does not respond to you when you walk in and say “Good evening Mr. Smith”. You would then move down the scale and try to rouse Mr. Smith, attempt to orient Mr. Smith and then do your motor test.

Tip #4– Motor is easy and again, goes hand in hand with cranial nerves. Motor is rated on a scale of 0-4. 4 being full strength.

> Arms up in front of you, ask patient to close eyes, observe for drift. Place your hands on top of their arms, ask them to push up with light resistance, then switch your hands to under theirs and ask them to push down, giving light resistance. Ask them to bend at the elbow and repeat the steps I just outlined going into and away from their body with resistance. 

> Ask patient to bend their own leg at the knee, then extend leg back down

> Assess for sensation/ numbness or tingling on your way down to their toes by applying light touch to their skin. 

> Ask patient to move their feet back and forth, then place hands on top of feet and ask patient to pull up against you, and then switch hands to bottom of feet and ask them to push down.