Neurological assessment

The history is the most important element in defining the clinical problem, neurological examination is performed to localize a lesion in the central nervous system (CNS) or peripheral nervous system (PNS). The statement has been made, "History tells you what it is, and the examination tells you where it is." The history and examination allow the neurologist to arrive at the etiology and pathology of the condition, which are essential for treatment planning.

History

The history of the presenting illness or chief complaint should include the following information:

• Symptom onset (eg, acute, subacute, chronic, insidious)

• Duration

• Course of the condition (eg, static, progressive, or relapsing and remitting)

• Associated symptoms, such as pain, headache, nausea, vomiting weakness, and seizures

Pain should be further defined in terms of the following:

• Location

• Radiation

• Quality

• Severity or quantity

• Precipitating factors

• Relieving factors

The Physical Examination

The complete neurologic examination may be performed by the health care provider-the physician or advance practice nurse. Most nurse how ever perform focused assessments based on client’s presenting symptoms and diagnosis. The establishment of base line data is more important.

Equipment Needed

• Reflex Hammer

• 128 and 512 (or 1024) Hz Tuning Forks

• A Snellen Eye Chart or Pocket Vision Card

• Pen Light or Otoscope

• Wooden Handled Cotton Swabs

• Paper Clips

General Considerations

• Always consider left to right symmetry

• Consider central vs. peripheral deficits

• Organize your thinking into seven categories:

  1. Mental Status

  2. Cranial Nerves

  3. Motor

  4. Coordination and Gait

  5. Reflexes

  6. Sensory

  7. Special Tests

Category: Medicine Notes