Physical assessment - Neurological system: Nursing

Assessment of the neurological system should be completed as part of a comprehensive client assessment, or as part of a focused exam if the client is experiencing issues that might be related to neurological function, like a facial droop or confusion. Now, let’s review the process of completing a neurological assessment.

Okay, the supplies you’ll need include a cotton ball; a tuning fork; an object that can be easily recognized by touch like a paper clip, key, or coin; a reflex hammer; a tongue blade; drapes, and gloves.

Then, prepare for the exam by ensuring your client is in a comfortable position, that your hands are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

While much of the neurological system assessment involves observation, you will need to locate the deep tendon reflexes to assess spinal cord intactness. Commonly tested deep tendon reflexes include the triceps, biceps, brachioradialis, patellar reflexes, and achilles reflexes.

Alright, the methods of assessment for the neurological system include inspection and palpation. Your assessment will evaluate your client’s cerebellar function, which includes the client’s balance and coordination; sensory function, which includes their ability to feel and differentiate between light touch and pain; and motor function, which includes deep tendon reflexes.

Okay, begin your assessment of cerebellar function by observing your client’s gait, or how they walk. You can take the opportunity to do this as they enter the examination room or, if they are seated or in a bed, you can ask them to stand and walk across the room. While they ambulate, take note of their posture, coordination, and the movement of their legs and feet. Their gait should appear smooth and steady without hesitation, shuffling, or swaying.

Next, test balance and equilibrium with the Romberg test. Ask your client to stand with their feet together with their eyes open, and their arms at their sides. They should remain balanced and their body shouldn’t sway. Next, ask them to close their eyes for about 30 seconds while you observe their ability to stay upright. Be sure to stay close to your client to support them in the event they lose their balance. Your client should be able to maintain their balance with only mild swaying. The Romberg test is abnormal if your client demonstrates a loss of balance, by excessive swaying, moving their feet, or if they begin to fall.