Tip of the Day

Today's tip: When transferring a patient from another unit (whether it's an outside hospital or inside hospital transfer) to a neuro unit...GET A NEURO EXAM! It's easy, promise a good neuro exam can take you less then 5 min let's go through it step by step...

1) walk into the patient's room, see if they open their eyes when you walk in (tip: give neuro pts, at least 30 secs to respond to anything you do, and 30 sec is longer then you think!)
2)if the pt doesn't open their eyes, say hello, introduce yourself and explain why your there, see if they open their eyes.
3) if they still haven't opened their eyes you have to move onto painful stimulus, this is what scares new nurses the most. Just remember if they need this, they need it, you're not hurting them to hurt them.
Tips to giving go stimulus: avoid the sternal rub if you can, to do a good rub you should leave your nail marks on your hand and a bruise on their sternum (get the picture) There are better places to produce stimulus. My favorites: Take a 1 1/2 inch pinch of the trapezius muscle (grabbing muscle, not just skin) and twist (try this on yourself it hurts.

4)if after giving painful stimulus (try multiple types in multiple locations) they haven't opened their eyes, you can say that they aren't responding.
5) next, look at their eyes. This may mean opening them yourself. Take a penlight and see if they react. A general rule of thumb that the neurosurgeons go by is that if they have pinpoint pupils they may be sluggish, but they cannot be fixed.
6) Check for movement in all extremities. If they're not moving one limb or one side, first ask them to look at that limb and move it, if that doesn't get a response pinch that limb and see if you get a response. Again, if they need a pinch to get moving, you need that information.
7)If they're moving everything and following commands there are a few more things that you can have them do, if not you may have to stop at this point.
8) ask them to take your hands and pull you towards them, push you away, this will give you an idea of arm strength
9) ask them to lift their foot off the bed and keep it up as you try to push it back down onto the bed, do the same on the other foot
10) have them stick their tongue out at you (some pt enjoy trying to touch their tongue to their nose as well, and it makes them smile which gives you a good idea of facial symmetry)
11) have them give you a good cough, take a sip of water (not necessary if you're short on time)


See it's easy, now let's see what info we have gathered.....You've been talking to them, so you know speech status, you know PEERLA, strength, you may know orientation, you have successfully assessed their motor function and their consciousness!
Not knowing the exact size of their pupils, or the total Glasgow Coma Scale score, EOMs, sensations aren't a huge deal, any neuro nurse will be grateful that you took the time to do a simple neuro exam and that information is going to allow us to be prepared for what is coming!

The exam may look long, but trust me, it is simple, it just takes a bit of practice and you'll have your style down, before you know it you'll be assessing neuro status on the fly in the grocery store!