Ongoing Neurological Assessments Reveal Subtle Changes

Patients with alterations in level of consciousness are among the most difficult to assess and may have subtle neurological changes that can occur suddenly and become life-threatening if they go unnoticed.

Nurses who care for these patients must have the knowledge, skill, and time to confidently perform comprehensive neurological assessments to identify changes that require quick diagnosis and intervention by the multidisciplinary team, according to a new article in Critical Care Nurse.

“Assessing Patients With Altered Level of Consciousness” discusses methods to assess these patients and describes the neurological assessment and potential causes for altered levels of consciousness.

Co-author Melissa Moreda, MSN, APRN, ACCNS-AG, CDCES, CNRN, SCRN, is an inpatient diabetes clinical nurse specialist at Duke Raleigh Hospital in North Carolina.

“Neurologically impaired patients are among the most vulnerable, often unable to communicate, advocate for, or defend themselves,” she says. “Direct care nurses are at the forefront of care, and it’s imperative to understand key components of an assessment and be able to evaluate trends rather than isolated events.”

The article provides guidance for conducting a thorough neurological assessment, including:

General behavior and body position
Vital signs
Level of consciousness
Mental status
Motor control and sensory function
Cranial nerve function
Pupillary response
Language and speech
Reflexes
Cerebellar function

Many of the components of a neurological assessment are subjective, and changes in status may be subtle, requiring ongoing and astute monitoring. When minute changes are identified quickly, interventions critical for brain preservation can be implemented rapidly to prevent long-term complications and provide quality care for patients with altered levels of consciousness.