One of the touchiest areas of medicine is critical care nursing, and that's because the stakes are so high. You're literally in the life-and-death business, and any mistake could cost someone their life. But it's not just the level of responsibility that makes critical care such a challenging area to work in; it's also the sheer volume of knowledge you have to absorb.
Most patients in critical care situations often have conditions that are hard to diagnose and present with many symptoms that can be difficult to link. And because so many diseases can cause similar symptoms, it's often hard to know exactly what's wrong with the patient until you perform a comprehensive neuro exam.
However, every reliable neurological exam was successful because of some neurological tools. These tools are used to help you determine the severity of a patient's condition, as well as their level of consciousness. And when used properly, they can help you make an accurate diagnosis so that treatment can begin as quickly as possible.
So, what are the most common neurological examination tools? And how can they help you determine whether your patient has a neurological condition? Let’s take a look.
1.The Mini-Mental State Examination
The MMSE is one of the most common neurological examination tools. It’s a quick and easy way for doctors to evaluate a patient’s mental state, including their memory and language abilities.
The exam consists of 15 questions you ask your patient while sitting in front of you. Each question requires them to answer with either "yes" or "no." You then score each response based on its appropriateness for the given situation.
2. Cranial Nerve Assessment
Cranial nerves are a group of nerves that connect the brain to the rest of our body. They’re responsible for sensory and motor functions, including eye movement and facial sensation.
Each nerve has specific functions, so if one is damaged or impaired; it can cause symptoms like double vision or difficulty chewing. The most common cranial nerve exam involves checking reflexes by applying pressure to different areas on your patient’s head.
3. Pupillary Response Evaluation
Pupillary response evaluation is an integral part of a pupil exam. It can help you determine if there’s damage to your patient’s optic nerve or brainstem. The logic behind this is simple: since there is a link between the optic nerve and the brainstem, if there’s damage to one of these structures, it will affect the other.
If a patient has an irregular pupillary response evaluation, it may indicate damage to their optic nerve or brainstem. To test pupillary response, shine a small flashlight into one eye at a time and watch for any changes in size. The pupil should constrict when light hits it, then dilate back to standard size once removed from the beam.
4. Reflex Response Evaluation
A comprehensive neurological exam should include a reflex response evaluation. This is an essential part of a neurological exam because it can help you detect abnormalities in the brainstem, responsible for controlling several vital bodily functions, including breathing and heart rate.
The patient should be sitting upright with their feet dangling off the edge of the bed or chair when they do this test.
5. Sensory and Cerebellar Function Assessment
The brain is responsible for processing and making sense of all the information it receives from the body’s sensory organs. It does this by integrating information from a variety of different systems, including the visual system, somatosensory system (which includes touch, pressure, and pain receptors), vestibular system (responsible for balance), auditory system (responsible for hearing), and olfactory system (sense of smell).
A sensory and cerebellar function assessment is a way of evaluating how well these systems are working. The sensory and cerebellar function assessment can identify any deficiencies in sensation or movement that may be present, which could indicate the presence of neurological disease or damage.
6. Gait Assessment
Motion and brain function are closely connected. Any problems with the nerves and pathways that control movement can cause changes in gait, which is a person’s manner of walking or running.
A gait assessment evaluates how well someone walks and runs (if appropriate). Doctors and nurses may also use it to assess whether balance or coordination issues are associated with the patient’s neurological condition.
To perform this test on a patient, the doctor will have the patient walk or run on a straight path. The doctor will observe the patient’s movements, looking for abnormalities.
7. Glasgow Coma Scale
The neurological pupil index (NPi) measures how responsive and reactive someone is in a coma. Doctors use it to help determine whether a patient’s condition will improve or worsen during their hospital stay.
The Glasgow Coma Scale (GCS) is a test that measures the level of consciousness in a person. In general, someone with a low GCS score is less likely to recover from their coma than someone with a high GCS score. The NPi test is used to determine whether someone’s condition will improve or worsen during their stay in the hospital.
8. Babinski Reflex Testing
The Babinski reflex is a nervous system test that measures whether someone has suffered damage to their upper extremities. It is calculated by comparing how hard someone can lift one of their feet off the ground and how much force they use.
This can indicate whether someone has sustained brain damage and provide information about other neurological disorders, such as Parkinson’s disease and multiple sclerosis.
To perform the Babinski reflex test, the practitioner will use their thumb to stimulate the bottom of someone’s foot. They will then watch how hard they have to push to elicit a response from the patient, which can indicate whether a person has suffered damage to their nervous system.
9. Motor Coordination and Strength Testing
Motor functions are those that relate to the ability to move and can include motor coordination and strength. Motor coordination tests indicate how well someone can control their movements, while strength testing determines how much force someone can exert.
The APGAR test is an excellent example of a motor coordination test; this procedure involves using reflexes to test an infant's strength and coordination. The test is also used in adults, especially when a person has been injured or developed a condition that affects their motor functions.
Strength tests are often performed by asking patients to lift weights, push against resistance bands, or point at targets with their fingers.
10. Romberg Test
Another essential test doctors can use during a neuro exam is the Romberg test. This test is used to detect balance problems and neurological conditions such as vertigo, Meniere’s disease, and other balance disorders.
In this test, a patient stands with his feet together and eyes closed for 30 seconds; if they can maintain their position without swaying or falling over, they are likely healthy.
Conclusion
Every nurse should be familiar with these exams because they are used frequently in assessing and diagnosing conditions ranging from stroke to spinal cord injury to brain tumors. It is crucial to keep up-to-date on the benefits and drawbacks of each exam and be able to explain their use and value in patient evaluations. This will make you a better nurse by informing you of newer technologies and techniques.
