Neuro Checks and Assessment | Neurovitals for Nurses

Neuro checks assess an individual’s neurological functions, motor and sensory response, and level of consciousness.

It allows medical specialists to determine whether a patient’s neurological functions are working and reacting correctly.

A neurological exam also allows healthcare professionals to diagnose potential neurological conditions.

They can identify whether a patient requires medical treatment to manage the condition.

A neurological assessment aims to ensure a patient’s neurological functions aren’t impaired or non-responsive.

Performing a neuro assessment after an individual receives an injury or has surgery is instrumental.

In addition, neurological exams assess the mental status of individuals with head injuries, cervical nerve damage, or CVS.

Medical specialists perform a neurological exam every 15 minutes, 30 minutes, or as needed.

As a result, they can regularly assess the patient’s visual, verbal, audible, physical, mental, and emotional responses.

You may execute the following tests when performing a neuro check/assessment.

Neuro Check/Assessment

  • Check for level of consciousness or LOC (full consciousness, lethargy, obtundation, stupor, coma)
  • Perform a pupil check (PERRLA: pupils equal, round, react to light and accommodation)
  • Check for and observe facial symmetry (have the patient smile and lift eyebrows)
  • Perform an A/O (alert & oriented) and make a comparison against the patient’s baseline
  • Perform tongue midline (have patient stick their tongue out and observe any sideways deviation)
  • Check and observe the patient’s speech clarity for slurs, impediments, or incoherence.
  • Perform light touch (feather), cotton, or pressure tests (observe physical response, and sensitivity to touch, and check for numbness or lack of movement)
  • Check and observe patients’ grasp strength (have them squeeze your finger)
  • Have the patient raise each arm and wiggle fingers. Push against arms to check for arm strength, balance, tremors, or drifting
  • Have the patient lift each leg and wiggle toes. Push against the legs to check for leg strength, balance, tremors, or drifting.

Before and while performing these tests, assessing the patient’s conciseness level and comparing it against their baseline and previous test results is essential.

Check for deviations from their previous tests and note any improvements or declines in their performance during these assessments.

The Levels of Consciousness (LOC) Include:

  • Full Consciousness
  • Lethargy
  • Obtundation
  • Stupor
  • Coma

Full Consciousness

The patient is alert, attentive, and follows commands when fully conscious.

They answer questions appropriately and respond well to stimuli, physical examinations, and mental tests.

If they are asleep, they respond quickly to external stimuli such as loud noise or pain, and once awake, they are attentive and alert.

Lethargy

The patient is aware and conscious; however, they are drowsy, and lethargic and respond slowly to stimuli, questions, and commands.

They can perform their tasks but inattentively and at a slower pace.

The patient appears sleepy and drowsy, without any other signs of neurological impairment.

Obtundation

Arousal is difficult, and the patient requires constant stimulation to follow basic commands when obtunded.

The patient may provide short verbal responses (one or two words) but drift back into unconscious or sleep without constant and immediate stimulation.

Stupor

The patient requires vigorous and continuous stimulation to provide any response.

Painful stimulation may be required to arouse the patient, and when they do respond, it is typically a brief whine or moans.

The patient may also make movements or responses to withdraw from the pain or remove the painful stimuli when stupor.

Coma

The patient does not respond to stimuli, even if continuous or painful during a coma.

There are no physical or verbal responses, except for possible reflex responses in certain situations.

Reflex responses may occur without stimulation, and stimulation may or may not be responded to when applied.

Depending on the individual’s level of consciousness, their ability to respond to these assessments will vary.

Aside from performing standard physical assessments, you may also ask the individual a series of questions to test their cognitive and emotional condition and if they are conscious and able to respond.

These questions will help you assess and evaluate any potential neurological complications that the patient may be dealing with, such as memory loss, difficulty responding to stimuli, physical limitations, and the ability to respond to various questions.

Questions To Assess Neurological & Physiological Functions:

  • What is your name, where are you from, and what year is it?
  • Can you smile for me and lift your eyebrows (check for symmetry and proper facial response)
  • Can you please stick your tongue out (check to see if the tongue deviates to one side)
  • Do you have a headache, physical pain, tingling, or numbness in any part of your body? (even if the patient says they feel o.k., you should still perform a variety of physical tests to determine their condition)
  • Is your vision impaired or blurred, or are you seeing double? (use a penlight/flashlight to check pupil size, response, and eye movement)
  • Can you raise your arms for 10 seconds and move your fingers?
  • Can you touch your nose with each index finger?
  • Can you squeeze my finger (check for physical strength and neurological response)
  • Can you lift each leg and wiggle your toes (observe difficulty/area of movement, non-responsiveness, tremors, or drifting)

Additional Steps

The tests performed on an individual may vary depending on their injury, neurological condition, physical condition, or level of consciousness.

Therefore not every individual requires all of these tests.

Depending on the patient’s age, health, and physical abilities, some variations may be required.

For example, when dealing with an elderly patient, it may be better to ask them what month it is rather than what day or the date.

Some physical tests may also be modified or changed to adapt to older patients, such as having them lift their arms for shorter periods or perform shorter movements on mobility checks.

If an individual appears to perform well on most question-based assessments but answers one or two of them wrong, ask them a different but similar question and observe their response, as they may have forgotten the answer.

In most medical situations where a neuro assessment is required, the hospital or healthcare center may provide you with a checklist of neuro checks you can perform to assess whether they are reacting correctly and their level of conciseness.

If unsure what checks should be performed, ask your coworkers if they have any assessment checklists or sheets they use during these medical situations.