Focused Preanesthetic Assessment of the Nervous System

Focused Preanesthetic Assessment of the Nervous System

The manner in which you progress with your neurological assessment depends upon the patient's level of consciousness. To perform a complete neurological exam on the patient, he/she must be able to cooperate.

Health History Assessment

A neurological health history can be obtained if the patient is alert enough and oriented to person, place, and time. If the person appears to be disoriented or confused upon questioning, ask family members and friends to confirm the information.

The person should be questioned as to previous history of seizures, loss of consciousness, anesthesia (an absence of normal sensation - especially to pain), paresthesia (numbness and tingling; a "pins and needles" feeling), neuralgia, twitches, tremors, personality changes, memory deficits, mental deterioration, nervousness, anxiety, history of psychiatric problems, vertigo, sensory disturbance, phobias, hallucinations, delusions, illusions, nightmares, insomnia, and/or grandiose ideas.

Physical Assessment

A complete neurologic assessment consists of five steps: Mental status examination, Cranial nerve assessment, Reflex testing, Motor system assessment and Sensory system assessment

The mental status exam really assesses the patient's cerebral function. Remember that the cerebrum controls sophisticated mental functions such as speech, problem solving, and memory. As you perform this portion of the neurological assessment, pay special attention to the patient's speech and language abilities. Speech should be clear, coherent, and spoken at an appropriate rate. The language used should be appropriate for the education and socioeconomic levels of the person. Altered speech patterns can alert you to the possibility of neurologic problems.

The Glasgow Coma Scale (GCS) is an assessement tool or scale that is used for assessing the patient's response to tactile stimuli (if unconscious), pupillary response to light, corneal and gag reflexes, and motor function.

The GCS ( Table ) is based on the three criteria of eye opening, verbal responses, and motor responses to verbal commands or painful stimuli. It is particularly useful for monitoring changes during the acute phase, the first few days after a head injury.

Assessment for Glasgow Coma Scale