Saturday, March 26, 2011

Importance of Neurological Assessment

Serial, consistent, and well-documented neurological assessments are the most important aspect of nursing care for the pediatric neurosurgical patient. Subtle changes in the neurological assessment may first be noted by a bedside nurse. Keen observation skills and the ability to extract information about a patient’s baseline level of neurological function from the parents or primary caregivers are essential. The nurse’s response to assessment changes is essential to the prevention of secondary neurological sequelae and other complications associated with neurological disorders. These potential complications include, among others, inability to protect the airway, immobility, endocrine disorders related to central hormonal dysregulation, impaired communication, and behavioral issues.
It is understood that children are not always under the care and custody of their parents. However, the term “parent(s)” is intended to include family members who have custody of a child, foster parents, guardians, and other primary caregivers.
A neurological assessment includes several exams, tests and procedures which are used to make the diagnosis of nervous system diseases. So what can you expect when undergoing neurological evaluations? Every condition is different and therefore the assessment will vary considerable. However, there are some general tests and exams which many neuro patients will undergo. Here is an overview of some of these common parts of a neuro assessment.

Nursing Approach to Neurological Assessment
Neurological assessment should be an integral part of the entire physical assessment. The approach to neurological assessment should be systematic and include pertinent health history, for example coexisting conditions, the developmental status of the child, the nature and extent of the injury or surgery performed, and potential complications. Sources of this information include the verbal report or patient record and the neurosurgeon, neurologist, or other medical providers. Nurses must be aware that other physical and developmental disorders not directly associated with the neurological condition, such as renal, cardiac, or pulmonary, may also affect the patient’s long-term prognosis and ultimate quality of life. Care planning should be a team approach that involves the parents and the multidisciplinary team to assure optimal outcomes. Factors that impact the assessment will be the age of the child, the family dynamics, the nature of the child’s illness, the setting in which the assessment takes place, and input from other member of the multidisciplinary team.

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