Neurological

Assessment
 Tools
The following tools will be used during
the neurological exam:
• Reflex hammer (tomahawk
model)
• Penlight
• Tongue blade
• Safety pin
• Cotton swab
• Ophthalmoscope
• Eye chart
• Tuning fork
• Dermatome chart
 NSF
 Cooperative Yes No
 Memory Changes Yes No
 Dizziness Yes No
 Headaches Yes No
 Oriented to: Person __ Place __ Time __
 Deviation: ________________Pupils Size: __________________
 PEARLA Yes No
 Reaction: Brisk __ Sluggish __ No Response __
 LOC: Alert __ Confused __ Sedated __ Somnolent __ Comatose
Agitated __ Other ___
 Speech: Clear __ Slurred __ Aphasic __ Dysphasia __ None
 Grips: ________Foot pushes: _________Gag reflex: ___________
Neuro Documentation
 Rapid Assessment

Stroke  Cardiac  Comfort

 Pulmonar  ECG, cardiac
y monitor
 Safety  O2 2LPM, Pulse
Ox
 Lab works –
CBC, Coags
 Rapid Assessment
Changes  Neuro  Safety
in  Cardiac  Lab works – CBC,
Mental  Safety lytes, U/A
Status  Following MD order
– sitter or restraints
 ECG, Cardiac
monitor
 O2 at 2LPM, Pulse
Ox
 Accucheck
 NPO ?
 Rapid Assessment
Seizure  Neuro  Safety
 Safety  Airway
 Lab works – CBC,
lytes, urine
toxicology, ETOH
level
 CT Brain
 Accucheck
 Pulse Ox
 Meds – Ativan 2mg
IV
 NPO
Cardiac Assessment
 The Heart Chambers and Major Vessels

http://www.nucleusinc.com/animation2.php
  Patient Positions and Special Techniques for Auscultation

 Position  Use

 supine  general auscultation and most heart sounds

sitting up and leaning

 aortic stenosis, aortic regurgitation, pericardial
forward and holding
rubs
exhalation
 S3, S4, mitral stenosis (using bell of
 left lateral decubitus
stethoscope)
 increases intensity of mitral valve prolapse and
 Vasalva manoeuver hypertrophic cardiomyopathy, decreases intensity
of aortic stenosis
 increases intensity of aortic stenosis, decreases
 squatting and standing intensity of outflow obstruction in hypertrophic
cardiomyopathy
1) LV area: apex of the heart at 4th or 5th intercostal space (ICS) along
MCL
2) RV area: 3rd to 5th ICS along the left sternal border (LSB)
3) pulmonic area: 2nd ICS along the LSB
4) aortic area: 2nd ICS along the right sternal border (RSB)
 Murmurs
When you encounter a murmur
while auscultating, it is
important to evaluate the
following characteristics:

1. systolic vs. diastolic

2. duration
3. pitch: high, medium, low
4. quality: harsh, rumbling,
blowing
5. intensity: eg crescendo,
decrescendo, crescendo-
decrescendo, plateau
Distal Pulses
Using a Doppler
Internal Pacemaker
External (Temp) Pacemaker
 ECG Animations
Lead Placement --
http://nobelprize.org/medicine/educational/ecg/index
.html
6Second Strips --
http://www.skillstat.com/ECG_Sim_demo.html
Cardiac Sounds –
http://www.med.ucla.edu/wilkes/Systolic.htm
 INTERNATIONAL CODES DESCRIBING
PACEMAKERS AND IMPLANTED DEVICES
 Cardiovascular
 NSF
 Cardiac Rate: Regular Irregular Irregularly irregular
 Chest Discomfort Yes No – Where:_______
Intensity (1 -10) _______ Onset _______________
Duration_____________Resolution ____________
 Radial Pulse (R)/(L) Yes No
 Pedal Pulse (R)/(L) Yes No
 JVD (R)/(L)
 Edema – Location __________Pitting __ Non-pitting __
 Pacemaker – Date Inserted ________________
Type _____________Where: __________________
 Murmur: Yes No
Cardiac Documentation
 Rapid Assessment
Chest  Cardiac  Comfort
Pain  Pulmonary  Lab works – CBC,
 Pain CPK with Iso.
Troponin
 Stat ECG
 O2 at 2LPM,
Pulse Ox
 Meds – ASA,
NTG, MSO4
 Rapid Assessment

Atrial  Cardiac  Stat ECG

Fib or
 Cardiac
A
Flutter monitor
 Meds
 BR