Guidelines: Neurological Assessment

Neurological examinations are not routine organizations. However, due to the fact that we administer anesthetics, neurological assessment maybe warranted in certain situations. 


1.  Equipment needed:
    A.  Stethoscope
    B.  Sphygmomanometer or automatic blood pressure
    C.  Watch with a second hand
    D.  Thermometer
    E.  Flashlight
2.  Neurologic assessment includes level of responsiveness,
    motor ability and strength, pupil status, blood pressure,
    temperature, pulse, respirations and observations of
    patient's spontaneous activity.
3.  The first assessment recordings are used as the base 
    line.  Subsequent assessments are done at regular 
    intervals as ordered by the staff member.
4.  Condition permitting, explain procedure to patient to 
    allay fears and gain cooperation.  If condition permits, 
    place patient in dorsal recumbent position.
5.  Document assessment on patient's medical record.

6.  To assess level of responsiveness:
    A.  Evaluate speech by requesting patient to respond 
        to simple questions.  Ascertain orientation to 
        self, time, and place.
    B.  Evaluate ability to follow simple orders and 
        perform some movement.
    C.  Evaluate pain perception by applying stimuli to 
        the toes, fingers, arms or thighs by pinching 
        the skin.
    D.  Evaluate state of consciousness:
         -Alert:  responds immediately, fully oriented
         -Lethargic:  drowsy, delayed or incomplete 
          responses, confused
         -Stuporous: sleep like; vigorous continued 
          stimulation elicits only simple responses 
         -Semicomatose:  needs painful stimuli to elicit 
         -Unconsciousness: nonresponsive; cannot be aroused
7.  To assess level of motor ability and strength: 
    A.  Have patient raise extremity off bed and hold 
    B.  Have patient grasp your hand and press. 
    C.  Have patient push extremities against your hand. 
    D.  Observe patient's spontaneous movements.
8.  To assess pupil status:
    A.  Evaluate size:  normal, small, pinpoint, dilated
    B.  Evaluate reaction to light:  normal, sluggish, 
    C.  Evaluate equal reactivity of pupils
9.  To assess vital signs:  Take and record pulse, blood 
    pressure, respirations and temperature on regular 
10. To assess spontaneous activity:
    A.  Evaluate for retching or vomiting 
    B.  Evaluate for restlessness, frequent turning, 
    C.  Evaluate for tremors, twitching or convulsions 
    D.  Evaluate for paralysis of an extremity 
    E.  Evaluate for visual disturbances
11. Record neurologic signs and observations. Record exact
    time of assessments.  Sign all entries.

Approved By Governing Board    
Control #69.1