 Hi guys, welcome back to this video today We are going to be talking about how to perform a neuro exam and I'm going to kind of talk about performing like a basic neuro exam and then a neuro exam on someone who's like intubated and as nurses We know that performing a good assessment is fundamental to Being a nurse it helps us determine if there's a change in Condition and improvement in condition when we need to know a doctor when we do not and Having a good assessment is critical And so we are just going to focus on the neuro portion of the assessment today But before we get started, I wanted to mention that this video is sponsored by pick Monic Pick Monic is an awesome awesome resource for nurses, especially nursing students who are focusing on Passing their NCLEX pick Monic is a website and also an app where you can Learn all things related to nursing and then also practice study questions on these topics and they make it fun and easy by using different graphics and images to help you remember the nursing content and Solidify your knowledge throughout this video I'm actually going to show you how I use pick Monic to help me form parts of this neuro assessment Make sure you guys check out the link in my description box to try pick Monic for free There are so many great features on there that you can use they even have most nursing textbooks Linked to pick Monic so you can literally search your nursing textbook Let's say you don't want to read 60,000 pages for your next nursing assignment You can go on search your nursing textbook search that topic or chapter to use pick Monic to help you have another way To learn and solidify that knowledge that you're already learning in your classes. All right Let's get started so the biggest takeaway for nursing neuro assessments is to understand that we want everything to be Equal and consistent and the same for example if you can move your left side We ideally want you to be able to move your right side the same and so if you are seeing Something that is not equal that should be a red flag Of course, you need to understand your patient's baseline Neuro assessment for example if they've had a stroke and they have left-sided weakness that might be their Normal if you're wanting to go more in-depth with strokes if you're using pick Monic All you have to do is type in the search bar for strokes And it'll pop up the different types of strokes and you can learn all about them Here is a little sample of pick Monic This typewriter when stroking its oars one day for a nice little canoe ride down the river It was a beautiful day so beautiful in fact all warning signs ending a danger ahead were ignored First he started seeing transient bums and ice ski masks They lived in vans down by the river and attacked any who passed Then there were the guys with reversed hats and ice ski masks But they went running away soon enough and the typewriter figured it would be smooth sailing the rest of the way But then he saw just why the Ryan fellow had reversed his course There was a fork in the river up ahead along with a break in the riverbank and Any of these three routes would surely give the little typewriter a stroke And so he started stroking those oars with everything he had stroke stroke stroke The ice ski mask route was full of junkers They were scavenging the water for trombones and piling them up along the riverbank narrowing the river as Commanded by their crime lord the clogged artery guy. They'd surely scrapped the little typewriter for parts The other route was completely blocked by Elmo and as a typewriter neared He saw the mouth of his childhood friend open wide As his atrial heart alarm clock went off As though it were saying it's time for dinner and worst of all the third route wasn't a route at all a Giant hammered smashed through the riverbank causing it to hemorrhage The hiker BP just couldn't handle all the pressure in his life anymore and snapped or rather He severed and found a way to relieve the pressure stroke stroke Stroke Wasn't that the greatest video ever to help you remember strokes so when I'm performing my neuro assessment It starts the second that I walk in the room when you walk in the room. Look at your patient. What do they look like are they? Uptended meaning not super responsive. Are they alert and oriented if you have a patient that's able to talk with you You can start off your assessment by just asking them questions. Hey, how's it going? How did you sleep last night? How are you doing? How are you feeling? Do you remember why you came here? What's been going on and a patient can tell you their name and what's been going on and and all of that then you know that They are responsive to you and that's a big part of your neuro assessment if you walk in and someone is completely Unresponsive then that is a big red flag of hmm. Why is this going on? Are we doing that to them intentionally maybe sedating them if you're not that's a big trigger of hey What else is going on with this patient when your patients are talking back with you listen to their speech? How does it sound? Are they able to answer questions formulate their words? Are they slurring their words together or mixing them up or having a hard time communicating? Those are all parts of a neuro assessment is how was your patient speaking? Can they comprehend what you're saying to them and respond next? I like to check my patients pupil response So I will use a pen light and I will look at their pupils to see are they equal and reactive Can they follow my finger and track it and can they see everything in their periphery and around if you go on to pick Monic and you learn about the different types of strokes You'll learn that in certain types of strokes patients may have a loss of vision on one side or the other next I like to move on to movement and sensation. So can your patient feel everything equally starting from head to toe? I will go down and see if they have sensation all over In most patients if they're alert oriented, they can tell you if you touch them. Hey, can you feel this? Hey, can you feel that if they can't feel it then do something a little bit more? Invasive as far as maybe you need to kind of pinch their skin or use an object That's a little bit more sharp to kind of poke and prod at them. I'm not saying be abusive, but Apply some more stimuli if they're not feeling the light touch sensation next move on to your patients movement Can they move equally on both sides and have equal strength on both sides? So you can check this by having your patients hold their arms for a certain amount of time Squeeze your hands push their feet against your hands pull back on your hands If your patient is ambulating down the hallways and they don't have any abnormal gait Then you can gauge that their lower extremities are pretty much equal with their movement and strength Now if you have a patient who's unable to follow commands whether we are doing it to them intentionally Or maybe they have something else going on that's preventing them from following your commands Then how do we check their neuro status? This can get a little tricky But if you have a patient that's unable to tell you like hey, yeah, I can feel this on both sides or hey Yeah, look at I can hold up both arms squeeze your hands Then we have to go a little bit more in depth and how we do this is if I have a patient who sedated for example and Intubated and they're laying in bed. I will start by just touching them to see do they respond? To that touch if they don't then I'll apply a little bit more painful stimuli Maybe I will push on their fingernail a little bit if they don't respond to that Then maybe I'll pinch their skin on their lower half and their upper half Applying a little pressure on their shoulder is another great spot to see if a patient can respond to stimuli And I will do that in all of their extremities to see hey Do they move that extremity back or respond to that touch when I apply it? Some other basic neuro reflexes to check especially in your patients who can't communicate well Is their boreal reflex so can they blink or if you were to flick some little bit of water sailing in their eyes Do they react to blinking? Do they have a gag and a cough? That's another huge Brandstem reflex that we'd like to check if someone's intubated You can do this by doing oral care and kind of pushing the oral care Toothbrush or swab back into their throat to see if they kind of react and gag that way This is a hard thing to do when someone's intubated because they already have a tube down their throat And so that gag reflex sometimes can be inhibited. You can also check if they have a cough by Advancing your suction catheter down their ET tube to see if they respond by coughing Again, I want you guys to realize that it is so important at the beginning of your shift You have a solid neuro assessment because you want to be able to predict if something has changed in your patient If you have a patient that you walk in in the morning and they're communicating to you and talking to you and like everything's fine They're moving everything. They're walking. They're getting up and down to the bathroom And then you go in four hours later and you're like trying to arouse them and applying a sternal rub And they're not responding at all That is no point out and you're gonna need to call your doctor ASAP or look more into what the heck is going on There are a lot of other little more fine details to neuro assessments And i'm not going to quite get into because it's more specific if you're like a neuro ICU nurse or maybe a neuro tele nurse But um, there's also ways to check all the dermatomes You also have all your cranial nerve reflexes that you can check like taste and smell and all that I don't necessarily do those on all of my patients unless it pertains to them Like maybe they have an epidural and I need to check dermatomes or maybe they are stroke patient And i'm checking more of those cranial nerve reflexes, but as far as my standard ICU patient I like to check How alert and responsive are they? How is their movement and sensation and strength? How are their pupils? Are they reactive? Are they brisk? Do they have their basic brainstem reflexes? Corneals gag and cough and if it pertains to them, I will go more in depth with the cranial nerves I hope this gives you guys kind of a basic rundown of how to perform a good neuro assessment Thank you pick monic for sponsoring today's video I'm so glad that I can use pick monic to help me with all things neuro related because neuro is very tricky Honestly, neuro is not my strong suit And so I constantly have to be keeping up and learning about the different types of strokes The different type of neurological diseases and how they present in different patients Make sure you check out pick monics link down below Give this video a thumbs up and subscribe to my channel and I'll see you guys next time. Bye