Neurological Assessment To Injury Patient †Myassignmenthelp.Com

Question: Discuss About The Neurological Assessment To A Injury Patient? Answer: Introducation Neurological assessment is the most important component in the care of head injury patients. It helps detect the presence of neurological deficit, injury and examine its progression, helps in determination of patients response to the carers interventions and the type of care they should be provided with. First up, a comprehensive exam should be carried out covering movement, reflexes, sensation, cranial nerves, cerebellar function, mentation and consciousness. This examination will form a foundation for comparison of subsequent findings. Subsequent examinations are focused on problems, specifying on the NS parts of the patient (Menon et al. 2010). The patients condition determines the frequency of the assessments. In the case of a closed or open head injury, the initial assessment should be coupled up with resuscitation in application of the principles of severe trauma management. These will minimize ischaemia and hypoxia from causing secondary brain injury (Papa et al. 2012). Its important to avoid distraction of attention from carrying out core tasks like maintaining perfusion and cerebral oxygenation and securing an airway in cases of open head wound. The patients level of consciousness is assessed continuously through the shift and up to 72 hours. This ensures outoward pathology is in check since consciousness is its cardinal sign. Obvious injuries like bruises/ contusions and lacerations on the scalp are observed, memory loss, balance/ gait problems, confusion, visual disturbances, difficulty in speaking, headache, pupil reactions and unequal sizes, vomiting and alternating periods of lethargy and coherence (Hoffmann et al. 2012). These observations go on until the patient is asymptomatic for a particular amount of time or a minimum of 72 hours. The frequency of the neurological assessment should be 15mins. For 2hrs; 30mins. For 2hrs; 60mins. For 4hrs; 8hrs. For 16hrs and 8hrs for a minimum of 72 hrs and until the patient is stable. At a minimum, neurological assessments include: blood pressure, pulse and respiration measurements. Reactivity and pupil size assessment and hand grip strength. The Glasgow coma scale is completed im mediately then once in each proceeding shifts to help keep the findings objective. Consciousness disturbance may trail focal damage to the reticular pattern that extends to the caudal medulla from the midbrain rostral. The caudal medulla projects widely to the limbic system and the cerebral cortex as all sensory pathways input to it. Consciousness is not affected by focal cortical lesions but cerebral cortex general depression may lead to a coma. Since pure descriptive methods have flaws in the measurement of consciousness as one observers drowsy is anothers somnolent, a Glasgow Coma Scale is used as a measure of the same. The Glasgow Coma Scale changes therefore form the basis of many management decisions. It takes into account human anatomy and physiology to derive graphical representations of the assessments outcome i.e. patients eye opening (these includes spontaneous, to speech or to pain and none), best verbal response (here we have none, incomprehensible to sounds, inappropriate words, confused, oriented and for tracheostomy tube patients its T) and best motor response (the patient is required to perform tasks like lifting arms or squeezing fingers). The primary assessment is followed by a secondary survey which includes a more thorough neurological exam and GCS reassessment. The face, neck and head are re examined. Higher functions are assessed, followed by cranial nerves, motor function and sensory function (Leblanc, 2012). The important neurological observation is to notice a trend that will be useful in identification of neurological deficit. Observations become more useful with subsequent observations. An increase in GCS with time is a good sign while its drop may require urgent surgery since it marks a deterioration. References Hoffmann, M., Lefering, R., Rueger, J. M., Kolb, J. P., Izbicki, J. R., Ruecker, A. H., ... Lehmann, W. (2012). Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. British journal of surgery, 99(S1), 122-130. Leblanc, A. (2012). The cranial nerves: anatomy imaging vascularisation. Springer Science Business Media. Menon, D. K., Schwab, K., Wright, D. W., Maas, A. I. (2010). Position statement: definition of traumatic brain injury. Archives of physical medicine and rehabilitation, 91(11), 1637-1640 Papa, L., Lewis, L. M., Silvestri, S., Falk, J. L., Giordano, P., Brophy, G. M., ... Mondello, S. (2012). Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention. Journal of Trauma and Acute Care Surgery, 72(5), 1335-1344.