Thorough and ongoing neurological assessments crucial to care of patients with altered level of consciousness

Patients with altered level of consciousness are among the most difficult to assess and may have subtle neurological changes that can occur suddenly and become life-threatening if they go unnoticed.

Nurses who care for these patients must have the knowledge, skill and time to confidently perform comprehensive neurological assessments to identify changes that require quick diagnosis and intervention by the multidisciplinary team.

The article "Assessing Patients With Altered Level of Consciousness" discusses methods to assess these patients and describes the neurological assessment of and potential causes for altered level of consciousness. It is published in the August issue of Critical Care Nurse.

Co-author Melissa Moreda, MSN, APRN, ACCNS-AG, CDCES, CNRN, SCRN, is an inpatient diabetes clinical nurse specialist at Duke Raleigh Hospital in North Carolina.

"Neurologically impaired patients are among the most vulnerable, often unable to communicate, advocate for, or defend themselves," she said. "Direct care nurses are at the forefront of care, and it's imperative to understand key components of an assessment and be able to evaluate trends rather than isolated events."

The article provides guidance for conducting a thorough neurological assessment, including:

• General behavior and body position
• Vital signs
• Level of consciousness
• Mental status
• Motor control and sensory function
• Cranial nerve function
• Pupillary response
• Language and speech
• Reflexes
• Cerebellar function

Many of the components of a neurological assessment are subjective, and changes in status may be subtle, requiring ongoing and astute monitoring. When minute changes are identified quickly, interventions critical for brain preservation can be implemented rapidly to prevent long-term complications and provide quality care for patients with altered level of consciousness.