Neurological Assessment Nursing: Complete Guide for Students

Neurological assessment is one of the most detailed and important skills in nursing. It helps nurses check how well the brain, spinal cord, and nerves are working. Early recognition of changes in a patient’s neurological status can save lives, especially in conditions like stroke, traumatic brain injury, or seizures.

This guide explains the essentials of a nursing neurological assessment, how to use the Glasgow Coma Scale (GCS), how to assess the cranial nerves, and how these assessments connect to creating a neurological disorders nursing care plan.

What is a Nursing Neurological Assessment?

A neurological assessment for nurses is a series of observations and tests that evaluate how well the nervous system is functioning. Nurses assess consciousness, pupils, speech, movement, sensation, and sometimes all 12 cranial nerves.

The goal is to establish a baseline and monitor for any changes that may indicate neurological deterioration.

The Glasgow Coma Scale (GCS)

The Glasgow Coma Scale is one of the most important tools in neurological assessment. It measures a patient’s level of consciousness in three areas: eye opening, verbal response, and motor response.

Eye Opening (E)

  • 4 = Opens eyes spontaneously
  • 3 = Opens eyes to speech
  • 2 = Opens eyes to pain
  • 1 = No eye opening

Verbal Response (V)

  • 5 = Oriented (knows person, place, and time)
  • 4 = Confused conversation
  • 3 = Inappropriate words
  • 2 = Incomprehensible sounds
  • 1 = No verbal response

Motor Response (M)

  • 6 = Follows commands
  • 5 = Localizes to pain
  • 4 = Withdraws from pain
  • 3 = Abnormal flexion (decorticate posturing)
  • 2 = Abnormal extension (decerebrate posturing)
  • 1 = No motor response

Scoring:

  • Best possible score = 15 (normal)
  • Score ≤ 8 = severe neurological impairment
  • Score = 3 = no neurological response

Levels of Consciousness

In addition to GCS, nurses describe levels of consciousness:

  • Alert – awake and responsive
  • Confused – disoriented to person, place, time, or situation
  • Lethargic – drowsy but easily aroused
  • Obtunded – difficult to arouse, minimal response
  • Stuporous – requires vigorous, repeated stimulation
  • Comatose – no response to stimulation.

 

The 12 Cranial Nerves in Neurological Assessment

Nurses may perform a cranial nerve assessment to evaluate specific brain function.

CN I – Olfactory (Smell)

Ask the patient to identify a familiar odor (coffee, peppermint).

CN II – Optic (Vision)

Test visual acuity (reading a chart or sign) and visual fields.

CN III – Oculomotor (Eye Movement, Pupil Response)

Shine a light into pupils and observe constriction. Ask patient to move eyes up, down, and inward.

CN IV – Trochlear (Eye Movement)

Ask the patient to move eyes downward and inward.

CN V – Trigeminal (Facial Sensation, Chewing)

Touch forehead, cheeks, and jaw with cotton or blunt/sharp object. Ask patient to clench teeth.

CN VI – Abducens (Eye Movement)

Ask patient to move eyes side to side.

CN VII – Facial (Facial Expression, Taste)

Ask patient to smile, frown, and raise eyebrows. Test taste on anterior tongue with sugar or lemon.

CN VIII – Acoustic (Hearing, Balance)

Rub fingers near each ear to test hearing. Perform Romberg test for balance.

CN IX – Glossopharyngeal (Swallowing, Taste)

Assess swallowing and gag reflex. Test taste on the posterior tongue.

CN X – Vagus (Speech, Swallowing)

Listen for hoarseness. Ask patient to say “ah” and observe uvula movement.

CN XI – Accessory (Shoulder, Neck Movement)

Ask patient to shrug shoulders and turn head against resistance.

CN XII – Hypoglossal (Tongue Movement)

Ask patient to stick out tongue and move it side to side. Note symmetry.

General Neurological Assessment Checklist

  • Level of consciousness (LOC) – using GCS
  • Pupil size and reaction – equal and responsive to light
  • Motor function – strength, symmetry, coordination
  • Sensation – numbness, tingling, light touch
  • Speech – clear, slurred, or confused
  • Cranial nerves – if indicated
  • Reflexes – gag reflex, limb responses

Sample Neurological Disorders Nursing Care Plan

Nursing Diagnosis:
Impaired Verbal Communication related to neurological impairment secondary to stroke as evidenced by slurred speech and difficulty finding words.

Goals/Outcomes:

  1. Patient will demonstrate improved communication using words or assistive devices within 1 week.
  2. Patient will participate in speech therapy sessions daily.
  3. Patient’s frustration with communication barriers will decrease as shown by calmer interactions.

Nursing Interventions with Rationales:

  1. Assess speech clarity and comprehension regularly – Detects changes in neurological function.
  2. Allow extra time for responses – Reduces patient stress and supports communication.
  3. Use picture boards, writing tools, or electronic devices – Provides alternative ways to communicate.
  4. Collaborate with speech therapy – Supports specialized rehabilitation strategies.
  5. Encourage family to use simple, short sentences – Helps patient understand more easily.

Evaluation:
Patient communicates needs effectively through speech or assistive methods and shows improved participation in daily activities.

Key Takeaways

  • Neurological assessment nursing involves checking level of consciousness, pupils, speech, motor function, sensation, and cranial nerves.
  • The Glasgow Coma Scale is a vital tool for measuring consciousness.
  • A full cranial nerve assessment helps identify specific neurological problems.
  • Regular and accurate assessments are critical for creating a safe and effective neurological disorders nursing care plan.
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