Neurovascular Assessment
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#1 Neurological assessment is Level Of Consciousness. If the LOC changes, there is a problem!
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Assessing Neurological Status with the Glasgow Coma Scale
Assesses response to stimuli
- Minimum score = 3
- Maximum score = 15
- 15= fully alert and oriented client
- < 8 = unconscious client
- 3= severe neurological impairment
Pupillary Reaction
- Shine a light and pupils constrict. Remove the light and pupils dilate
- Normal: PERRLA = pupils equal, round, reactive, to light and accommodation
- Size of pupils 2-6 mm
- Pupillary reaction is mainly assessing CN III which originates, like most cranial nerves from the brain stem. The brain stem is the site of vital functions (Breathing, Heart rate, BP)
- Decorticate posturing is a reflex pose that’s a symptom of damage to or disruptions in brain activity. It causes your legs to become rigid and straight, while your arms flex upward and hold tensely to your chest. It’s usually a sign of brain damage or disrupted brain activity.
- Decerebrate posturing involves a reflex movement of muscle groups throughout your body, causing your limbs to extend and hold rigidly. These movements can happen automatically when there’s severe damage to your brain or major disruptions in brain function. I means SEVERE brain damage.