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Andrew Pollack-Gray

Nursing Notes

Neurological Observations

3 min read

What Am I Assessing?

Observe a resident’s neurological functioning and recognize changes that may indicate illness, injury, or an emergency.
Key Principle: Compare observations with the resident’s usual baseline.

What Should I Look For?

Level of Consciousness

  • Alertness and responsiveness.
  • Unusual drowsiness or difficulty waking.
  • Unresponsiveness.

Orientation & Cognition

  • New confusion or disorientation.
  • Difficulty recognizing familiar people or surroundings.
  • Sudden changes in attention or behavior.

Speech & Communication

  • Slurred or unclear speech.
  • Difficulty finding words.
  • Difficulty understanding instructions.
  • New inability to communicate.

Movement & Strength

  • New weakness, especially on one side.
  • Changes in walking or coordination.
  • New facial drooping or asymmetry.
  • Unusual movements or seizures.

Sensation & Vision

  • New numbness or tingling.
  • Sudden vision changes.
  • New dizziness or loss of balance.

Additional Warning Signs

  • Sudden severe headache.
  • Vomiting associated with an acute neurological change.
  • Sudden changes following a fall or head injury.

What Could It Mean?

Possible causes include:

  • Stroke or transient ischemic attack (TIA).
  • Head injury.
  • Seizure activity.
  • Infection or delirium.
  • Medication effects.
  • Abnormal blood glucose or other metabolic disturbances.
    Important: These observations do not establish a diagnosis.

What Should I Do?

Routine Observations

  1. Observe the resident during regular care.
  2. Compare behavior, movement, speech, and responsiveness with their baseline.
  3. Ask simple questions appropriate to the resident’s abilities.
  4. Report new or worsening changes promptly.
  5. Document objective observations according to facility policy.

Suspected Stroke — BE FAST

  • B — Balance: Sudden loss of balance or coordination.
  • E — Eyes: Sudden vision changes.
  • F — Face: Uneven smile or facial drooping.
  • A — Arms: New arm weakness or drifting.
  • S — Speech: Slurred speech or difficulty speaking.
  • T — Time: Activate emergency response immediately; note symptom onset or last-known-well time.

Emergency Response

  • Activate the facility emergency response system for sudden neurological changes.
  • Stay with the resident when safe.
  • Observe breathing and responsiveness.
  • Follow directions from the nurse or emergency team.
  • Do not give food or drink to a resident with altered consciousness or suspected swallowing impairment.

Important Considerations

  • Sudden confusion is not automatically dementia.
  • A resident with chronic neurological impairment may have an established baseline different from other residents.
  • Sudden changes require prompt evaluation even if symptoms improve.
  • CNAs observe and report; formal neurological examination and diagnosis belong to qualified clinicians.

Sources

Flashcards

What does BE FAST stand for?01-foundations / assessment
Answer

Balance, Eyes, Face, Arms, Speech, Time.

What is the response to sudden facial droop and new slurred speech?03-application / assessment
Answer

Activate emergency response for possible stroke.

Why compare neurological findings with baseline?02-mechanisms / assessment
Answer

Chronic deficits differ from sudden changes needing escalation.

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