Neurological Assessment

. Contribution of neurological assessment towards the overall holistic health assessment of the client.

            Neurological assessments entail various tests, procedures and exams undertaken to make a diagnosis on diseases affecting the nervous system. The assessment helps in the detection of abnormalities that can lead to fatal neurological diseases.  A general practitioner or nurse can carry out the initial examination but a more comprehensive assessment is carried out by a medical specialist (a neurological surgeon or neurologist). Dysfunctional sections of the nervous system can easily be detected. In addition, patients suffering from neurological conditions are likely to exhibit very specific symptoms. Such manifested symptoms are the most conspicuous links to sections of the nervous system responsible for the disturbance (Tsatsanis & Volkmar, 2001).

            This evaluation comprises of three integral types of assessments which include patient medical history review, focused diagnostic testing and neurological examination. A neurological exam takes a focused approach and its objective is to identify symptoms that are linked to the morphology as well as the physiology of the nervous system. This examination is elaborate and different body sections are examined. Most noteworthy is mental status analysis which mainly assesses the patient’s basic cognitive functions via detailed questioning. The health practitioner checks on the patient’s perception on appearance and attitude, response to surrounding, thoughts and people. This helps in the detection of dementia. Other examinations include examination of cranial nerves and motor system inspection (Judge, 2007).

            Review of a patient’s medical history enables the medical examiner to get information on the complaints as well as manifested symptoms. Important information that is relevant to the current health status includes allergies, medication, family history as well as the patient’s medical history.  Diagnostic testing is usually the last neurological examination and is used to confirm a suspected pathology. These diagnostic tests include: MRI scans, X-rays, blood tests, EMG (electromyelography), head and spine CT scans, EEG (electroencephalograms), tumor biopsy etc.

2. Discuss five questions you would ask a client in relation to this specific assessment and provide the rationale for asking these questions?

            Patient interrogation forms a crucial component of the neurological examination since neurological diseases like dementia adversely affect the patient’s intellectual status, personality features as well as emotional responsiveness. Dementia is characterized by personality changes, disorientation, communication problems, bizarre/new behavior and loss of ability in undertaking routine tasks as well as solving problems (Coughlan, 1995).  A series of questions are posed to the patient to assess these aforementioned features. As a neurological examiner, I would begin by asking the patient to state his/her name. This is important as it helps in the identification of person disorientation. This state is associated with amnesia, trauma, psychosis or seizures.

Secondly I would ask the patient to identify the physical location where he/she is currently in. Alternatively I could ask the patient to state his /home address. Either of these questions helps in the determination of place disorientation. This might be an indicator for a psychiatric, trauma or chemical impairment disorder as well as organic brain syndrome.  Third, I would require the patient to state the present day/season/month. The response given will help in the assessment of time disorientation which is a key indicator of trauma, depression, organic brain syndrome or anxiety.

Fourth, the patient should describe how he she is feeling. This question is in line with basic neurological evaluation. Common symptoms manifested by patients include: backache, headache, vertigo/dizziness, faintness/lightheadedness and visual disturbance. These are indicators of neurological abnormalities and more focused evaluation coupled with diagnostic testing should be undertaken. Fifth, in line with patient history evaluation, I would inquire if the patient is on any medication. Consumption and of particular medication elicits adverse neurological symptoms. For instance, neuro toxidromes arise after alcohol ingestion. Cimetadine triggers confusion in elderly patients. Overdosing also causes adverse neurological effects and there is need to ascertain the amount and time in which the patient took the last dose.

3. Discuss a common abnormal finding you may come across when performing the specific assessment. What plan would you initiate if you found this abnormal finding? How would you communicate this as a health professional to the health care team?

            Cogwheeling is an example of an abnormal finding in the course of neurological evaluation. This symptom is unique to Parkinson’s disease. Generally the patient’s muscles are rigid and this is largely manifested in both legs and arms. Upon extension of the rigid arm, the patient grabs and releases it to prevent the extension. It is a jerky response that is detected by an examiner, when he/she attempts to extend a rigid limb (D’Amato & Hartlage, 2008).

            Following the observation on cogwheeling, I would proceed to carry out tests used to diagnose Parkinson’s disease. This entails closer scrutiny of the patient’s speech with emphasis on the volume as it’s a basal ganglia disease. Affected patients usually exhibit soft, feeble speech. There is also examination on eye movement, posture and rigidity. The patients also exhibit an asymmetrical walking style. If an early diagnosis of Parkinson’s disease is made, appropriate medication should be prescribed. This diagnosis should be reported to neurology specialists i.e. neurologist/ neurology surgeon. Nurses, family and other care givers should also be made aware on the diagnosis. Consequently they will be considerate throughout their interaction with the patients.

4. Professional, ethical and legal considerations in the process of conducting this specific health assessment.

It is important to maintain safeguard the privacy of the patient and the diagnostic information should be treated with utmost confidentiality. Such information should only be utilized for the purpose in which it was consented to and only with the authorization of the patient. With regard to ethics, health assessment is based on several approaches and this includes right, utilitarian, common good and virtue (Johnson, 2011). The rights approach advocates the need to treat patients with respect. The dignity of patients should be given due consideration throughout the examination and treatment process. Health professionals should be well aware of their patients’ rights. In addition each individual has a just claim to treatment and this should never be withheld by any health practitioner.

The utilitarian approach directs health practitioners to make decisions that impart maximal benefits to the patients and minimal harm. Medication might trigger the onset of adverse effects but they should not be more potent than the ailment. Alternative safe solutions should always be considered in case a patient is uncomfortable with the current therapeutic regime. The common good approach requires health personnel to be compassionate and caring in their interaction with patients. Moreover there character should be virtuous. They should exhibit qualities such as integrity, honesty, politeness, kindness etc. Legal issues concerning health matters mainly touch on patient safety and diagnosis. Health practitioners need to function with utmost sobriety in the examination process. This will facilitate formation of accurate diagnoses. Misdiagnosis leads to adverse health effects and fatalities such as paralysis, coma and even death is known to result. This can lead to prosecution and subsequent imprisonment of the health officer concerned. In addition any form of treatment prescribed should be approved by relevant health bodies e.g. Food and Drug Administration (FDA). Medical procedures such as surgery need to be legal. This is highly relevant to neurology as euthanasia, a procedure that is illegal in most countries, is recommended for advanced neurological conditions such as Alzheimer’s and Parkinson’s disease.

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