Neurological Assessment Checklist  Document findings immediately, noting any changes

1. Level of Consciousness (LOC) from baseline.

o Questions to Ask:  Record GCS scores and pupil size/reaction accurately.
 "Can you tell me your name?"  Communicate significant changes to the medical team
 "Do you know where you are?" promptly.
 "Can you tell me today's date?" This checklist provides a structured approach to conducting a
o Actions: thorough neurological assessment in the ICU setting.
 Observe the patient's response 4o
You said:
to verbal stimuli.
please be specific and covers alls the neurologic assessment. do it
 Evaluate orientation to person, again
place, and time.
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2. Glasgow Coma Scale (GCS)
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o Actions: Here's a comprehensive and specific guide for conducting a
 Eye Opening (1-4): Check if the neurological assessment of a patient in the ICU, covering all
eyes open spontaneously, to essential components:
voice, to pain, or not at all. Complete Neurological Assessment in ICU
 Verbal Response (1-5): Assess 1. Level of Consciousness (LOC) and Orientation
the patient's ability to speak or o Questions to Ask:
make sounds.  "Can you tell me your name?"
 Motor Response (1-6): Ask the (Person)
patient to follow commands  "Where are you right now?"
(e.g., "Squeeze my hand"). (Place)
3. Pupil Assessment
 "What is today's date?" or "What
o Actions: season is it?" (Time)
 Check pupil size, shape, equality, o Actions:
and reactivity to light using a
 Observe response to verbal
penlight.
stimuli, voice loudness, and tone
 Note any differences between if needed.
the pupils (anisocoria).
 Note if the patient is alert,
4. Motor Function and Strength
lethargic, obtunded, stuporous,
o Questions to Ask: or comatose.
 "Can you move your fingers and 2. Glasgow Coma Scale (GCS)
toes?" o Actions:
 "Can you squeeze my hands?"  Eye Opening (E)
o Actions:  4 = Spontaneous
 Assess the strength of  3 = To voice
extremities bilaterally (0-5 scale).  2 = To pain
 Observe for any drift, weakness,  1 = None
or abnormal movements.
5. Sensory Assessment
 Verbal Response (V)
o Actions:  5 = Oriented
 4 = Confused
 Test sensation to light touch and
pain (e.g., prick with a cotton
 3 = Inappropriate
words
swab or pin).
 Ask if the sensation feels normal,  2 = Incomprehensible
sounds
tingling, or numb.
6. Cranial Nerve Assessment (if indicated)  1 = None
o Actions:  Motor Response (M)
 Test cranial nerves as needed  6 = Obeys commands
(e.g., facial symmetry, tongue  5 = Localizes pain
movement, eye movements).  4 = Withdraws to pain
7. Reflexes (if indicated)  3 = Flexion
o Actions: (decorticate)
 Check deep tendon reflexes  2 = Extension
(DTRs) if indicated (e.g., biceps, (decerebrate)
patellar).  1 = None
8. Vital Signs Monitoring 3. Pupil Assessment
o Actions: o Actions:
 Monitor for changes in blood  Measure pupil size (in mm) and
pressure, heart rate, and compare bilaterally (normal size:
respiratory rate as they can 2-5 mm).
affect neurological status.  Assess shape and equality
Documentation Tips: (round, equal).
  Check reactivity to light using a  Assess deep tendon reflexes
penlight (brisk, sluggish, or non- (DTRs) (biceps, triceps, patellar,
reactive). Achilles) and rate 0-4+ scale:
 Note any abnormalities (e.g.,  0 = No response
anisocoria, fixed, or dilated  2+ = Normal
pupils).  4+ = Hyperactive with
4. Motor Function and Muscle Strength clonus
o Questions to Ask:  Check plantar reflex (Babinski
 "Can you lift your arms/legs?" sign) – normal is toes down-
 "Can you squeeze my hands?" going; abnormal is toes up-going.
(bilateral check) 8. Coordination and Gait (if possible)
o Actions: o Actions:
 Assess strength bilaterally using  Finger-to-nose test: Check
a 0-5 scale: accuracy and smoothness of
 5 = Normal strength movement.
 4 = Weak but able to  Heel-to-shin test: Evaluate
move against coordination.
resistance  Gait assessment: If the patient
 3 = Moves against can stand, assess balance and
gravity but not walking (steady, unsteady).
resistance 9. Vital Signs Monitoring
 2 = Moves with o Actions:
gravity eliminated  Regularly monitor and document
 1 = Trace movement blood pressure, heart rate,
 0 = No movement respiratory rate, temperature,
 Check for drift or abnormal and oxygen saturation.
movements (e.g., tremors).  Observe for any changes that
5. Sensory Assessment could indicate increased
o Actions: intracranial pressure or other
neurological changes.
 Test light touch using cotton
10. Pain Assessment
swab and pain sensation using a
pin (sharp vs. dull). o Questions to Ask:
 Compare bilaterally across all  "Are you in any pain right now?"
limbs.  "Can you rate your pain on a
 Ask if the sensation is the same scale from 0 to 10?"
on both sides or if there's o Actions:
numbness or tingling.  Note location, quality, and
6. Cranial Nerve Assessment (if indicated) nature of pain.
o Actions:
 CN II (Optic): Check visual fields
and pupil reaction.
 CN III, IV, VI (Oculomotor,
Trochlear, Abducens): Check eye
movements; look for nystagmus
or ptosis.
 CN V (Trigeminal): Test facial
sensation and jaw clenching.
 CN VII (Facial): Assess for facial
symmetry by asking the patient
to smile, raise eyebrows, and
close eyes tightly.
 CN IX, X (Glossopharyngeal,
Vagus): Assess gag reflex and
swallowing.
 CN XI (Accessory): Ask the
patient to shrug shoulders and
turn head against resistance.
 CN XII (Hypoglossal): Ask the
patient to stick out their tongue
and move it side to side.
7. Reflexes
o Actions: