Assessment: The Neurologic Examination
An important aspect of the neurologic assessment is the history of the present illness. The initial interview provides an excellent opportunity to systematically explore the patient’s current con-dition and related events while simultaneously observing overall appearance, mental status, posture, movement and affect. De-pending on the patient’s condition, the nurse may need to rely on yes-or-no answers to questions, on a review of the medical record, or input from the family or a combination of these.
Neurologic disease may be stable or progressive, with both in-termittent symptom-free periods as well as times with fluctua-tions in symptoms. The health history therefore includes details about the onset, character, severity, location, duration, and fre-quency of symptoms and signs; associated complaints; precipi-tating, aggravating, and relieving factors; progression, remission, and exacerbation; and the presence or absence of similar symp-toms among family members. The nurse may also use the inter-view to inquire about any family history of genetic diseases.
Included in the health history is a review of the medical history, including a system-by-system evaluation. The nurse should be aware of any history of trauma or falls that may have involved the head or spinal cord. Questions regarding the use of alcohol, med-ications, and recreational drugs are also included. The history-taking portion of the neurologic examination is critical and, in many cases of neurologic disease, leads to an accurate diagnosis.