9.3 General Assessment of the Nervous System
Risk Factors and Social Determinants of Health Related to Nervous System Health
As with other body systems, neurologic health disparities are created and perpetuated by structural and social determinants of health. These factors include, but are not limited to, interpersonal bias, institutional factors that lead to disparate access to care, and neighborhood-level factors, such as socioeconomic status, segregation, and access to healthy food. Effects of these determinants of health can be seen throughout neurology, including in stroke, epilepsy, headache, amyotrophic lateral sclerosis, multiple sclerosis, and dementia.[1] Research shows that Black and Hispanic individuals were 30%-40% less likely to see an outpatient neurologist for care of a neurological condition compared with White individuals, even after adjusting for demographic, insurance, and health status differences.[2]
The environments in which individuals live and work also affect brain health. Lower socioeconomic status can result in exposure to toxic and unhealthy environments that increase risk for neurological disease.[3]
Health History
Before obtaining a health history, note the client’s cognition, appearance, speech, and motor function. If any deficits in speech, hearing, or cognition are noticed, it is helpful to interview a family member or significant other to obtain accurate baseline information. If a family member or significant other is not available, the nurse may need to use questions with “Yes” or “No” answers and rely on information in the electronic health record.
Interview questions often include the following questions[4]:
- Are you experiencing any current neurological concerns such as headache, decreased vision, dizziness, weakness, numbness, tingling, tremors, loss of balance, or decreased coordination?
- Have you experienced any difficulty swallowing or speaking?
- Have you experienced any recent falls or head injury?
- Have you ever experienced a neurological condition such as a stroke, transient ischemic attack, seizure, dementia, Parkinson’s disease, multiple sclerosis, or myasthenia gravis?
- Are you currently taking any medications, herbs, or supplements for a neurological condition? (The nurse should be aware if the client is taking sedatives, analgesics, or neuromuscular-blocking agents, as these may interfere with an accurate neurologic assessment.)
- Do you use alcohol, marijuana, or other street drugs?
The nurse is also aware that neurologic disorders may be acute or progressive, and some are characterized by variation in symptoms or symptom-free periods.
Physical Examination of the Neurological System
The brain and spinal cord cannot be examined directly, so physical examination of the nervous system is performed using a variety of observations, assessments, and clinical testing. Much of the examination is an indirect evaluation of the functioning of specific body part(s) controlled or innervated by the nervo