Psychomotor Assessment 1st Method Psychomotor Assessment Neurological

Psychomotor Assessment

1st Method Psychomotor Assessment

Neurological observation as relating to psychomotor Assessment framework revolves around collecting data about the CNS or brain and spinal cord of a patient. Some of the areas that are assessed include Level of Conscious, Alertness, Pupillary Response, Vitals, and Motor Response (Mooney and Comerford, 2003).

In categorizing the level of consciousness some of the observations include alertness, being aware of surrounding environment, in contrast to drowsiness or slower responses. As stimuli is applied, it is important to record not only if there is a response, but the rate or speed of the response could indicate there is an uncharacteristic condition. If a patient is not conscious, there is no response even to a pain induced stimuli such as heat, pressure, or light. A problem could exist when there is pressure on the brain caused by excess fluid or a head trauma of some type.

Vitals are part of an accurate assessment according to (Mooney and Comerford, 2003). with the Respiratory being checked first to determine if oxygen is getting to the brain. The rate of breathing can be recorded to indicate any irregularities. Next the temperature of the hypothalamus should be taken to determine if there are any abnormalities. The next vitals that should be assessed are blood pressure which can help in ruling of heightened ICP. If vitals are not in normal range, this could indicate distress within the level of consciousness.

Pupil response is considered normal at 2 to 6mm diameter according to Tollefson (2010). If there is a change outside this range, it may be indicative of a compressed optic nerve (Mooney and Comerford, 2003).

Use of a penlight or pen torch can assist the nurse or clinician in assessing pupil reaction of a patient. The size of the pupil should also be observed as the range of diameter is 1 to 9 mm (Rhoads, 2006).

Motor response generally refer to the upper body limbs. The types of movement include flexion which refers to bending the limb. The other is Extension which refers to extending or straightening out of the limb (Aucken & Crawford, 1998).

2nd Method GCS Assessment

Glasgow Coma Scale is used in Psychomotor assessments. The GCS was introduced by Teasdale and Jennett in 1974 (Tellefson, 2010, p. 125). The assessment consists of three stages. The first is based on optical responsiveness, the second verbal reaction, and thirdly activity of motor skills (Mooney and Comerford, 2003). Scores are given based on the patient's response in these core areas. A GCS scoring is then applied and assessed with the high score set at 15 and the low at three. Scoring within the range of three to 15 shows how conscious a patient appears to be to their surroundings.

The Eye or optical criteria include how the patient responds when someone approaches them. If they open their eyes when someone approaches or when they are spoken to indicate a response. If unresponsive use of stimuli such as light, pressure, or other stimuli may be applied to induce optical reaction (Mooney and Comerford, 2003). Though the patient may have eye movement sometimes this is involuntary and may not be an indication of consciousness (Tellefson, 2010).

Verbal reaction is used to assess consciousness. When a patient is conscious they may be able to understand when they are spoken to or when their name is spoken. They may know their surroundings and possibly give personal information such as an address or indicate the date or time. However, a patient that is unable to respond to such questions can often carry on a conversation, but may not be aware of who or where they are. As questions are asked the answers may be unrelated or incoherent. This can indicate a psychomotor or neurological condition.

Motor responsiveness can be determined using a few verbal instructions such as "apply pressure to my hand" or "lift your arms or legs up" and 'show your tongue'. When making such assessments, note the amount of strength in the application by the patient. Take account of a level of weakness. If there is no response to commands it may be necessary to apply a pain related stimuli such as slight heat, cold, or light to draw a response. Three common stimuli used in such a case for motor response are the trapezium squeeze which uses the thumb and a couple fingers to squeeze and slightly twist a muscle. Another is supraorbital pressuring by moving a single finger across the eye rim along the bone. This is to applicable where there are no facial contusions or fractures (Mooney and Comerford, 2003).

A third assessment is using a sterna rubdown by using the knuckles of a closed hand to gently press the sternum to observe any response (Rhoads, 2006).

The GCS is well-known and often used as a standard assessment in the case of neurological examination. The only tool necessary is a small penlight torch and a GCS assessment form for documenting results or observations.

Ethical Considerations

Ethical considerations of the GCS revolve around protecting the patient's rights and personal space or privacy. In applying the assessment proper protocols and disclosures must be approved by the patient or a member of the family that the patient has given the legal authority to act on their behalf. The Australian Nursing Registration Authority Council has set up guidelines that are to be followed for ethical treatment of patients. One of the first values in relation to GCS specifically would be Value statement number one which states that 'nurses must respect the needs, values, culture, and vulnerability' (Tellefson, 2010).