Running head: Neurological Assessment

Neurological Assessment
Student: Oladapo Olowoyeye
Student No: 825 223 449
Date Submitted: October 31, 2014
NURS 104: Health Assessment
Professor: Karen Goodwin
Humber College ITAL

Neurological Assessment
Looking at Mr. Chestnut case study, there seems to be some priority areas of the
neurological assessment that should be focus on for this patient. However, I will be
focusing on two main priorities for this patient. It is important to point out that Mr.
Chestnut is an 89 year old client. The two main neurological assessments in Mr.
Chestnut case is hearing acuity and mental status. In this paper, I will be discussing
the reasons why these are the two main priority areas for this client.
Firstly, Mr. Chestnut hearing acuity is a priority to look at under the neurological
assessment. According to the case study about the client you have to call his
name out loudly before he hears you. This is a sign of decrease or loss of hearing. This
is a big problem for the patient, because the patient will not be able to have a good
conversation with the nurse; and it will be hard for the patient to understand everything
the nurse is telling him. According to Jarvis (2014), hearing acuity is the ability of a
patient to hear normal conversation, by the whispered voice test, and by Weber and
Rinne turning fork tests. Mr. Chestnut will have difficulties in getting some of his
physiological needs because of his hearing impairment. For example he will not able to
communicate properly and this will limit his access to food, water, and good sleep,
which are very important for his well-being. There are evidence to proof that hearing
acuity is a priority area of the neurological assessment that need to be focus on for this
client. As Bentur et al., (2012) stated, hearing loss is a chronic health condition. Hearing
loss is linked with distressing problem and has major implications for older peoples
quality of life. A diminished ability to hear is also associated with disability, social

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isolation, depression, and difficulty in performing normal activities of daily living. These
evidence proofs that hearing impairment is an important area that needs to be focus on
for Mr. Chestnut. The ability to hear clearly by the patient will prevent potential cases of
depression, social isolation, and will help the client to perform normal activities of daily
living without difficulties. This shows why it is important to focus on the hearing acuity
assessment immediately.
Nursing interventions should be provided for the patient because of the loss of
hearing. The client should undergo hearing screening regularly to promote early
detection of hearing impairment, and it will also help to prevent potential illness and
functional disability (Bentur et al., 2012). The nurse need to speak loud and in
appropriate tone when speaking to the client. The nurse must make sure he or she
speak clearly to him. The nurse must make sure that Mr. Chestnut hearing aid is always
in place if he has one, and if he doesnt have hearing aid , this need to be brought to
the attention of his next of kin or family so that it can be provided for him.
Secondly, mental status is a priority area of the neurological assessment to focus
on for the patient. Mental status includes the clients alertness and orientation to person,
place and time. Mental status also includes the patient state of mind (Jarvis, 2014).
Looking at the case study, it can be said that Mr. Chestnut is not alert or aware of my
presence in his room. I can also say that the patient is suffering from an altered state of
mind. This means that the patient has a state of mind that is different from the normal
state of consciousness of a person. This is a priority area that needs to be focus on
immediately for this client. His mental status can be due to his febrile state. Looking at
his vital signs, specifically the temperature which shows that it is higher than normal, but
further test is needed to make a conclusive diagnosis.

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There are good reasons why mental status should be a priority area for the
assessment of the client. As stated by Jarvis (2014), mental status is a part of mental
health that includes emotional and cognitive functioning. This means that if there is an
alteration in the state of mind of Mr. Chestnut, it will affect his emotion and cognitive
function. If the mental status examination is not done as soon as possible, and proper
steps are not taken, it will affect the patient cognitive efficiency. This means that the
patient behavior and thought process will be affected. If the behavior of the patient is
affected, the patient will start exhibiting strange behaviors. According to McGuire, Ford,
and Arjani (2006), cognitive functioning is an important part of human being that helps
to recognize consciousness, interact with the social and physical environment, and to
ensure survival. This means that if he is not cognitively effective, it will affect the way he
relate to everything around him. For example, in Mr. Chestnut case, the way he
interacts with the nurse and also his family will be affected because of his cognitive
disability. Our quality of life depends on how we can think properly, how we can be able
to recognize our strengths and weaknesses, aspirations and dreams (McGuire, Ford, &
Arjani, 2006). This means that optimal cognitive functioning will help Mr. Chestnut alter
his behavior to match his abilities.
Nursing interventions should be provided for the patient to optimize his cognitive
functioning, and to help him have a stable state of mind. These nursing interventions
include: giving the patient neurotrophic medications which helps some adult
experiencing loss in cognitive functioning (Meyer et al., 2002), and keep orienting the
patient to person, place, and time. Cognitive remediation therapy is also an effective
way to improve cognitive functioning (Vance et al., 2007).

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In conclusion, the two main areas that should be focused on for Mr. Chestnut
neurological assessment are hearing acuity and the mental status. Hearing acuity which
include decrease or loss of hearing can lead to depression, social isolation and
difficulty in performing normal activities of daily living. Mental status which includes:
emotional and cognitive functioning, alteration of state of mind, and alertness and
orientation of the patient to person, place and time, can lead to inability of the patient to
interact with social and physical environment, and can affect his behavior and thought
processes. These are the reasons why these two main areas should be the priority of
the neurological assessment of the patient.

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References

Bentur, N., Valinsky, L., Lemberger, J., Ben Moshe, Y., Heymann, A.D. (2012).
Primary care intervention programme to improve early detection of
hearing loss in the elderly. The Journal of laryngology and otology, ISSN 00222151, Volume 126, Issue 6, p. 574.
Jarvis, C. (2014). Physical examination & health assessment: Second Canadian
edition. (A.J. Brown, J.MacDonald-Jenkins, & M.Luctkar-Flude). Toronto:
Saunders/Elsevier.
Vance, David, Larsen, Kirsten I., Eagerton, Gregory, Wright, Mary A. (2011).
Comorbidities and cognitive functioning: implications for nursing research and
practice. The Journal of neuroscience nursing : journal of the American
Association of Neuroscience Nurses, ISSN 0888-0395, Volume 43, Issue 4,
P. 215.