Nursing Assessment of Coordination and Sensation

00:01 Now, let's move on when we're talking about the neurological system and talk about coordination.

00:06 Now, this is typically done if you suspect some sort of neurological damage, you may have to test this in particular, but just know this is actually considered more of a focused assessment.

00:17 So depending on where you work, this may or may not be appropriate.

00:22 Now, here's a couple of things that you can do to test coordination.

00:26 One of those are a finger-to-nose test.

00:28 And sometimes we'll do this on a neurological or stroke unit, for example.

00:32 So all this is here, as you see in the image, we're going to ask the patient to take their finger and say, "Okay, Mr. Jones, I want you to touch your nose.

00:41 And then as the provider, we're going to have our finger out and have them reach out and touch your finger.

00:45 Now, we're going to have repeat this several times from nose to finger.

00:49 And as you see as the provider, will move the finger around and have them touch that, and see what the patients and assess their coordination here.

00:58 Now, the second way to assess coordination is what we call the heel-to-shin test.

01:03 Now, if you're assessing coordination of patient and you use the finger-to-nose, or the heel-to-shin test, and you notice the patient is just completely missing their target, then that may mean they have neurological damage, and you want to make sure you report this to the physician.

01:20 Ask the client to place their left heel onto their right shin just below the knee.

01:25 Ask them to slowly inaccurately run their heel down the length of the shin to the top of the foot, and then back up again.

01:33 Now, we're gonna ask the patient to repeat this several times and then perform the same test on the other side.

01:40 Some patients have a lot of illness, there can be a lot of disease process and things going on, that they're so weak, that they can even pull up their foot or their leg up off the bed to touch their shin.

01:53 This weakness doesn't mean that there's a coordination issue.

01:57 Now, let's talk about the sensory piece of the neurological system.

02:01 Now, when we're talking about sensory think about sensation and being able to feel with your patients.

02:08 Meaning certain patients, such as stroke, or post-op back procedures, or trauma patients can may have a different or a decrease in sensation in different parts of their body.

02:19 Now, sometimes, if they're sensory issues, we may need to do a more focused assessment and can do a complete sensory exam.

02:27 Now, this may include like pain, or temperature, or even position, vibration, and even fine touch.

02:35 Now, if you take a look at this dermatome map, just one thing I want you to keep in mind and take a look at this map while we talk.

02:42 Now, each area of our spine innervate the specific area of the body.

02:46 So if a specific area of your spinal cord is injured, now, you're going to expect to see those effects in particular areas of the body. It all kinds of correlates.

02:57 So for example, if you take a look at our map here on this image, now you can imagine that if you see injuries to the sacral area, which is here shown in purple, you're going to expect to see these problems or symptoms in the patient's legs.

03:11 Now let's further discuss this whole topic.

03:14 Now, if someone is having an epidural, for example.

03:18 This dermatome map is really helpful to consider.

03:21 So when I say this word epidural, now this is just when a medication is put directly into someone's spine.

03:28 Now, by doing this at a specific spinal level, it affects the neurological status of the entire dermatome.

03:36 So just know that an epidural, it's important to know where it is.

03:41 So you can tell if the med is beginning to go up or down the spinal column.

03:46 Now, here's a great example of this, like let's say the epidural is put into the lumbar region of the back.

03:52 Now, you're going to expect that the patient has some sensory or motor loss in the lumbar regions, because that's expected.

03:59 But what you don't expect is them to have issues at, or above the belly button, right? Now, if this is different, and if you assess this, you need to let the provider know immediately.

04:13 Now, let's talk about a sensation assessment.

04:16 This can tell us a lot about the patient including their ability to be able to feel or move, or even acknowledge that there's a presence of a part of the body.

04:26 Now, the start office sensation assessment we're going to explain to the client that they need to report when they feel a sensation on their extremity.

04:35 Then we're going to use our fingers or tool and touch the client's extremity to produce that feeling.

04:42 And then you're going to make sure you tell the client to report it.

04:45 Now, here's a great little tip, you can use your finger or specific tool.

04:49 So a lot of the times in nursing we can get just a Q-tip on the floor because you've got a soft end,and of course you've got the sharp end, and you can use both for assessment.

05:00 Now, have the client close their eyes, and you will ask them to close their eyes and we don't want them to be able to either see, or sense, or see the movement of our extremities when we're assessing the client.

05:12 Now, you're going to use your fingers, or your tools or your cotton swab, and lightly touch the client without them seeing this.

05:20 Now particularly, what I'll do is I'll have the blanket over the clients legs, I'll have my hands or my Q-tip or tool underneath the blanket.

05:29 That way my patient can't see me touch each side and assess.

05:33 So again, we're gonna assess one side versus the other, and then maybe both, and we're gonna keep repeating this and ask our client to report.

05:41 Now, the whole goal here is to see if the client can feel the touch without even being able to see which parts assessed.

05:49 So this may be like, here's the client's feet, that covers over it.

05:54 And I may say, "Okay, Mr. Jones, which side am I touching now? Tell me if it's right or left, or both.

06:01 So under the covers with my hands hidden or my tool, I'll do right, I'll do left, I'll do both.

06:07 I may go right again, right, right, left.

06:11 So I just vary this to see if the client can report appropriately what they feel.

06:16 Now, during this time, you can assess for numbness, tingling, and any decrease in sation in the extremity.

06:24 Now let's talk about paralysis.

06:26 There's different types, meaning some patients have no ability to feel or even move these parts of their body.

06:33 And again, we call this paralysis and there's different types.

06:37 So all of these, unfortunately, are going to result from some kind of injury to someone's central nervous system.

06:43 So, here's varying degrees of this.

06:46 So, if you take a look at this one side called hemiplegia.

06:50 As you can see here in the green, this is the affected part of the patient's body.

06:54 So as you can see it's hemi, meaning one side, this is typically going to occur in stroke.

07:00 So you see the upper, the lower side of the body, the patient's whole side, they may not be able to feel or move the side of the body.

07:08 Now when we're talking about paraplegia, or quadriplegia, this is usually from some sort of spine injury.

07:15 Here's something to know, the higher the injury is on the patient's spine, usually everything below it can be damaged, meaning they can't move it or they can't feel it.

07:27 Now when we're talking about monoplegia this can happen as course as stroke or maybe nerve compression, some sort of inflammation or some sort of motor neuron disease.

07:38 So again, taking a look at the slide.

07:40 As you can see, there are different types of paralysis that we need to assess, and note in our documentation.