Neurologic, Sensory, and Musculoskeletal Care
Neuro Checks, Mobility, and Sensory Safety
Neurologic questions emphasize serial assessment and early change detection. Use a consistent scale such as the Glasgow Coma Scale and compare pupils, motor strength, and level of consciousness over time. A new unequal pupil, sudden weakness, or change in speech suggests a neurologic emergency. For stroke, remember time is brain: recognize signs, activate the stroke pathway, and know the thrombolytic window and contraindications. Seizure precautions include padded rails, suction at the bedside, and never restraining a seizing patient or placing objects in the mouth. For musculoskeletal care, assess circulation, motion, and sensation distal to injury or cast, and know that compartment syndrome pain is out of proportion and unrelieved by elevation or analgesia.
Traps to Watch
Questions often test positioning after hip replacement (avoid extreme flexion and crossing legs) and after spinal injury (maintain alignment). Sensory deficits increase fall and injury risk - teach checking water temperature and inspecting skin. Do not attribute a new neurologic finding to fatigue or medication without further assessment.
Rule of Thumb
For any cast or injured limb, check the five Ps: pain, pallor, pulselessness, paresthesia, and paralysis. Worsening pain is the earliest sign of compartment syndrome.
Worked Example
After a leg cast is applied, the patient reports severe pain not relieved by analgesia and cannot wiggle the toes. The nurse elevates to heart level only if ordered, notifies the provider immediately, and prepares for possible fasciotomy.