NEUROLOGICAL ASSESSMENT

NEUROLOGICAL ASSESSMENT

KEY

PUPIL SIZE (using lighting)

NEUROCHECK 15 MIN X 4 30 MIN X 4 Q HOUR X 4 Q 4 HOURS X 4 Q SHIFT X 2

REACTION   S – sluggish B – brisk N – non-reactive

EXTREMITIES   S – strong                    W – weak F – flaccid R – rigid

DATE

TIME

Neurocheck

Q15

Q15

Q15

Q15

Q30

Q30

Q30

Q30

Q1

Q1

Q1

Q1

Q4

Q4

Q4

Q4

QS

QS

Vital Signs

Blood Pressure

Temperature

Pulse

Respirations

Normal

Shallow

Deep

Irregular

Pupils Extremities

R. Pupil         Size/React

L. Pupil         Size/React

á         Ext. L / R

â         Ext. L / R

Consciousness

Orient

Disorient

Restless

Drowsiness

Speech

Clear

Garbled

Response to

Name

Pain

Environment

Unresponsive

Other

Seizure

Headache

.

Vomiting

SIGNATURE AND STATUS

Last Name                               First Name                    Middle Int.

Attending Physician

Room No.

Medical Rec #