Clinical assessment and neurodiagnostics

Effective brain resuscitation demands the expert clinical assessment skills of a multidisciplinary team. The nurse's role in the evaluation of a patient with acute brain injury is the ongoing monitoring of vital signs and neurological status. A comprehensive clinical evaluation includes obtaining a medical history, performing a clinical examination, and securing appropriate neurodiagnostic tests. The initial assessment of the brain-injured patient focuses on an evaluation of cardiopulmonary as well as neurological function. Priority in brain resuscitation is given to the evaluation of the adequacy of oxygenation and circulation. Once circulation is re-established, specific brain-oriented evaluation begins. This assessment includes a comprehensive neurological exam, as well as an evaluation of metabolic factors believed to influence neuronal recovery. Data derived from the clinical assessment is useful in guiding therapy and determining patient prognosis. This information is critical to informed decision-making regarding the appropriateness of aggressive therapy.