Pathophysiology
Clinical meaning
Neurological checks (neuro checks) are serial standardized assessments performed to detect changes in neurological function that may indicate clinical deterioration or improvement. The core components include level of consciousness (Glasgow Coma Scale -- eye opening, verbal response, motor response), pupillary assessment (size in millimeters, shape, reactivity to light, comparing bilateral responses), motor function (strength in all four extremities graded 0-5, comparing bilateral responses, assessing for pronator drift), sensory function (light touch, pain response), and vital sign pattern assessment (Cushing triad of hypertension, bradycardia, and irregular respirations indicates critically elevated ICP with impending herniation). Trending neurological findings over time is essential: a decrease of 2 or more points on the GCS, new pupillary asymmetry, new focal motor deficit, or emergence of Cushing triad all require immediate escalation. The nurse performs neuro checks at prescribed intervals (every 15 minutes to every 4 hours depending on acuity), uses consistent technique across assessments for reliable comparison, documents component scores rather than just totals, recognizes patterns of deterioration (rostral-to-caudal progression in herniation), differentiates neurological changes from sedation effects, and communicates changes immediately using SBAR format...