The nurse is assessing a client's motor responses and applies pressure to the client's nailbed. The client responds by reaching over with the other hand to brush the nurse away. How does the nurse chart this finding?

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Quizplus · Accepted Answer

Localization is when the client takes an extremity, crosses the midline, and attempts to push the noxious stimulation away. Decorticate posturing involves flexion and bringing extremities into the body. Decerebrate posturing involves extension and movement of extremities away from the body. Withdrawal is pulling away from the stimulation.

The Nurse Is Assessing a Client's Motor Responses and Applies