1. NURS2520 Health Assessment II
Neurological Assessment

2. Objective One Assess the components of the basic neurological assessment

3. The brain is highly dependent on blood flow and a consistent supply of oxygen and glucose to maintain neuronal function. Any decrease can cause neuronal malfunction. Older adults tend to be vulnerable to cognitive dysfunction secondary to many causes, ranging from decreased blood pressure to infections. Thus, any acute change in cognitive functioning needs to be assessed for an underlying cause.

4. Neurological System
Functions through transmission of chemical and electrical signals between the body and the brain
Receives, processes, and sends out information
Controls and coordinates the functioning of all other systems in response to environment/surroundings
Involves cognition, emotion, memory, sensation and perception, and regulation of homeostasis
Comprised of the central nervous system (CNS) and the peripheral nervous system (PNS)
CNS = Brain and spinal cord
PNS = Cranial and spinal nerves

6. Two neurons with synapse (from MyNursingLab)

7. The PNS
includes nerves emerging from the brain (cranial nerves) and nerves emerging from the spinal cord (spinal nerves).
These nerves are divided into sensory nerves that conduct messages from various parts of the body to the CNS, whilst motor nerves conduct impulses from the CNS to muscles and glands.
is further divided into the Somatic System (SNS) and Autonomic System (ANS), depending on the area of the body these messages are transmitted to and from.

8. The SNS
consists of sensory neurons from the head, body wall, extremities, and motor neurons to skeletal muscle.
The motor responses are under conscious control and therefore the SNS is voluntary.
Certain peripheral nerves perform specialized functions and form the autonomic nervous system; they control various activities that occur automatically or involuntarily such as the contraction of smooth muscle in the walls of the digestive system.
The autonomic system is further divided into the sympathetic and parasympathetic systems. These two systems provide nerve stimuli to the same organs throughout the body, but bring about different effects.
The balance between these two systems is controlled to create a state of homeostasis that is where the internal stability of the bodily systems are maintained in response to the external environment

9. Parasympathetic Nervous System
slows down the body
helps prepare for a more relaxed state, ready for digestion and sleep.
It will therefore increase peristalsis of the alimentary canal, slow down the heart rate, and constrict the bronchioles in the lungs. .

10. The Sympathetic Nervous System
helps prepare the body for "fight or flight" and create conditions in the tissues for physical activity.
is stimulated by strong emotions such as anger and excitement and will therefore speed up heart rate, increase the activity of sweat glands, adrenal glands, and decrease those of the digestive system.
also produces rapid redistribution of blood between the skin and skeletal muscles.

12. Brain and spinal cord (from MyNursingLab)

14. Age-Related Considerations
Birth reflexes include rooting, sucking, palmar grasp, tonic neck reflex, and Moro
Disappear during infancy
May return w/stroke or trauma
Denver Developmental Screening Test II (DDST) used to screen young children
Neurons decrease over lifetime, resulting in slowed reaction time, problem-solving skills, and voluntary movement
Decreases in intelligence and memory not normal in the elderly, and indicate a neurological deficit
Medication effects, dehydration, Alzheimer’s dementia, etc

15. Cerebral Function Level of consciousness (LOC)
Arousal (alert, lethargic, stuporous, comatose)
Verbal stimuli
Tactile stimuli
Painful stimuli
Orientation (person, place, time)
Mental status and cognitive function
Behavior, appearance, response to external stimuli, speech, recent and remote memory, communication, judgment
Posture, gait, motor movements, dress, hygiene/grooming, mood, affect, facial expression
Consider language/education/culture during neuro exam

16. Glasgow Coma Scale

17. Objective Two Demonstrate the proper technique for the assessment of reflex activity

18. Reflex Function
Deep tendon reflex is tested with a rubber percussion hammer to tap a slightly stretched muscle
Normal response = muscle contraction
Response grading scale:
0 = No response detected
+1 = Diminished response
+2 = Response normal
+3 = Response somewhat stronger than normal
+4 = Response hyperactive with clonus
Clonus refers to involuntary continuous contractions of a muscle or group of muscles
Superficial reflexes are tested by lightly touching the body with the base of a reflex hammer or tongue blade, beginning with the most peripheral part of the limb
Graded as positive or negative
Determine sensory loss area by testing every 1-2 inches

19. Testing Reflexes Biceps Reflex Triceps Brachioradialis Patellar
Rest client’s elbow in nondominant hand with thumb over biceps tendon; strike percussion hammer to own thumb
Triceps
Abduct client’s arm at the shoulder, flexing at the elbow; support upper arm with nondominant hand, letting forearm hang loosely; strike the triceps tendon 2 inches above the olecranon process
Brachioradialis
Rest client’s arm on his leg; strike with percussion hammer 1-2 inches above bony prominence of the wrist on the thumb side
Patellar
Position client in seated position with legs dangling; strike the tendon directly below the patella with a percussion hammer
Achilles
Position client in the supine or seated position with legs dangling; hold client’s foot slightly dorsiflexed; strike the Achilles tendon about 2 inches above the heel with the percussion hammer
Plantar
Superficial
Stroke the sole of the client’s foot in an arc from the lateral heel to medially across the ball of the foot
Deep Tendon Reflexes:

20. Objective Three Demonstrate the assessment techniques employed in the assessment of cranial nerves

21. Dorsal aspect of brain w/cranial nerves (from MyNursingLab)

22. Cranial Nerves

23. Checking Cranial Nerves
CN I
Identify the smell of common substances
CN II
Test visual acuity and visual fields
CN III, IV, & VI
Test extraocular movement by having client move eyes through the 6 cardinal fields of gaze with head held steady; test papillary reaction to light and accommodation
CN V - Motor function
Move jaw from side to side, clenching jaw, and biting down on a tongue blade
CN V - Sensory function
Have client close eyes and identify when he is being touched on the forehead, cheeks, and chin; test corneal reflex by puffing air over the cornea
CN VII - Motor function
Have client make faces (smile, frown, whistle)
CN VII - Taste
Test taste on anterior portion of tongue by placing something sweet, salty, or sour on the tip of the client’s tongue
CN VIII
Test client’s hearing using wristwatch; test air/bone conduction using Weber & Rinne test; test for balance using Romberg test

24. Checking Cranial Nerves
CN IX & X - Motor function
Observe client’s ability to talk, swallow, and cough; have client say “ahhh” while depressing tongue with tongue blade and observing rise of soft palate and uvula
CN IX & X - Sensory function
Induce client’s gag reflex (do NOT perform in lab practice)
CN IX & X - Taste
Test taste on posterior portion of tongue by placing something sweet, salty, or sour at the back of the client’s tongue
CN XI
Place hands on client’s shoulders, and have him shrug shoulders against resistance; have client turn head from side to side against resistance
CN XII
Have client say “d”, “l”, “n”, “t”; have client protrude tongue and move it from side to side

25. Neuro exam
Part 1
Part 2

26. Objective Four Demonstrate the complete assessment of the neurological system (*Lab Practice)