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Neurological Assessment
Health Assessment
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Objectives Describe the anatomy and physiology of the nervous system.
Develop questions to be used when completing the focused interview. Describe the techniques required for assessment of the nervous system. Differentiate normal from abnormal findings in physical assessment of the neurologic system.
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Neurologic System Complex Integration, Coordination, and Regulation of Body Systems
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Nervous System Central Peripheral
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Central Nervous System
Brain Spinal cord
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Brain Cerebral cortex Frontal Parietal Occipital Temporal Diencephalon
Thalamus Hypothalamus Epithalamus
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Brain Cerebellum Brain stem Midbrain Pons Medulla oblongata
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Regions of the brain 8
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Spinal Cord Meninges Cerebrospinal fluid Vertebrae
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Peripheral Nervous System
Cranial nerves Spinal nerves
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12 Pairs of Cranial Nerves
Originate in the brain Control many activities in the body Take impulses to and from the brain
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Cranial nerves and their target regions
Cranial nerves and their target regions. (Sensory nerves are shown in blue; motor nerves, in red.) 12
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Cranial Nerves 13
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Spinal Cord 31 pairs of spinal nerves 8 pairs of cervical nerves
12 pairs of thoracic nerves 5 pairs of lumbar nerves 5 pairs of sacral nerves 1 pair of coccygeal nerves Dermatome
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Spinal nerves 15
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Focused Interview Specific questions Illness, infection, or injury
Symptoms Pain Behaviors
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Physical Assessment of the Neurologic System
Techniques Inspection Palpation Auscultation of the carotid arteries Sensory and motor function Reflexes
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Areas of the Neurologic System Assessment
Observing mental status, speech, and language Observing sensorium, memory, calculation ability, abstract thinking ability, mood, emotional state, perceptions, thought processes, ability to make judgments
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Tools for Assessment of Mental Status EBP
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Cranial Nerves l. Olfactory: smell ll. Optic: vision
lll. Oculomotor: moves eye constricts pupil, opens eyelid lV. Trochlear: moves eye in and down
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Cranial Nerves V. Trigeminal: sensation to face, scalp cornea
Vl. Abducens: moves eye laterally Vll. Facial: moves face Vlll. Acoustic: hearing and balance
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Cranial Nerves lX. Glossopharyngeal: swallow & speech
X. Vagus: voice quality Xl. Spinal Accessory: moves head & shoulders Xll. Hypoglossal: moves tongue
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Cranial Nerves Assess together: lll, lV & Vl (EOMs)
Assess together: lX, X & Xll (swallow, gag & dysarthria)
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Areas of the Neurologic System Assessment
Motor function Observation of gait and balance Administration of the Romberg test Administration of the finger-to-nose test Observation of rapid alternating action movements Administration of the heel-to-shin test
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Evaluation of gait. 25
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Heel-to-toe walk 26
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Romberg’s test for balance
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Finger-to-nose test 28
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Alternative for pass point test
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Testing rapid alternating movement, palms down.
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Testing rapid alternating movement, palms up
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Testing coordination using the finger-to-finger test.
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Heel-to-shin test. 33
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Areas of the Neurologic System Assessment
Sensory function Observation of light touch identification Sharp, dull, temperature, and vibration determination Stereognosis Graphesthesia Two-point discrimination Topognosis Position sense
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Evaluation of light touch
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Testing the client’s ability to identify sharp sensations
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Testing the client’s ability to identify dull sensations
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Testing the client’s ability to feel vibrations, the toe
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Testing the client’s ability to feel vibrations, the knee
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Position sense of joint movement
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Areas of the Neurologic System Assessment
Reflexes Biceps Triceps Brachioradialsis Patellar Achilles Plantar Abdominal
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Testing the biceps reflex
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testing the triceps reflex
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Testing the brachioradialis reflex.
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Testing patellar reflex, client in a sitting position
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Testing patellar reflex using a relaxation technique.
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Testing the Achilles tendon reflex with client in a sitting position
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Testing the Achilles tendon reflex with client in a supine position.
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Testing the plantar reflex
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Babinski response 50
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Abdominal reflex testing pattern
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Areas of the Neurologic System Assessment
Additional assessments Carotid auscultation Meningeal assessment Glasgow Coma Scale
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Glasgow Coma Scale 53
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Neurosurgery Considerations
Assess for increased intracranial pressure (ICP) Level of consciousness (LOC) Motor function Pupillary response Vital signs Following an ICU stay of several days, client will normally be confused about the date.
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Pupils Assess for size, shape & reaction to light.
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Pupils Fixed Dilated= ICP, Prolonged diffuse hypoxia, Atropine
Controlled by: CN-III Brainstem Midbrain Pupillary Assessment Size N= 3-5mm Reaction Shape… N=Round Abn=oval – ICP (15-20mmHg) post frontal / anterior temporal lesions Contusions… Fixed Dilated= ICP, Prolonged diffuse hypoxia, Atropine Pinpoint pupil = Narcotics (Morphine, Demerol), Long Acting analgesia (Fentanyl)
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Glossary analgesia The absence of pain sensation.
anesthesia The inability to perceive the sense of touch. Babinski response The fanning of the toes with the great toe pointing toward the dorsum of the foot, considered an abnormal response in the adult that may indicate upper motor neuron disease. brainstem Located between the cerebrum and spinal cord, contains the midbrain, pons, and medulla oblongata and connects pathways between the higher and lower structures. central nervous system System of the body that consists of the brain and the spinal cord. cerebellum Located below the cerebrum and behind the brain stem, it coordinates stimuli from the cerebral cortex to provide precise timing for skeletal muscle coordination and smooth movements; also assists with maintaining equilibrium and muscle tone.
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Glossary cerebrum The largest portion of the brain, responsible for all conscious behavior. clonus Rhythmically alternating flexion and extension, confirms upper motor neuron disease. coma Amore prolonged state of unconsciousness, with pronounced and persistent changes. dermatome An area of skin innervated by the cutaneous branch of one spinal nerve. diplopia Double vision. dysphagia Difficulty with swallowing. hypalgesia Decreased pain sensation. hyperesthesia An increased sensation.
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Glossary meninges Three connective tissue membranes that cover, protect, and nourish the central nervous system. nuchal rigidity Stiffness of the neck as experienced when the meningeal membranes are irritated or inflamed. nystagmus The constant involuntary movement of the eyeball. peripheral nervous system System of the body that consists of the cranial nerves and spinal nerves. reflexes Stimulus-response activities of the body. Romberg test A test that assesses coordination and equilibrium. seizures Sudden, rapid, and excessive discharges of electrical energy in the brain. spinal cord A continuation of the medulla oblongata that has the ability to transmit impulses to and from the brain via the ascending and descending pathways. syncope Brief loss of consciousness, usually sudden.
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The END ! ? Any questions GOOD DAY ! and THANK YOU FOR LISTENING !
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