1. ASSESSING THE SENSORY-NEUROLOGICAL SYSTEM

2. Structures Cerebrum  Cortex Frontal lobe  Temporal lobe
Limbic system  Parietal lobe
Occipital lobe  RAS
Thalamus  Hypothalamus
Cerebellum  Brainstem
Midbrain  Medulla
Meninges  Ventricles

3. Functions What are the functions of…
Cerebrum:
Largest part of brain (2 hemispheres – each with 4 lobes)
Cortex:
Outer layer of cerebrum; controls most conscious processes
Frontal Lobe:
Emotional expression, Broca’s area (expressive language) (Continued)

4. Functions What are the functions of…
Temporal lobe:
Hearing, taste, smell, memory, Wernike’s Area (language comprehension)
Limbic system:
Emotions, sexual arousal, behavioral expression, recent memory (Continued)

5. Functions What are the functions of…
Parietal:
Sensory input
Occipital lobe:
Vision and spatial relationships
RAS:
Wakefulness; Screens & channels incoming sensory input
(Continued)

6. Functions What are the functions of…
Thalamus:
Clusters multiple sensory stimuli
Hypothalamus:
Controls autonomic nervous system and pituitary gland
Cerebellum:
Coordination, equilibrium
(Continued)

7. Functions What are the functions of…
Brainstem:
Involuntary survival behaviors;
includes midbrain, medulla and pons
Midbrain:
Visual, auditory, pupils, and eye movements
(Continued)

8. Functions What are the functions of…
Medulla:
Regulates heart, respiratory rates, B/P, and protective reflexes
Pons:
Helps with respiratory function, facial sensation and movement
(Continued)

9. Functions What are the functions of…
Meninges:
3 layers (pia, arachnoid, dura); protect brain and spinal cord
Ventricles:
4 cavities; capillaries produce and reabsorb CSF
(Continued)

12. Relationship to Other Systems
Integumentary  Respiratory
HEENT  Musculoskeletal
Lymphatic  Genitourinary
Cardiovascular  Endocrine
Hematological  Gastrointestinal

13. Developmental Variations in Older Adults
Fact
Neurons are continually lost during our lives
Neural impulses slow down
Fiction
Misconception that creative, critical and abstract thinking, or problem-solving ability slip with age
Neurological Deficits
Meds, Malnutrition, Dehydration, Cerebral perfusion, Diabetes, Trauma, CA, Alzheimer’s, Parkinson’s, ETOH/Drug abuse, Isolation (Abuse/Neglect), Psychiatric disorders

14. Cultural Variations African Americans Irish Native Americans HTN, CVA
Neural tube defects
Native Americans
Unique Neuropathy that causes death by age 24

15. Case Study
Leon Webster, 21-year-old, African American, college senior, plays football
MVA not wearing seat belt; lost control of car; hit tree
Alert & oriented; C/O headache and neck pain

16. History What can the history tell you about
History What can the history tell you about the neurologic/sensory system?
Biographical data
Current health status
Past health history
Family history
Review of systems
Psychosocial history

17. Symptoms What symptoms would signal a problem with the neurologic/sensory system?
Headache
Mental status change
Dizziness, vertigo, syncope
Numbness or loss of sensation
Deficits of the 5 senses

18. Pertinent History Findings
Headache and neck pain from hitting head in MVA; dizzy, nauseated after MVA
Had a few beers before accident
Unsure if lost consciousness; a little confused at time
Lives on campus; home 1 hour away from school
(Continued)

19. Pertinent History Findings
Concussion and fractured fibula in high school while playing football
+ family history of HTN

20. Physical Assessment Approach: inspection, palpation, and auscultation
Position: sitting
Tools: stethoscope, B/P cuff, penlight, gloves, cotton, sharp object, coin, fragrance, sweet and sour substance, tongue blade, test tubes, reflex hammer, ophthalmoscope
General Survey and head-to-toe scan

21. Cerebral Function Behavior Level of consciousness: time, place, person
Glasgow Coma Scale (pg 770 new- 668 old)
Memory: immediate, recent, remote
Mathematical ability
Thought process  Judgement
General knowledge  Communication

22. Cranial Nerves CN I - olfactory: sensory smell
CN II - optic: sensory sight
CN III - oculomotor: pupils, EOM
CN IV - trochlear: EOM
CN V - trigeminal: facial sensations & motor,muscles of mastication
CN VI - abducen: EOM
CN VII - facial: motor, facial muscles, sensory, taste anterior tongue
(Continued)

23. Cranial Nerves
CN VIII - acoustic: hearing
CN IX - glossopharyngeal: swallowing, voice, gag, taste posterior tongue
CN X - vagus: swallowing, voice, gag
CN XI - accessory: motor, neck muscles
CN XII - hypoglossal: motor, tongue muscle

24. Sensory Function Superficial sensations: Light touch Pain Temperature
Deep sensations:
Vibratory sensations
Kinesthetics
(Continued)

25. Sensory Function Discriminatory sensations: Stereognosis Graphesthesia
Recognition of solid object by touch
Graphesthesia
Recognition of outlines, numbers, words, symbols when written on skin
2 point discrimination
Point localization
Extinction

26. Deep Tendon Reflexes Biceps Triceps Brachioradialis Patellar Achilles
(pg 785 new 684 old)

27. Superficial Reflexes Plantar Abdominal Anal Cremasteric
Bulbocavernosus

28. Protective Reflexes
Gag
Cough
Swallow
Blink
Corneal

29. Primitive Reflexes Babinski Page 784 new, 684 old Sucking Grasp
Rooting
Snout
Glabellar

30. Meningeal Signs Nuchal rigidity pg 784 new, 689 old
Kernig’s Sign (+ if contraction
or pain of hamstring present)
Brudzinski’s Sign (+ if
flexion of the hips occurs)

31. Pertinent Physical Findings
AAO x 3, Glasgow Coma Scale 15
Memory: immediate and remote intact, doesn’t remember events of accident
Cognitive function intact
CN 1 through XII intact
+2 DTR, + plantar
2” sutured laceration on forehead

32. Nursing Diagnosis
What actual or potential problems can you identify for Leon Webster?