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Neurological Assessment 3

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169 views30 pages

Neurological Assessment 3

Uploaded by

raheelfatima729
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Neurological

Assessment
By
Aroona Javed
Nursing Lecturer
Objectives
By the end of the lecture students will be able to
• Perform mental status examination of client
• Assess cranial nerve, sensory, sense of proprioception and cerebellar
functions and deep tendon reflexes
• Document findings
• List changes in nervous system related to aging process
Lobes of Cerebral Hemispheres
Cranial Nerves
Subjective Data

Numbness
Headaches Seizures Dizziness
& Tingling

Senses &
Difficult Difficult Muscle
Memory
Speaking Swallowing control
loss
Subjective Data

Past
Family Lifestyle
Health
History Practices
History
Objective Data
A complete neurological examination consists of evaluating following
five areas
Mental Status
Cranial Nerves
Motor and Cerebellar Systems
Sensory System
Reflexes
Equipment
Cranial Nerve Examination
Cotton tipped applicators Snellen Chart
Newsprint to read Tongue Depressor
Ophthalmoscope Tunning Fork
Paper clip Penlight
Sterile cotton ball
Substances to smell or taste
( soap, coffee, salt, sugar)
Equipment
Motor and Cerebellar Examination
Tape measure
Reflex Examination
Cotton tipped applicator
Reflex hammer
Sensory Examination
Cotton ball
Key
Tunning fork
Glasco Coma Scale
Cranial Nerves Assessment
Test CN I ( Olfactory)
• Identifying scented objects (soap, coffee or vanilla)
Test CN II ( Optic)
• Use Snellen chart
• Reading newspaper
• Visual field by confrontation
• View retina or optic disc of each eye
Cranial Nerve Assessment
Assess CN III,IV & VI ( oculomotor, trochlear, abducen)
• Inspect margins of eyelids
• Assess extraocular movements
• Assess pupillary response & Accommodation
Assess CN V (Trigeminal)
• Test motor function
• Test sensory function
• Test corneal reflex
Assess CN VII (Facial)
• Test motor function
Test CN VIII (acoustic/ vestibulocochlear)
• Assess hearing ability
• Weber and Rinne tests
Weber Test Rinne
Test
Test CN IX (glossopharyngeal) & X (Vagus)
• Test motor function
• Test gag reflex
• Check ability to swallow
Test CN XI( Spinal accessory)
• Shrug shoulder against resistance
• Turn head against resistance
• Test CN XII (Hypoglossal)
Motor and Cerebellar Systems
Ability to follow commands
Muscle tone
Muscle strength
Coordination (finger to nose test)
Gait & Balance (Romberg test)
Rapid alternating movements
Heel to shin test
Gaits

• Gait abnormalities. Left to right: hemiplegic gait, paraplegic gait, parkinsonian gait, steppage
gait, dystrophic gait. (From Springhouse. Handbook of Signs & Symptoms. 3rd ed. Ambler, PA:
Lippincott Williams & Wilkins; 2006.
Sensory system
Assess light touch, pain and temperature sensation
Test vibratory sensation
Test sensitivity to position
Tactile discrimination
Test point localization
Test graphesthesia
Test extinction
Reflexes
Deep tendon reflexes
Bicep reflex
Brachioradialis
Tricep
Patellar
Achilles
Ankle clonus
Superficial reflexes
• Plantar
Old Age Considerations
Decreased taste and scent sensation
Decrease in hearing, smell, taste and seeing ability
Intentional tremor
Reduced muscle mass from degeneration of muscle fibres
Head tremors (dyskinesia)
Slow uncertain gait
Romberg test and rapid movements difficult
Light touch and pain sensations decrease & vibratory sensation at ankles
Deep tendon reflexes intact, reaction time slow
Achilles reflex absent or difficult
Reference
• Janet R. Weber & Jane H. Kelly Health Assessment in Nursing, 8th
edition pg number 545-581

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