Neuro 2013 Rev MP

Learning Objectives
Neurological
Assessment
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Myung-Hee Pak, RN, MSN, CNS
Neurological Anatomy
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Neurons The Building Blocks of Our

Mental Computer
Nervous system- divided into 2 structural parts

Central Nervous System (CNS)- brain & spinal cord
Peripheral Nervous System cranial nerves (carry
impulses to and from brain) & spinal nerve (carry
messages to and from spinal cord
Nerve Conduction:
http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/
000089.htm
Parkinsons disease:
000095.htm
Neuro. Videos
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Identify the structures and functions of the Nervous

system
Discuss how the nurse focus and prioritize subjective /
objective data collection
- pt safety r/t metallic piercings or allergy
Identify normal and abnormal findings
Identify teaching opportunities for health promotion
and risk reduction r/t the neurological system
Demonstrate application of the knowledge: Think like
Nurse & Act like Nurse: Pulling it ALL together:
Reflection and critical thinking
Alzheimers Disease
000003.htm
Bladder Function neurological control:
000009.htm
Brain components:
000016.htm
Basic Anatomy
Impulses transmitted by:
Neurons- Basic structures for receiving
and sending signals.
Dendrites receive signals
Axons send signals
Synapse is space between axon and
dendrite.
Brain
Cerebrum
l Frontal
Cerebrum
Largest part of the brain, composed of 2
hemispheres and 4 lobes. Frontal, parietal,
temporal and occipital.
- Conceptualization, motor ability

and judgment, thought process, emotions.
l Parietal Interpretation of sensory
information, ability to recognize body parts.
l Temporal memory storage, integration of
auditory stimuli.
l Occipital Visual Center.
Cerebral Cortex
Components of the Central Nervous System
Cerebellum
lCerebellum[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
Keeps person oriented

in space, balance. Doesnt initiate
movement but coordinates it
lControls skeletal muscles
lControls voluntary movements
Pat Thomas, 2006.
Diencephalon
Area between cerebral hemispheres and
the brainstem it contains:
Thalamus relay station for the nervous
system, sorts out impulses and directs
them to the cerebral cortex
Hypothalamus maintains homeostasis
by controlling vital functions:
temperature, heart rate, BP, pituitary
regulator, emotions
Figure 8-14.
l Medial
View of the Right Cerebral

Hemisphere
Sensory Pathways
Motor Pathways
Pat Thomas, 2006.
Pat Thomas, 2006.
Brain Stem
stem central core of the brain,
contains midbrain, pons and medulla.
l Midbrain- contains many neurons and
tracts
l Pons Controls rhythmicity of respiration,
contains motor and sensory pathways.
l Medulla Cardiac, respiratory, vasomotor
control. Swallow, gag and cough reflex.
Motor and sensory fibers cross here.
l Spinal Cord continues with the brain
stem.
Cerebral Circulation
l Brain
Originates from carotid and vertebral arteries.
Blood Brain Barrier: Prevents diffusion of toxic

substances and large molecules.
Cerebrospinal fluid: Contains: no RBCs, few

WBCs, Glucose 45-75mg/dl, Protein 15-45 mg/dl.
Functional Divisions
Neuro. Videos
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Stroke (CVA)
http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000123.htm
Cerebral aneurysm:
Concussion:
000034.htm
Pain:
000054.htm
Coverings of the Brain &

Spinal cord
lMeninges:
3 layers tissue
Dura mater
Arachnoid layer
Pia mater
Spaces:
Epidural
Subdural
Subarahnoid
l Functional
divisions of Nervous System:

Nervous System: Brain and spinal
cord, receives and conducts stimuli.
l Autonomic Nervous System: Regulates
autonomic body functions, ex. Heart rate.
l Central
Sympathetic- maintains homeostasis and
defense against stressors. Fight/flight
Parasympathetic- Restorative and vegetative
functions; Decrease heart rate, dilates blood

vessels constricts pupils. S= Stress and P=
Peace.
Neurological Assessment
Subjective
l Headaches
Mental Status Assessment

lLevel
of Consciousness (LOC): alert,

somnolent, stuporous, comatose.
lOrientation: person, place, time =
A&O x 3.
lMemory:
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Immediate, recent and remote
l Paresthesia
(burning/
numbness/tingling)
injury
l Syncope (faint) l Dysphagia (difficulty
swallowing)
l Dizziness
l Dysphasia (difficulty
l Vertigo (rotational
speaking
spinning)
l Significant past Hx
l Seizures
l Environmental/occupational
l Tremors
hazards
l Head
Cognitive Assessment
Thought process
l Calculations
l Current events
l Response to proverbs
l Judgment & problem solving ability
l Communication abilities
l Emotion- Mood and affect
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Cranial Nerve Assessment

Cranial nerves 12 pairs, motor, sensory, mixed
function.
l CN 1 Olfactory (sensory) smell.
l http://www.nlm.nih.gov/medlineplus/ency/
anatomyvideos/000117.htm
l CN 2 Optic (sensory) sight.
l CN 3 Oculomotor (motor) eye movements
l CN 4 Trochlear (motor) eye movements
l CN 5 Trigeminal (motor & sensory) chewing
and pain sensations of face.
l CN 6 Abducens (motor) eye movements
Figure 8-26.
Trigeminal Nerve V
l : sensory function
l -Corneal Reflex Test
l Facial Nerve VII
: motor function
- Eye Blinking
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Trigeminal Nerve
: Motor Test
8-27.
l Six
Cardinal Positions of Gaze
Trigeminal Nerve V
: sensory function
- Cotton ball light touch
& Sharp and dull test on Face
Figure 8-28.
l PERRLA
Figure 8-29.
Figure 8-31.
Cranial Nerve Assessment

CN 7 Facial (motor) facial expressions
Facial (sensory) - taste
l CN 8 Vestibulocochlear (acoustic) hearing
l CN 9 Glassopharyngeal swallowing
l http://www.nlm.nih.gov/medlineplus/ency/
anatomyvideos/000126.htm
l CN10 Vagus swallowing, gag
l CN11 Spinal Accessory trapezius,
sternomastoid muscles
l CN 12 Hypoglossal motor tongue.
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l Pupil
Accommodation
Figure 8-33.
Figure 8-34.
Figure 8-35.
Motor Function Assessment

l Motor
function- Test motor strength and

compare bilaterally. Assess ROM against
resistance.
l Scale used:
5 = Full ROM full resistance
4 = Full ROM some resistance
3 = Full AROM
2 = Full PROM
1 = trace movement, flicker finger.
Figure 8-37.
Muscle Tone Assessment

l Muscle
Tone- ranges from flaccid to taut

- no muscle tone, no resistance
l Hypotonia-slight muscle tone, little
resistance
l Hypertonia- too much resistance
l Spasticity- stiff, awkward movements
l Rigidity- tightness, inability to bend
l Involuntary movements- tics,
fasciculations (fine tremors) and tremors
(resting or intentional).
l Atonia
Sensory Assessment
l Sensory
Function:Perform all sensory

testing with the patients eyes closed and
test bilaterally.
l Spinothalamic
tract- pain, temp. touch
l Posterior
(Dorsal) Columns position

(proprioception), vibration and tactile
discrimination (fine touch)
Sensory Assessment
l Vibration
tuning fork to bony

prominence
l Position (kinesthesia) Grasp toe or
finger and move it up/down or side/
side.
l Stereognosis place object in hand to
identify (coin, paperclip).
l Graphesthesia trace letter or number
on palm to identify.
Figure 8-41.
Figure 8-42.
l Pain
Perception (Sharp and Dull) Test
Figure 8-43.
Figure 8-44.
Cerebellar Function
Assessment
Figure 8-46.
l Evaluation
of Gait
l Posture
and gait steady gait with arm

swing, balance maintained.
l Romberg test Have pt. stand, feet
together, arms side, eyes closed.
l Finger to nose test Eyes closed touch his
finger to nose. Have pt. touch his fingertip
to your fingertip, alter position.
Figure 8-47.
Figure 8-48.
l Finger-to-Nose
Test
Cerebellar Assessment
Figure 8-50.
l Hand
movements- Tap finger to

thumb, rapidly. Tap each finger to
thumb rapidly.
l Pronate
and supinate hands rapidly.
l Feet
movements Tap toes rapidly,

stand on one foot, hop on one foot,
walk on heels, then toes, run heel down
opposite shin.
Rapid Alternating Movement
Figure 8-51.
l Diadochokinesia
Test
Figure 8-53.
Deep Tendon Reflexes

Assessment
l Deep
tendon reflexes- Have pt. in relaxed

position, with joint supported.
l DTR compare L to R
l Short blow with reflex hammer to the
muscles insertion tendon (wrist action)
l Reinforcement Have pt. contract muscles
not being tested this aids in relaxing
muscles to be tested
Reflex Arc
DTR Assessment
l Scale
0 - 4+
= absent,
l 1+ = diminished
l 2+ = average
l 3+ = brisk
l 4+ = hyperactive,
clonus.
l 0
DTR Assessment
Figure 8-57.
l Deep
Tendon Reflexes (DTR)

Forearm flexes at elbow.
l Triceps Forearm extends at elbow.
l Brachioradialis Slight flexion of forearm
at elbow and forearm pronation.
l Patella leg extends at knee.
l Achilles Plantar flexion.
l Biceps
Figure 8-59.
Figure 8-60.
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Figure 8-61.
Figure 8-62.
l Alternate
Method for Performing Triceps

Reflex Test
Figure 8-63.
Figure 8-64.
Superficial Cutaneous
Reflex Assessment
Figure 8-66.
l Abdominal
- Umbilicus shifts toward
stimulus.
l Cremasteric
Testicle on same side of

stimulation rises.
l Babisnki
(Plantar) Toes flex.
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Figure 8-67.
Glasgow Coma Scale

p.663
Using the Glasgow Coma Scale

Every brain injury is dierent, but generally, brain
injury is classied as:
Severe: GCS 3-8 (You cannot score lower than a 3.)
Moderate: GCS 9-12
Mild: GCS 13-15
http://www.youtube.com/watch?v=FihnmEx6Rqk
Summary
l Neurological
assessment includes:
l Mental
status
assessment
l Cranial nerves
l Motor Functions & Muscle tone
l Sensory Function
l Cerebellar Function
l DTR & superficial cutaneous reflexes
l Glasgow Coma Scale
l Cognitive
12

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Learning Objectives

Myung-Hee Pak, RN, MSN, CNS

Neurons The Building Blocks of Our

Nervous system- divided into 2 structural parts

Identify the structures and functions of the Nervous

- Conceptualization, motor ability

Components of the Central Nervous System

Keeps person oriented

Pat Thomas, 2006.

View of the Right Cerebral

Pat Thomas, 2006.

Pat Thomas, 2006.

Originates from carotid and vertebral arteries.

Blood Brain Barrier: Prevents diffusion of toxic

Cerebrospinal fluid: Contains: no RBCs, few

Coverings of the Brain &

divisions of Nervous System:

Sympathetic- maintains homeostasis and

defense against stressors. Fight/flight

Parasympathetic- Restorative and vegetative

functions; Decrease heart rate, dilates blood

Mental Status Assessment

of Consciousness (LOC): alert,

Immediate, recent and remote

Cranial Nerve Assessment

Cardinal Positions of Gaze

Cranial Nerve Assessment

Motor Function Assessment

function- Test motor strength and

Muscle Tone Assessment

Tone- ranges from flaccid to taut

Function:Perform all sensory

tract- pain, temp. touch

(Dorsal) Columns position

tuning fork to bony

Perception (Sharp and Dull) Test

and gait steady gait with arm

movements- Tap finger to

and supinate hands rapidly.

movements Tap toes rapidly,

Rapid Alternating Movement

Deep Tendon Reflexes

tendon reflexes- Have pt. in relaxed

Tendon Reflexes (DTR)

Method for Performing Triceps

- Umbilicus shifts toward

Testicle on same side of

(Plantar) Toes flex.

Glasgow Coma Scale

Using the Glasgow Coma Scale

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