neurological system

• Neurologic Assessment


  • Review structure and function of neurologic system
  • Identify the equipment for neurological examination
  • Perform the assessment of the nervous system using the nursing process
• Neurologic system


  Responsible for coordinating and regulating all body functions
• Structural components of the neurologic system


  • CNS
  • PNS
• Central Nervous System (CNS)


  • Brain
  • Spinal cord
  • Meninges
• Components of the brain


  • Cerebrum
  • Diencephalon
  • Brain stem
  • Cerebellum

  
• Spinal Cord


  Part of the CNS
• Peripheral Nervous System (PNS)


  • Cranial nerves
  • Spinal nerves
  • Autonomic Nervous System
• Areas evaluated in a complete neurological assessment


  • Mental status exam
  • Cranial nerve evaluation
  • Motor and cerebellar system assessment
  • Sensory system examination
  • Reflexes

  
• Neurological assessment procedures


  • Neuro check
  • Level of consciousness
  • Pupillary check
  • Movement and strength of extremities
  • Sensation in extremities
  • Vital signs
• Equipment for neurological examination


  • Gloves
  • Pencil and paper
  • Cotton tipped applicator
  • Newsprint
  • Ophthalmoscope
  • Paper clip
  • Penlight
  • Snellen chart
  • Sterile cotton ball
  • Substance to smell or taste
  • Tongue depressor
  • Tuning fork
  • Tape measure
  • Objects to feel
  • Test tubes with hot and cold water
  • Percussion hammer
• Level of consciousness


  The single most valuable indicator of neurological function
• Levels of consciousness


  • Alert
  • Lethargic
  • Obtunded
  • Stupor
  • Coma
• Glasgow Coma Scale (GCS)


  A simple means of assessing level of consciousness, with a score of 15 indicating optimal level
• Things to observe as the patient enters the room


  • Posture and motor behavior
  • Dress, grooming, and personal hygiene
  • Facial expression
  • Speech manner, mood, and relation to persons and things around him
• Affect/mood


  Observe the patient's mood and emotional expressions, noting any disturbances
• Cognitive abilities to observe


  • Orientation
  • Concentration
  • Recent memory
  • Remote memory
  • Use of memory to learn new information
  • Abstract reasoning
  • Judgement
  • Visual perceptual and constructional ability
• Testing Cranial Nerve I (Olfactory)


  Close eyes, occlude one nostril, identify substance placed under open nostril
• Testing Cranial Nerve II (Optic)


  Use Snellen chart, assess visual fields, use ophthalmoscope to view retina and optic disc
• Testing Cranial Nerves III, IV, VI (Oculomotor, Trochlear, Abducens)


  Inspect eyelid margins, assess extraocular movements, assess pupillary response
• Testing Cranial Nerve V (Trigeminal)


  1. Assess sensory component by touching forehead, cheek, and jaw with cotton

  2. Assess motor component by having patient clench teeth and palpating temporal and masseter muscles

  
• Testing Cranial Nerve VII (Facial)


  Observe face for symmetry at rest and with facial expressions, test muscle strength by attempting to open eyes

  
• Testing Cranial Nerve VIII (Acoustic/Vestibulocochlear)

  Test hearing ability
• Testing Cranial Nerves IX (Glossopharyngeal) and X (Vagus)


  Assess palatal-uvula positioning, stimulate pharynx to elicit gag reflex
• Testing Cranial Nerve XI (Spinal Accessory)


  Observe shoulder shrug and head turn

  
• Testing Cranial Nerve XII (Hypoglossal)


  Observe tongue protrusion and movements
• Cerebellum


  Controls skeletal muscles and coordinates voluntary muscular movement
• Cerebellar function tests


  • Finger to finger test
  • Finger to nose test
  • Tandem walking
  • Rapid alternating movements
  • Heel-to-shin test
• Romberg test


  Stand with feet together and arms at sides, close eyes and maintain position for 10 seconds
• Sensory system assessment


  Assess light touch, pain, temperature, vibratory, and position sensation
• Sensory assessment techniques


  • Use cotton for light touch
  • Use blunt and sharp objects for pain
  • Use tuning fork for vibration
  • Test joint position sense
• Tactile discrimination


  Test for sterognosis, point localization, graphesthesia, two-point discrimination, extinction
• Kinesthesia


  Awareness of position and sense of joint movement
• Stereognosis


  Ability to identify an object placed in the hand with eyes closed
• Graphesthesia


  Ability to perceive writing on the skin
• Topognosis


  Ability to identify an area of the body that has been touched
• Reflexes assessed


  • Deep tendon reflexes (biceps, brachioradialis, triceps, patellar, Achilles)
  • Plantar (Babinski) reflex
  • Abdominal reflex
  • Cremasteric reflex
• Areflexia


  Absence of reflex
• Hyperreflexia


  A response far larger than considered normal
• Babinski reflex may be absent in adults without pathology or overridden by voluntary control
• Testing for meningeal irritation/inflammation


  Assess Kernig's sign (inability to straighten leg when hip is flexed to 90 degrees)