Neurologic Assessment
Unit 9

Neuro system controls cognitive and voluntary behavioral processes and subconscious and involuntary bodily functions

Neurologic Assessment

Neurologic Exam

Organized into 6 major areas:

  1. Mental Status
  2. Cranial Nerves
  3. Sensory System
  4. Motor System
  5. Cerebellar
  6. Reflexes

Neurologic Exam

Anatomy & Physiology Nervous System

Central

Brain

  • cerebrum
  • cerbellum
  • brainstem

Spinal Cord

Peripheral

spinal nerves
cranial nerves

Central Nervous System

Cerebrum

mental status
highest mental function
largest
sensory and motor function
memory

CN 1 (Olfactory)

Frontal lobe
Parietal
Occipital
Temporal

Cerebellum

balance, equilibrium, coordination, posture,
role in muscle tone
role in voluntary muscular activities

 

Brainstem controls subconscious and reflex activity

all afferent/efferent tracks
spinal cord to brain
cranial nerves
(all except olfactory)

Peripheral Nervous System

Spinal nerves - 31 pair

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

Each has afferent and efferent component
Area of skin supplied by a single peripheral/spinal nerve is called a
                DERMATOME

Cranial nerves - 12 pair

some sensory
some
motor
some
both

SensorySystem

Motor System

Cerebrum

cerebral cortex has important role in motor function
but if damage to

Cerebellum

movement becomes uncontrolled, uncoordinated

Reflexes

Need intact spinal cord function
intact reflex arc

Developmental Considerations

Infants Children Pregnancy Older adults Elderly

Neurologic Assessment

Is CC related to neuro function?

History

changes in balance, coordination - Falls ?

Family History

Neurologic Exam

Organized into 6 major areas:

  1. Mental Status
  2. Cranial Nerves
  3. Sensory System
  4. Motor System
  5. Cerebellar
  6. Reflexes

1. Mental Status

  • general appearance and movement
    • posture
    • gait, movement
    • dress, hygiene
    • facial expression, speech
  • mood
    • appropriate, labile
  • thought process
    • logical, realistic
    • follows directions
  • Cognition
    • level of consciousness
    • memory
    • abstract reasoning
    • judgment
    • perception, coordination
  • Cognition
    • level of consciousness describes orientation

" level of arousability:
alert
lethargic

stuporous

semicomatose
comatose

"AAO X 3"

Glasgow Coma Scale (see syllabus pg. )

Best eye-opening response

purposeful/spontaneous 4
to voice 3
to pain 2
no response 1

Best verbal response

oriented 5
disoriented 4
inappropriate words 3
incomprehensible words 2
no response 1

Best motor response

obeys commands 6
localizes pain 5
withdraws to pain 4
flexion/extension to pain 3/2
no response 1

  • Cognition
    • memory - recent, remote
    • abstract reasoning - proverbs

serial 7s, 3s

cultural considerations

    • judgment
    • perception, coordination
    • children < 6 - DDST
      • gross and fine motor
      • language skills
      • social skills

 

  • Mental status tests
  • Mini-mental screening- Bates p 120
  • Glasgow coma scale- p
  • Standardized tests

2. Cranial nerves

Cranial Nerve VII - Facial
        Motor component
                6 facial movements:
Cranial Nerve VII - Acoustic

Done with assessment of ears
Can be done during neuro exam

Cranial Nerve IX- X

Glassopharyngeal & Vagus

Cranial Nerve XI - Spinal Accessory
Cranial Nerve XII - Hypoglossal

3. Sensory System

  • Testing ability to localize sensations
  • Compare bilaterally
  • Stimuli should be random but symmetrical
  • Test proximal or distal first ?
  • Testing ability to localize sensations
  • Compare bilaterally
  • Test proximal or distal first ?
  • Identify

light touch, sharp, dull pain, vibration, tactile discrimination,
       
2-point
        object (stereognosis)
        number (graphesthesia)
position sense

4. Motor System

5. Proprioception and Cerebellar Function

Assess coordination of upper and lower extremities

6. Reflexes

Testing intact reflex arcs
Useful to determine level of spinal cord lesions

Deep tendon reflexes (intact reflex arc)

    • biceps, triceps, brachioradialis, patellar, Achilles
    • test with reflex hammer
    • looking for symmetry
    • may need to use reinforcement prn
    • Grade 0 - 4

0 = no response
+1 = below normal, slightly diminished
+2 = average
+3 = more brisk than normal
+4 = very intense (clonus)

    • document on stick figure

Neonatal Reflexes (< 1 year)

Pathological Reflexes (> 1 year)


Nursing Diagnoses

Neuro exam/ frequent neuro check

Teaching Opportunities

  • Neuro symptoms to look for after trauma
  • Intervention with seizures
  • Medications
  • Coping with neurologic problem
  • Prevention- use of safety items