Neurological Assessment

Objective One

Assess the components of the basic neurological

assessment

The brain is highly dependent on blood flow and a consistent supply of oxygen and glucose to maintain neuronal function. Any decrease can cause neuronal malfunction. Older adults tend to be vulnerable to cognitive dysfunction secondary to many causes, ranging from decreased blood pressure to infections. Thus, any acute change in cognitive functioning needs to be assessed for an underlying cause.

Neurological SystemFunctions through transmission of chemical and

electrical signals between the body and the brain

Receives, processes, and sends out informationControls and coordinates the functioning of all

other systems in response to environment/surroundings

Involves cognition, emotion, memory, sensation and perception, and regulation of homeostasis

Comprised of the central nervous system (CNS) and the peripheral nervous system (PNS)CNS = Brain and spinal cordPNS = Cranial and spinal nerves

Two neurons with synapse (from MyNursingLab)

The PNS• includes nerves emerging from the brain (cranial

nerves) and nerves emerging from the spinal cord (spinal nerves).

• These nerves are divided into sensory nerves that conduct messages from various parts of the body to the CNS, whilst motor nerves conduct impulses from the CNS to muscles and glands.

• is further divided into the Somatic System (SNS) and Autonomic System (ANS), depending on the area of the body these messages are transmitted to and from.

The SNS• consists of sensory neurons from the head, body wall,

extremities, and motor neurons to skeletal muscle.• The motor responses are under conscious control and

therefore the SNS is voluntary.• Certain peripheral nerves perform specialized functions and

form the autonomic nervous system; they control various activities that occur automatically or involuntarily such as the contraction of smooth muscle in the walls of the digestive system.– The autonomic system is further divided into the

sympathetic and parasympathetic systems. These two systems provide nerve stimuli to the same organs throughout the body, but bring about different effects.• The balance between these two systems is

controlled to create a state of homeostasis that is where the internal stability of the bodily systems are maintained in response to the external environment

Parasympathetic Nervous System

• slows down the body• helps prepare for a more relaxed state, ready

for digestion and sleep. • It will therefore increase peristalsis of the

alimentary canal, slow down the heart rate, and constrict the bronchioles in the lungs.

.

The Sympathetic Nervous System

• helps prepare the body for "fight or flight" and create conditions in the tissues for physical activity.

• is stimulated by strong emotions such as anger and excitement and will therefore speed up heart rate, increase the activity of sweat glands, adrenal glands, and decrease those of the digestive system.

• also produces rapid redistribution of blood between the skin and skeletal muscles.

Brain and spinal cord (from MyNursingLab)

Age-Related ConsiderationsBirth reflexes include rooting, sucking,

palmar grasp, tonic neck reflex, and MoroDisappear during infancyMay return w/stroke or trauma

Denver Developmental Screening Test II (DDST) used to screen young children

Neurons decrease over lifetime, resulting in slowed reaction time, problem-solving skills, and voluntary movementDecreases in intelligence and memory not normal

in the elderly, and indicate a neurological deficit Medication effects, dehydration, Alzheimer’s dementia,

etc

Cerebral FunctionLevel of consciousness (LOC)

Arousal (alert, lethargic, stuporous, comatose) Verbal stimuli Tactile stimuli Painful stimuli

Orientation (person, place, time)Mental status and cognitive function

Behavior, appearance, response to external stimuli, speech, recent and remote memory, communication, judgment

Posture, gait, motor movements, dress, hygiene/grooming, mood, affect, facial expression

Consider language/education/culture during neuro exam

Glasgow Coma Scale

Objective Two

Demonstrate the proper technique for the assessment of

reflex activity

18

Reflex FunctionDeep tendon reflex is tested with a rubber

percussion hammer to tap a slightly stretched muscleNormal response = muscle contractionResponse grading scale:

0 = No response detected +1 = Diminished response +2 = Response normal +3 = Response somewhat stronger than normal +4 = Response hyperactive with clonus

Clonus refers to involuntary continuous contractions of a muscle or group of muscles

Superficial reflexes are tested by lightly touching the body with the base of a reflex hammer or tongue blade, beginning with the most peripheral part of the limbGraded as positive or negativeDetermine sensory loss area by testing every 1-2

inches

Testing ReflexesBicepsReflex

Rest client’s elbow in nondominant hand with thumb over biceps tendon; strike percussion hammer to own thumb

TricepsReflex

Abduct client’s arm at the shoulder, flexing at the elbow; support upper arm with nondominant hand, letting forearm hang loosely; strike the triceps tendon 2 inches above the olecranon process

BrachioradialisReflex

Rest client’s arm on his leg; strike with percussion hammer 1-2 inches above bony prominence of the wrist on the thumb side

PatellarReflex

Position client in seated position with legs dangling; strike the tendon directly below the patella with a percussion hammer

AchillesReflex

Position client in the supine or seated position with legs dangling; hold client’s foot slightly dorsiflexed; strike the Achilles tendon about 2 inches above the heel with the percussion hammer

PlantarSuperficialReflex

Stroke the sole of the client’s foot in an arc from the lateral heel to medially across the ball of the foothttp://www.youtube.com/watch?v=kOq5Np0eZ6A&feature=related

Deep Tendon Reflexes:http://www.youtube.com/watch?v=fymDY2q0FtE&feature=related

Objective Three

Demonstrate the assessment

techniques employed in the assessment of

cranial nerves

Dorsal aspect of brain w/cranial nerves (from MyNursingLab)

Cranial Nerves

Checking Cranial NervesCN I Identify the smell of common substances

CN II Test visual acuity and visual fields

CN III, IV, & VI

Test extraocular movement by having client move eyes through the 6 cardinal fields of gaze with head held steady; test papillary reaction to light and accommodationhttp://www.youtube.com/watch?v=YntJiBCz3pA&feature=related

CN V - Motor function

Move jaw from side to side, clenching jaw, and biting down on a tongue blade

CN V - Sensory function

Have client close eyes and identify when he is being touched on the forehead, cheeks, and chin; test corneal reflex by puffing air over the cornea

CN VII - Motor function

Have client make faces (smile, frown, whistle)

CN VII - Taste

Test taste on anterior portion of tongue by placing something sweet, salty, or sour on the tip of the client’s tongue

CN VIII Test client’s hearing using wristwatch; test air/bone conduction using Weber & Rinne test; test for balance using Romberg testhttp://video.google.com/videoplay?docid=1911735836954444981#http://www.youtube.com/watch?v=4hOSkmDYAR4&NR=1

Checking Cranial NervesCN IX & X - Motor function

Observe client’s ability to talk, swallow, and cough; have client say “ahhh” while depressing tongue with tongue blade and observing rise of soft palate and uvula

CN IX & X - Sensory function

Induce client’s gag reflex (do NOT perform in lab practice)

CN IX & X - Taste

Test taste on posterior portion of tongue by placing something sweet, salty, or sour at the back of the client’s tongue

CN XI Place hands on client’s shoulders, and have him shrug shoulders against resistance; have client turn head from side to side against resistance

CN XII Have client say “d”, “l”, “n”, “t”; have client protrude tongue and move it from side to side

Neuro examPart 1 http://www.youtube.com/watch?

v=nABAdENIbXY&feature=related Part 2 http://www.youtube.com/watch?

v=_1Rd1wVeqU4&feature=related

Objective Four

Demonstrate the complete assessment

of the neurological system

(*Lab Practice)