neurological assessment.ppt

8/17/2019 Neurological Assessment.ppt

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Copyright ©2012 by Pearson Education, Inc.

All rights reserved.

Health & Physical Assessment in Nursing, Second Edition

onita !A"ico # Colleen $arbarito

%eurological Assess"ent%eurological Assess"ent

&ecture '&ecture '

&ecture '&ecture '


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%ervous Syste"%ervous Syste"

Central Nervous System

•Brain

•Spinal cord

Peripheral Nervous System

•Cranial nerves

•Spinal nerves


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Central Nervous System-BrainCentral Nervous System-Brain


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Central Nervous System-Spinal CordCentral Nervous System-Spinal Cord


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Peripheral Nervous System-12 Pairs of Cranial NervesPeripheral Nervous System-12 Pairs of Cranial Nerves

• Originate in the brain

• Control many activities in

the body

• Tae impulses to and from

the brain


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Figure 24.4 Cranial nerves and their target regions. (Sensory nerves are sho)n in blue* "otor nerves, in red.+


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able

2-.1Cranial

Nerves


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Peripheral Nervous System-Spinal nervesPeripheral Nervous System-Spinal nerves

• 1 pairs o/ spinal nerves

' pairs o/ cervical nerves

12 pairs o/ thoracic nerves

pairs o/ lu"bar nerves

pairs o/ sacral nerves

1 pair o/ coccygeal nerves


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Dermatome: band

o/ sin innervated bythe sensory root o/ asingle spinal nerve

SP!N"# N$%&$SSP!N"# N$%&$S


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Co""on or Concerning Sy"pto"sCo""on or Concerning Sy"pto"s

o/ the %ervous Syste"o/ the %ervous Syste"• Observing mental status' speech' and language

• Observing sensorium' memory' abstract thining ability' speech' mood'

emotional state' perceptions' thought processes' ability to mae (udgments

•

)eadache• *i++iness or vertigo

• ,eaness

• Numbness

•

#oss of sensations• #oss of consciousness

• Sei+ures

• Tremors or involuntary movements


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Physical Assess"ent o/ thePhysical Assess"ent o/ the

%eurologic Syste"%eurologic Syste"

• Testing cranial nerves

• Testing otor function

• Testing Sensory function

• Testing %efle.es

/"l0ays consider left to right symmetry


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Areas o/ the %eurologic Syste" Areas o/ the %eurologic Syste"

Assess"ent Assess"ent

• esting cranial nerves

I

II

III

I3

3

3I

3II

3III

I4 4

4I

4II


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l. Olfactory: smelll. Olfactory: smell

• Client both eyes and one naris are closed

• Place a strong smelling item under each nostril

individually and as the person to identify it


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ll. Optic: visionll. Optic: vision

• &isual acuity

-*istance3Central vision4 Snellen eye chart

-Near vision /hand-held card

• $.amine the Optic 5undi by using the Ophthalmoscope


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• 3isual acuity

6 *istance3Central vision4 Snellen eye chart7

position patient 28 feet /9 meters from the

charto Patients should 0ear glasses if needed

o Test one eye at a time

Eyes echni5ues o/ E6a"inationEyes echni5ues o/ E6a"ination


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• 3isual acuity

6 Near vision4 use /:aeger or

%osenbaum chart /hand-held card

6 can also use to test visual acuity at

the bedside

6 hold 1; inches /about


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lll Oculomotor lll Oculomotor

l& Trochlear l& Trochlear

&l "bducens&l "bducens

• Test $.traocular ovements

• Test direct and consensual pupillary reaction to light

• "ccommodation


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# $.traocular movements3si. cardinal directions of ga+e30agon

0heel method

# The client must eep the head still 0hile follo0ing a pen that you 0ill move in several

directions to form a star in front of the client=s eyes

# "l0ays return the pen to the center before changing direction



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# Acco""odation An ob7ect held about 10 c" /ro" the client!s nose



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V. TrigeminalV. Trigeminal

• Bilaterally palpate temporal and masseter muscles0hile patient clenches teeth

• /Sensation "s client to closed his eyes and test

forehead' each chee' and (a0 on each side for sharpor dull /use a cotton s0ab sensation *irect the client

to say >no0= every time the cotton is felt

• /%efle. ,ith the individual?s eyes open and looing

up0ard' the practitioner taes a strand of cotton'

approaches the cornea from the side' and touches it

0ith the cotton This should initiate a blin response

Both eyes should be tested independently


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Vll. FacialVll. Facial

• "s the client to close both eyes and eep them closed Try to openthem by retracting the upper and lo0er lids simultaneously and

bilaterally

•

"s patient to raise eyebro0s' sho0 teeth' grimace' smile' puff bothchees /"ssess face for asymmetry' abnormal movements

• @se the s0eet' salty' sour and bitter items to test taste /Bet0een each

solution the mouth needs to be rinsed 0ith 0ater


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Vlll. AcousticVlll. Acoustic

• ,eber Test /by using a tuning for

• %inne test4 to compares air and bone

conduction

• %omberg test4 "s the patient to remain

still and close their eyes /for about 28

seconds


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Ears 8earing acuityEars 8earing acuity

6 Rinne

o Compare time of air vs bone conduction

o Place the base of the tuning for on the

client=s mastoid process- and note the

number of seconds

o Then move the for in front the e.ternal

auditory meatus /1-2 cm

Air and bone conduction (AC and BC)


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lA lossopharyngeallA lossopharyngeal

A &agusA &agus

• "s the client to open the mouth' depress theclient=s tongue 0ith the tongue blade' as the client

to say ah @sually' the soft palate raises and the

uvula remains in the midline

• Observe the individual s0allo0ing

• Test gag refle.' 0arning patient first


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#A #OSSOP)"%DN$"##A #OSSOP)"%DN$"#

A &"@SA &"@S

"s the client to open the mouth' depress the client=s tongue 0ith the tongue blade'as the client to say ah @sually' the soft palate raises and the uvula remains in

the midline


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All )ypoglossalAll )ypoglossal

• Ask patient to protrude tongue and move it sideto side. Assess for symmetry, atrophy.

A / th % l i S tA / th % l i S t


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• 9otor /unction

:bservation o/ gait and balance

Ad"inistration o/ the ;o"berg test

Ad"inistration o/ the /inger


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:bservation o/ gait and balance

As the client to )al across the roo" and return


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;o"berg!s test /or balance.

As the patient to re"ain still and close their eyes (/or about 20 seconds+.


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=inger


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:bservation o/ rapid alternating action "ove"ents


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• Sensory /unction

:bservation o/ light touch identi/ication

Sharp, dull deter"ination

Stereognosis

>raphesthesia (%u"ber identi/ication+


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esting the client!s ability to identi/y sharp sensations.


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• ;e/le6es /Stimulus-response activities of the body/

$iceps

riceps

$rachioradialsis

Patellar (nee+

Achilles

Plantar ($abinsi+.

Abdo"inal


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esting the biceps re/le6.


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esting the triceps re/le6.


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esting the brachioradialis re/le6.


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esting patellar (nee+ re/le6, client in a sitting position.


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esting the plantar re/le6 ($abinsi+.


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Abdo"inal re/le6 testing pattern.


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REFE!E": "CAE F#R $RAD%N$REFE!E": "CAE F#R $RAD%N$

;e/le6es are usually graded on a 0 to - scale

- 3ery bris, hyperactive, )ith clonus (rhyth"ic oscillationsbet)een /le6ion and e6tension+

$riser than average* possibly but not necessarily indicative o/disease

2 Average* nor"al

1 So"e)hat di"inished* lo) nor"al

0 %o response

Areas o/ the %eurologic Syste"Areas o/ the %eurologic Syste"


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