Assessment of the neurological system

CNS Central Nervous System- Brain and the spinal cord

PNS Peripheral Nervous System- cranial nerves, spinal nerves, autonomic nervous system (ANS) 

Brain: Cerebrum- ability to think/reason there are four lobes and to hemispheres (right and left hemisphere)

• - Parietal lobes: interpret pain
• - Occipital lobe: visual
• - Temporal lobe: teaching, comprehension
• - Frontal lobe: ability to reason and to know how to act. Good judgement personality

•     Weinicke area: written and spoken word
•     Broca area- being able to speak and write(aphasia)

• Basal Ganglia- automatic movement
• Thalmus- motor/sensory stimuli
• Hypothalamus- vital signs regulates your body temp, bp, piturary gland
• Limbic system- survival behavior

• Major motor and sensory pathway, coordinates voluntary
• movements, equilibrium

• Regulates heart rate, breathing and swallowing, coughing.
• Sensory/motor pathways to and from the cerebral cortex

• Primary pathway for messages to travel back and forth from
• the brain to the peripheral parts of the body. Sensory and motor pathways.

• - Spinal- sensory and motor
• - Cranial- comes directly from brain 12 pairs
• - ANS- involuntary function of cardiac and smooth muscle glands. Sympathetic/parasympathetic 

• 1.PP- changes in mental statues, headaches,
• difficulty in speaking, walking, tingling and numbness. Drooping eyelids

2. Hx of and head injuries, surgeries, siezures, did you lose consciousness? For how long

3. FHx- of any strokes, siezures, htn

• 4. Anyone at risk- dm circulation, high
• cholesterol- risk for stroke

• - mental statuses and speech
• - cranial nerves
• - sensory
• - motor
• - reflexes

• when you walk in the room does the pt respond to u saying his/her name. a change in this is an early indicator that something is
• going on with the pt;s neurological status.

Levels of Consciousness words to describe

• - Alert/wakefulness- responds to environment without delay
• - Confusion- disoriented (not sure who they are where they are), short attention span and not able to follow commands.
• - Drowisiness (lethargy)- responds with a lag
• before they answer
• - Stupor- unresponsive and you have to be physical in order to get their attention
• - Coma- unresponsive no matter what 

• Assessing Arousal/wakefulness
• Spontaneuous- walk in room and pt responds
• Normal voice
• Loud voice- yelling
• Tactile- touch
• Noxious – pain pinching nail bed

• -  Standard assessment tool for assessing levels of consciousness
• - Eye response, verbal and motor response
• - Each parameter is given a score
• - A score of less than 7 means u are in a coma

• Orientation to person, place, time- not knowing
• exact date is not important but knowing the season is good. Older patients need
• time to think about their responses. They maybe confused. 

• Appearance and behavior- are they dressed
• appropriately for the season- hygiene intact 

Communication- clear and articulate

• - Memory (recent/long term)- short term memory goes first
• - Attention span- can pt follow conversation
• - Ability calculate- can pt count by 2’s
• - Thought content- what pt is saying is logical and it makes sense able to follow
• - Abstract reasoning- pysch and children pt are more concrete thinkers- but are they able to understand concepts like the early
• bird catches the worm.
• - Judgement/insight- able to evaluate situations and make good judgments.
• - Emotional status- facial expressions match the situations

• Pupillary response- PERRLA size shape reactive
• to light. Consensual

• Abnormal movements- abn. Reflex posturing,
• involuntary movements

• 12 cranial nerves come from the brain
• known to be apart of the PNS
• Patient would need to be alert in order to do this
• assessment

• Olfactory- sense- smell- to test smell have pt close eyes
• and check each nostril with a different smell that people could recognize

Optic Nerve- Sense- to see

• Visual acuity (snellen chart 20ft in distance..have patient
• for this eye test with each eye). Peripheral vision- confortation. If not able
• to use snellen have the person read something and document how they read and if
• that had any devices aiding them.

• Oculomotor- motor
• Controls most eye movement, pupil response and eyelid
• function- test: having patient move eyes and eyelids. Use the pen light by
• using the consensual test

• Trochlear- motor
• Control eye movements downward and inward

Trigmental- sense/motor

• Touch forhead, cheek, and jaw with cotton ball and have pt
• close eyes and ask where they feel u touching (sense).  Jaw movement Chewing..have pt clench teeth to
• check muscle strength (motor).  Ophthalmic (corneal reflex), maxillary,
• mandibular. 

Abducens- motor

Controls lateral (side) movements of eye. H test to perform for all three nerves 3,4,6

Facial- sense/motor

• Facial expressions- muscles of face (motor). Taste on the
• anterior of the tongue 2/3 salt/sweet. (sense) abnormal would be drooping of
• the face

Acoustics- sense

• Controls hearing- whisper test, Weber test (head) and Rinne
• test ac>bc (turning fork)

Glosspharyngeal- sense/motor

• Controls pharyngeal and swallowing (motor). Taste on the
• posterior of the tongue (sense)

Vagus- sense/motor

Controls swallowing and speaking (motor)

• Controls sensations from the pharynx and carotids (palpate
• the carotids) (sense)

• Note if there is hoarseness in someone’s voice and if the
• person is unable to speak. If the person has uncontrolled drooling.

U can have person say, D N L T controls tongue movement

Accessory- motor

Head and neck movements

• Test with the shoulder shrug against resistance (testing
• strength). Also test by placing your hands on the person face and have them
• push against your hand…pushing against resistance. 0-5 below 3 is a disability

Hypoglossal- motor

• Involves tongue movement. Stick out tongue and move from
• side to side

• -  Screening
• - Testing the intactness of the peripheral nerve fibers, sensory tracts, and upper cortical discrimination
• - Pt need to be alert and oriented
• - Compares sensation on parts of the body
• - Try not to have a pattern

• - If u find a spot with alternative location find the border
• -Make sure to perform test with eye closed

DO THIS WITH THE PATIENTS EYE CLOSED

• DO THIS WITH THE PATIENTS EYE CLOSED
• 1. light touch- with cotton in random places
• 2. pain sensation- something a little sharp
• 3. temperature- something warm or cold
• 4. position and motion sense movement of
• extremities- put your fingers on the persons big toe. Ask where are u touching
• and move around big toe and ask pt what u are doing.
• 5. Stereognosis- placing a coin (a familiar object)
• in the patient’s hand and asking them to identify
• 6. Graphesthesia- drawing a number in someone’s hand and asking them to identify like the number three.
• 7. Vibration sense- placing the turning fork on a bony prominence and asking patient if they feel it.

• 8. Point localization- able to sense and locate
• area that is being stimulated- touch area and ask where did I touch you.
• 9. Sensory Extinction- simultaneously touching both sides at the same point. 

• 1. Gait, posture and balance
• - heel to toe (tandem) walking)
• - Romberg test- stand with feet together and eyes close (checking for balance)

• 2.  Muscle mass (size
• bulk)- atrophy/hypertrophy

• 3.  muscle tone
• (resistance to muscles to strenching)

• 4. Muscle strength (0-5)
• - pronator drift- standing with your hands out and eyes close…checking arms balance
• - hand grip
• - pushing against resistance
•   (testing for
• symmetry)

• 5.  Coordination
• - rapid alternatate movements with your hands (hand flapping
• back and forth)
• - point to point testing finger to
• finger test, heel to shin test

• - Evaluates the intactness of spinal cords and
• motor/sensory function
• - Pt must be relaxed in proper postion
• - Tendon is struck briskly
• - Reflexes are graded from 0-4 (2+ is normal)
• - Testing biceps reflex- put thumb on tendon and strucking it with the narrow part of the hammer
• - Testing triceps tendon- using narrow part struck the dented place near the elbow
• - Brachioradialis tendon- struck neat the radial pulse with the big part of the hammer- hand should move
• - Patellar reflex- big part- hyperactive thyroid might have a big kic
• - Achullies reflex- whole body moves
• - If unable to perform document as unable to elicit.
• - Abdominal reflex- side to center with q-tip.
• Abd. Should move.
• - Plantar response- Babinski reflex- test
• underneath foot- toes should remain erect or curl under. It if fans out that
• indicates neurological problem. Only infants fan out. 

• - Risk for ineffective cerebral tissue perfusion
• - Risk for injury- assisting to ambulate
• - Risk for aspirating – asssit with feeding
• - Impaired communication
• - Impaired physical mobility
• - confusion (acute/chronic)- administrated meds to help with confusion

• - Neuro assessments
• - Maintain safe environment- bed low, side rails padded, three rails up, airway, suction equipment at bedside
• - Administred anticonvulsants as ordered. Evaluate other meds the could increase seizure activity
• - If seizures occur then accurate documentation
• Pre seizure- Aura, during- icital, post- post ictial 

• - maintain safety- clear the path of anything that could hurt the pt
• - assess airway needs, seizure activity
• - notify md
• - administer anticonvulsants as ordered

• -      
• post seizure- VS including O2 stat, assess risk
• of injury provide emotional support and document