NEUROLOGICAL EXAMINAITION, BSN LEVEL 3 LESSON

NEUROLOGICAL EXAMINAITION, BSN LEVEL 3 LESSON

3. The cranial nerves are a set of 12 paired
nerves in the back of your brain. Cranial
nerves send electrical signals between your
brain, face, neck and torso. Your nerves
help you taste, smell, head and feel
sensations. They also help you make facial
expressions, blink your eyes and move your
tongue.

5. SMELL

6. With the , a patient
should be able to identify
common, familiar and non-
irritating odors
coffee
soap
flowers
fresh orange / kalamansi
camphor (Vicks)

7. such as alcohol, ammonia,
perfume, etc.
this will stimulate pain
rather than olfaction
which tests CN V rather
than CN I

8. CN I (OLFACTORY)
N: Identify scent in each
nostril
Abn: Neurogenic
Anosmia

9. VISION
Visual acuity
Snellen’s chart*
Visual fields
Confrontational test*

10. VISUAL ACUITY
have the patient read a
Snellen’s eye chart from a
distance of
patient covers one eye at a
time and reads to smallest
line possible

11. VISUAL ACUITY
if Snellen’s chart is
unavailable:
let the
from
his face
one eye at a time
let the patient wear
eyeglasses

13. RAISES UPPER LID
CONSTRICTS PUPIL

14. Check pupillary responses by
on one
pupil
both pupils should constrict
do the same for the other eye

16. Ptosis

17. EXTRA-OCULAR MOVEMENTS
Motor to extrinsic eye
muscles

19. have the patient hold his head
steady while you move your
finger about 1 foot from his
nose
forming a large capital-H
watch both of his eyes
move

20. If one eye appears to have the
inability to track the motion of
the object
cover the eye that was able
to track the motion
repeat the procedure

21. Abn: Nystagmus – cerebellar
disorders
limited eye movement –
increased ICP
paralytic strabismus -

25. SENSORY TO FACE AND TEETH
pain
touch
MOVEMENT OF MUSCLES OF MASTICATION
temporal muscles
masseter muscles

26. palpate the Masseter
instruct the patient to bite
down hard
next, ask the patient to
against resistance
applied by the instructor

27. Corneal Reflex
use a large Q-tip with the
cotton extended into a wisp
ask the patient to look at a
distant object then
approaching laterally,

28. look for the eye to blink
Repeat this on the other eye

30. MOVEMENT OF THE MUSCLES OF FACIAL EXPRESSION

31. Initially, inspect the face during conversation and rest
including:
drooping
sagging
smoothing of normal facial creases

32. Next, ask the patient to:
raise their eyebrows
smile showing their teeth
frown
puff out both cheeks
close both eyes tightly

35. When you wisp a piece of cotton on
your patient’s eyes, you are assessing
for the function of
A.CN III
B.CN IV
C.CN V
D.CN VI

36. HEARING*
BALANCE

37. Equilibrium can be tested using
the :
have the patient stand erect
with his feet close together
and his eyes closed
he might sway slightly, but
should not fall
stay close to the patient
in case he does begin to
fall

39. Taste and Touch at the back of the tongue
Movement of Pharyngeal muscles

40. Sensory to Pharynx, larynx, and viscera
Movement of palate, pharynx, and larynx

41. Ask the patient to and note any difficulty doing so
Next, note the quality and sound of the patient's

42. Ask the patient to open their
mouth wide, protrude tongue,
and
while the patient is
performing this task, flash
your penlight into the
patient's mouth
observe the soft palate,
uvula and pharynx for
symmetry

43. Next tell the patient you're
going to test his
use a tongue depressor or
the butt of a long Q-tip
perform this test by
touching the pharynx on
both the left and right sides,
observing the normal gag or
cough

45. Motor to:
Neck muscles
Upper back muscles

46. Place your hands on the
patients shoulders
Have him
upward while you exert slight
resistance
the strength and contraction
should be symmetrical

47. Next, place one hand on the
side of the and
the other on the opposite SCM
muscle
Have the patient turn his head
towards the hand on his jaw
while you apply slight
resistance

48. have the patient
and move it side
to side
normally, the tongue will be
protruded from the mouth and
remain midline

49. Note:
deviations of the tongue
from midline
a complete lack of ability to
protrude the tongue
tongue atrophy
fasciculation on the tongue

54. The Glasgow Coma Scale (GCS) is a neurological
scale used to assess a person’s level of
consciousness after a brain injury. It is commonly
used in emergency and intensive care settings to
evaluate the severity of brain injury based on eye
response, verbal response and motor response.

56. Obeys commands 6
Localizes pain 5
Withdraws to pain 4
Flexion to pain (Decorticate) 3
Extension to pain (Decerebrate) 2
None 1

59. Oriented 5
Confused 4
Inappropriate (Random speech) 3
Incomprehensible (Moaning) 2
None 1

60. Spontaneous 4
To speech 3
To pain 2
None 1

61. interpretation:
Severe brain injury GCS = 3 to 8
Moderate brain injuryGCS = 9 to 12
Minor brain injury GCS ≥ 13

62. N: score of 14-15 indicates optimal LOC
Abn: less than 14 – some impairment
less than 10 – emergency attention
less than 7 - coma
3 – deep coma

63. definition of terms (levels of consciousness):

64. normal; oriented

65. disoriented; impaired thinking and responses
people who do not respond quickly with information about their
name, location, and the time
caused by sleep deprivation, malnutrition, allergies,
environmental pollution, drugs, and infection

66. disoriented; restlessness, hallucinations, sometimes delusions
person may be restless or agitated
exhibit a marked deficit in attention

67. sleepy
shows excessive drowsiness
responds to stimuli only with incoherent mumbles or
disorganized movements

68. decreased alertness; slowed psychomotor responses
has a decreased interest in their surroundings, slowed
responses, and sleepiness

69. sleep-like state (not unconscious); little/no spontaneous activity
only respond by grimacing or drawing away from painful stimuli

70. cannot be aroused
noresponse to stimuli
have no corneal or gag reflex
may have no pupillary response to light

71. Using the Glascow coma scale, a patient is
given a score of 5. This is interpreted as
A.Deep coma
B.Some impairment
C.Coma
D.Emergency attention

72. Upon determining Mr. X’s level of
consciousness utilizing the Glasgow
coma scale, he flexes to pain, produces
incomprehensible words, and opens eyes
spontaneously, his score is
A.13
B.9
C.7
D.8

75. The deep tendon reflex is sometimes called the
stretch reflex or myotatic reflex because of the
stretch action and the muscle response
involved. Some authors argue that they are not
the same reflex. They believe the tendon reflex
occurs after the tendon's active stretching
when it is tapped with the hammer.

76. automatic / involuntary reaction in response to a stimulus
does NOT require conscious thought
does NOT reach higher brain centers

77. *use neuro hammer on your own fingers
to minimize trauma to the patient
to give the nurse better control

78. KNEE-JERK REFLEX /
PATELLAR REFLEX
muscles contract in
response to stretching force
applied to it

79. KNEE-JERK REFLEX /
PATELLAR REFLEX
If (–) or exaggerated
Brain or SC defect
muscle stretch
muscle contraction

80. 5+: sustained clonus
4+: non-sustained clonus (repetitive vibratory movements)
3+: brisk
1+: trace, or seen only with reinforcement
0 : absent reflex

81. Biceps Reflex

82. Brachioradialis reflex

83. Triceps reflex

84. Patellar Reflex

85. Achilles Reflex

88. Plantar Reflex
N: Flexion of toes
Abn: Fanning/Babinski

89. Abdominal Reflex
N: Contraction
Abn: no response
May be absent in obese
clients and pregnant

90. Cremasteric Reflex

92. Which among these reflexes does not
belong to the classification of
superficial reflexes?
A.Plantar reflex
B.Patellar reflex
C.Cremasteric reflex
D.Abdominal reflex

94. Grade:
5/5: normal strength
4/5: movement possible against some resistance by the
examiner
3/5: movement possible against gravity, but not against
resistance by the examiner

95. Grade:
2/5: movement possible, but not against gravity
1/5: muscle flicker, but no movement
0/5: no contraction