wardcne-170525141027.pdf cardiovascular system cardiovascular system

cardiovascular system

1. SreedeviMenon
Staff Nurse
FNSW
1
NEUROLOGICAL ASSESSMENT

2. Contents
2
Introduction
Objectives
Neurologic Examination
Cranial Nerve Examination
Motor System Assessment
Age Related Changes in the
Neurological System
Conclusion

3. Objectives
3
At the end of this lecture participates will be able to:
Define neurological assessment.
Identify the purpose of performing the neurological
examination.
List the main five components of neurological
assessment.
Outline what to assess in mental status.
Describe how to assess the cranial nerves.
Identify motor system assessment.
Identify sensory examination.
Explain examination of motor reflexes.
Describe age related to neurological changes.

4. Introduction
4
The nervous system consists of the central
nervous system (CNS), the peripheral
nervous system, and the autonomic
nervous system. The CNS includes the
brain and spinal cord.
Nervous
System
Central Nervous
System (CNS)
Brain
Spinal
Code
Peripheral
Nervous
System (PNS)
Autonomic
Nervous System

5. Introduction
5
Neurologic
Assessment
Cerebral
Function
Cranial
Nerves
Motor
System
Reflexes
A neurological
assessment is
composed four
components:
1. Cerebral
Function
2. Cranial Nerves
3. Motor System
4. Reflexes

6. DEFINITION
6
A neurological examination (also
called a neuro-exam) is a systematic
process that includes a variety of
tests and observations. It may be
performed with instruments, such as
lights and reflex hammers, and
usually does not cause any pain to
the patient.

7. 7
When is a Neurological
Examination Performed?

8. During a routine physical assessment
Following any type of trauma
To follow the progression of a disease
If the person has any of the following complaints:
Headaches
Blurry vision
Change in behavior
Fatigue
Change in balance or coordination
Numbness or tingling in the arms or legs
Decrease in movement of the arms or legs
Injury to the head, neck, or back
Fever
Seizures
Slurred speech
Weakness
Tremors
8

9. 9
How is a Neurological
Examination conducted?

10. MENTALSTATUS–
Appearance
Behavior
Dress
Grooming
Personal Hygiene
Posture & Gestures
Movements, Facial Expressions
Motor Activity
Manner of Speech
Level of Consciousness (GCS) 10
General appearances and
movements

11. INTELLECTUALFUNCTION-
Assess patient's immediate recall by
asking the patient to repeat a
sequence of numbers.
Assess patient's recent memory by
asking him to give details of
instructions given earlier in the
assessment.
11

12. THOUGHTCONTENT-
During the interview, it is important to
assess the patient's thought content.
Are the patient's thoughts
spontaneous, natural, clear, relevant,
and coherent?
12

13. EMOTIONALSTATUS-
Is the patient's affect natural and even,
or irritable and angry, anxious,
apathetic, or euphoric?
Does his or her mood fluctuate
normally, or does the patient
unpredictably swing from joy to
sadness during the interview?
13

14. PERCEPTION-
The examiner may consider more
specific areas of higher cortical
function. Agnosia is the inability to
interpret or recognize objects seen
through the special senses.
14

15. MOTORABILITY-
Assessment of cortical motor integration
is carried out by asking the patient to
perform a skilled act (throw a ball,
move a chair, etc.).
15

16. LANGUAGEABILITY-
The person with normal neurologic
function can understand and
communicate in spoken and written
language.
16

17. 17
THE CRANIAL NERVES
There are
12 cranial
nerves in
the human
body.

18. CRANIALNERVEI
Olfactory Nerve
This is the nerve of smell. The patient may be asked to
identify different smells with his/her eyes closed.
18

19. CRANIALNERVEII
Optic Nerve
This nerve carries vision to the brain. A visual test may be
given and the patient's eye may be examined with a
special light.
19

20. CRANIALNERVEIII
Oculomotor
This nerve is responsible for pupil size and certain
movements of the eye. The patient's doctor may
examine the pupil (the black part of the eye).
20

21. CRANIALNERVEIV
TrochlearNerve
This nerve also helps with the movement of the eyes.
21

22. CRANIALNERVEV
Trigeminal Nerve
This nerve allows for many functions, including the ability
to feel the face, inside the mouth, and move the muscles
involved with chewing.
22

23. CRANIALNERVEVI
Abducena
Nerve
This nerve helps with the
movement of the eyes.
The patient may be
asked to follow a light or
finger to move the eyes.
23

24. CRANIALNERVEVII
Facial Nerve
24

25. CRANIALNERVEVIII
Acoustic Nerve
This is the nerve of hearing.
25

26. CRANIALNERVEIX
GlossopharyngealNerve
This nerve in involved with taste and swallowing.
26

27. CRANIALNERVEX
VaguaNerve
This nerve is mainly responsible for the ability to
swallow, the gag reflex, some taste and part of speech .
27

28. CRANIALNERVEXI
Accessory Nerve
This nerve is involved in the movement of the shoulders
and neck.
28

29. CRANIALNERVEXII
Hypoglossal Nerve
The final cranial nerve is mainly responsible for
movement of the tongue.
29

30. MOTORSYSTEMASSESSMENT-
Assessment of the motor system
includes evaluation of:
Evaluation of Bilateral Muscle
Strength,
Coordination & Balance Tests and
Sensory System Assessment.
Be sure to assess bilaterally and
compare findings.
30

31. MUSCLESTRENGTH
Examine the arm and leg muscles looking for
atrophy and abnormal movements such as tremors
perform passive range of motion exercises and
note any resistance
instruct the patient to bend the forearm up at the
elbow (flexion) while you hold the patient’s wrist
exerting a slight downward pressure
test the triceps by having the patient extend his arm
while you push against his wrist
Ensure that the patient follows instructions to
release the hand when assessing grip strength
31

32. COORDINATIONANDBALANCETESTS
Coordination can be checked by
having the patient close the eyes and
touch the finger to the nose
Coordination can also be assessed
by having the patient perform rapid
alternating movements (RAMs).
32

33. FINGER-TO-NOSETEST
Ask the client to extend both arms from the sides of the body.
Ask the client to keep both eyes open.
Ask the client to touch the tip of the nose with right index finger, and then return the right
arm to an extended position.
Ask the client to touch the tip of the nose with left index finger, and then return the left
arm to an extended position.
Repeat the procedure several times.
Ask the client to close both eyes and repeat the alternating movements
33

34. FINGER-TO-NOSETEST
34

35. SENSORYSYSTEMASSESSMENT
Instruct the patient to keep his eyes
closed during all the tests. Compare
one side with the other, noting whether
sensory perception is bilateral.
35

36. REFLEXESTOCHECK:
I.Biceps
Flex patient’s arm at the elbow and rest his forearm on his thigh with the
palm up. Place your thumb firmly on the biceps tendon in the antecubital
fossa. Strike your thumb with the hammer. The elbow and forearm should
flex, and the biceps muscle should contract.
36

37. II. TRICEPS
The triceps tendon is tested with the patient’s arm flexed
at a 90°angle. Supporting the arm with your hand, strike
the triceps tendon on the posterior arm just above the
elbow. The tendon should contract and the elbow
extend.
37

38. III. BRACHIORADIALIS
38
Have the patient rest his slightly flexed
arm on his lap with the palm facing
downward. Strike the posterior arm
about two inches above the wrist on
the thumb side. The forearm should
rotate laterally and the palm turn
upward

39. IV. PATELLAR
39
Dangle the patient’s legs over
the side of the bed. Place
your hand on the patient’s
thigh and strike the distal
patellar tendon just below
the kneecap. The normal
response is contraction of the
quadriceps muscle with
extension of the knee.

40. V. ACHILLES
40
Have the patient dorsiflex(point downward) his
foot slightly and lightly tap the Achilles’stendon
on the posterior ankle area. A slight jerking of the
foot should be seen.

41. VI. ABDOMINALREFLEX
41
-Use a blunt object such as a key or tongue blade.
-Stroke the abdomen lightly on each side in an inward and
downward direction.
-Note the contraction of the abdominal muscles and deviation of
the umbilicus towards the stimulus.

42. VII. Plantar reflex (Babinski)
42
-Stroke the lateral aspect of the sole of
each foot with the end of a reflex
hammer or key.
-Observe for planter flexion of the foot

43. GRADINGREFLEXES
AnalysisObservation
Very brisk, hyperactive, with clonus
(rhythmic oscillations between flexion and
extension)
4+
Brisker than average; possibly but not
necessarily indicative of disease
3+
Average; normal2+
Somewhat diminished; low normal 1+
No response 0
43
Reflexes are usually graded on a 0 to 4+ scale.

44. Older people may not realize the air
temperature is too cold or too warm.
Vision is affected by aging.
Hearing decreases because of natural or
mechanical means.
By the time a person reaches the age of 80,
brain weight may be as much as 10% less
than what it was.
44

45. 45
Much of the patient's neurologic function is assessed
during the history and during early parts of physical
examination. Much can be learned from the speech
patterns, mental status, gait, stance, motor power, and
coordination during the nurse-patients interaction.
CONCLUSION

46. References
1.Retrived on 24/03/2013
http://nursinglink.monster.com/
training/articles/240-physicalassessment
2.Retrived on
24/03/2013http://medicalcenter.osu.edu/patie
ntcare/healthcare-services/nervous-system
3. C.Smeltzer,Suzanne(2009) RN,EdD,FAAN,
text book of medical & surgical. 9
th
edition,
philadeilphia: Lippincott
46

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