LESSON PLAN

ON
NEUROLOGICAL EXAMINATION

SUBMITTED TO SUBMITTED BY
Ms. Jygyasha Sharma Sadia Saleem
ASSISTANT PROFESSOR M.Sc. N 1st year
 LESSON PLAN
IDENTIFICATION DATA
Name of teacher : Ms. SADIA
Group : M.Sc. (NURSING) 1ST Year
Subject : PSYCHIATRY
Topic : Mental Health Care Act, 2017
AV Aids : PPTs, Handouts
Method of teaching : Lecture cum Discussion
Venue :
Duration of teaching : 50 minutes
Time :

OBJECTIVES:
General Objective: At the end of teaching, the group will be able to gain in depth knowledge about the topic, and will be able to use this
knowledge in practice
Specific Objectives: At the end of teaching, the group will be able to:
 Define neurological examination
 Explain aspects of neurological examination
 (Levels of consciousness, Mental status examination , Special cerebral functions , Cranial nerve function , Sensory function , Cerebellar
function and Reflexes )
 Explain role of nurse in neurological examination
Time Objectives Content Teaching Av Aids Evaluation
Learning
Activity
1 min To introduce Self Introduction: I am Sadia Saleem student of Chitkara University, Introduced - -
self Punjab herself to the
students
2 To announce Announcement of the topic: Announced - -
mins the topic Today, we will discuss about Neurological Examination the topic to
be taught
2 To assess Assessment of previous knowledge regarding Neurological Assessed - What is
mins previous Examination their previous Neurological
knowledge of knowledge Examination?
the group regarding
topic
3 To introduce INTRODUCTION : Introduced P What is
mins the topic the topic to Neurological
A neurological examination is a medical evaluation performed by a students Examination?
healthcare professional, typically a neurologist, to assess the function
P
and health of the nervous system.

It involves a series of tests and observations to diagnose, monitor, or T

evaluate a variety of neurological conditions or diseases

The purpose of neurological examination is to determine the presence

or absence of disease in the nervous system.
2 To explain Aspects of Neurological Examination: Explained What are
mins aspects of about aspects aspects of
Neurological  Levels of consciousness of P neurological
examination neurological examination
 Mental status examination
P
 Special cerebral functions examination
 Cranial nerve function T
 Sensory function
 Cerebellar function
 Reflexes

3 To explain 1.Levels of consciousness: Explained P What is level

mins about mental about level of of
illness and Most important aspect of neurologic examination Level of consciousness P consciousness?
capacity to consciousness first to deteriorate; changes often subtle, therefore
make mental T
requiring careful monitoring.
healthcare and
treatment
decisions Consciousness : composed of two components

Arousal (alertness)

Awareness(content)
3 To explain 2.Mental status examination: Explained Lecture What is MSE?
mins about MSE about Mental Cum
The components of mental status examination include the assessment Status Discussion
for following categories; General appearance, speech, thought process, Examination
mood, cognitive functions, attention, concentration, orientation,
memory, general knowledge, abstract reasoning, judgment & insight.

2 To explain 3.Special cerebral functions: Explained Lecture What are

mins about special about special special cerebral
cerebral cerebral functions?
 functions Assess for agnosia, apraxia & aphasia. functions Cum

Agnosia – inability to interpret sensations and hence to recognize Discussion

things,

Apraxia – inability to perform purposeful movements, but not

accompanied by a loss of sensory function or paralysis.

Aphasia – inability (or impaired ability) to understand or produce

speech, as a result of brain damage.
3 To explain 4.Cranial nerve examination : Explained Lecture What are
Mins about cranial about cranial cranial nerves?
nerves 1. Olfactory nerve (CN I) nerves Cum
2. Optic nerve (CN II)
Discussion
3. Oculomotor (CN III)
4. Trochlear (CN IV)
5. Trigeminal (CN V)
6. Abducens (CN VI)
7. Facial nerve (VII)
8. Vestibulocochlear or Acoustic nerve (CN VIII)
9. Glossopharyngeal (CN IX)
10. Vagus (CN X)
11. Accessory nerve (CN XI)
12. Hypoglossal nerve (CN XII)

3 To explain OLFACTORY NERVE: There is a network of nerve fibres called the Explained P What are the
Mins about function olfactory nerve that runs from the olfactory epithelium (a layer of about function of
of Olfactory specialised cells in the roof of the nose) to the olfactory bulbs in the Olfactory Olfactory
nerve brain (a pair of relatively tiny structures that can be seen on the nerve P nerve?
underside of the brain).
T
Odours can be detected and identified thanks to the olfactory nerve
 fibres, which relay information about the air's chemical comp
3mins To explain Optic Nerve Explained Lecture What are
about function about optic Cum function of
of optic nerve  Inspection of eye nerve Discussion optic nerve ?
 Visual Acuity
 Visual Fields by confrontation
 Afferent input to Pupillary Light Reflex

3 To explain Oculomotor Nerve Explained Lecture What is

mins about about oculomotor
oculomotor Eye movement: Moves eyes in all directions except outward and down oculomotor Cum nerve ?
nerve & in; nerve
discussion
Pupillary reaction to light: constricts pupil
3 To explain Trochlear Nerve : Explained Lecture What are
mins about trochlear about trochlear Cum function of
nerve It provides us eye movement freedom to look up, down, or in any nerve discussion trochlear
direction between the two extremes nerve ?
3 To explain Trigeminal Nerve : Explained P What are
mins about about mental health
Trigeminal The largest cranial nerve trigeminal P establishments?
Nerve nerve
T
Has three major branches: the ophthalmic nerve (V1), the maxillary
nerve (V2), and the mandibular nerve (V3).

Facial nerve

The ophthalmic and maxillary nerves are purely sensory, and the
mandibular nerve has sensory and motor functions
 The sensory function of the trigeminal nerve is to provide the tactile,
proprioceptive, and nociceptive afference of the face and mouth.

The motor function activates the muscles of the mastication, the tensor
tympani, tensor veli palatini, mylohyoid, and anterior belly of the stric.
3 To explain Abduces Nerve Explain about Lecture What are
mins about abduces abduces nerve functions of
nerve Abducens - CVI ("Abducts eyeball") Cum abduces nerve?

Discussions
FUNCTION: mainly motor

The abducens nerve arises between the pons and the medullaon the
brain and will travel through the SUPERIOR ORBITAL FISSURE to
innervate the lateral rectus muscle
2 To explain Facial Nerve: Explained P What are
mins about functions about facial functions
of facial nerve Primarily a motor nerve, but also carries special sensory (taste) fibers nerve P facial nerve ?
CVII emerges btw the pons and medulla on the brain and exitsthe skull
T
though the internal acoustic meatus, facial canal and finally the
STYLOMASTOID FORAMEN

Passes through the parotid gland

3 To explain Vestibulocochlear Nerve: Explained Lecture What are
mins about vestibulocochl function of
vestibulocochle Auditory aquity test ear nerve Cum vestibulocochle
ar nerve ar nerve ?
Discussions
Weber Test: screen for hearing loss(middle ear(conductive) and inner
ear( sensorineural ) Defective ear hears fork louder- conductive hear
loss
 Rinne Test:

It compares perception of sounds transmitted by air conduction to those

transmitted by bone conduction through the mastoid.

Air conduction should be greater than bone conduction.

A patient with profound sensorineural hearing loss may not hear

anything from the tuning fork placed on the mastoid process or near the
external auditory canal.
2 To explain Glossopharyngeal Nerve: Explained What are the
mins about about glossopharynge
Glossopharynge The glossopharyngeal nerve is the ninth set of 12 cranial nerves (CN glossopharyng al nerve ?
al Nerve IX). It provides motor, parasympathetic and sensory information to eal nerve
your mouth and throat. Among its many functions, the nerve helps raise
part of your throat, enabling swallowing.
3 To explain Vagus Nerve Explained P What are
mins about vagus about vagus functions of
nerve The vagus nerve aids in several vital bodily processes, including nerve P vagus nerve ?
digestion, heart regulation, and even speech.
T
Food digestion is aided by digestive fluids produced in response to
signals from the vagus nerve. It also signals the colon to speed up the
digestion process so that the nutrients can be absorbed

Similarly, the vagus nerve facilitates rest and relaxation. It has a

calming effect on the body and facilitates slower breathing. Because of
its significance in maintaining your health and well-
being, this is a must.
2 To explain Accessory Nerve: Explained P What are about
mins about accessory about accessory
nerve The accessory nerve, also known as the eleventh cranial nerve, cranial accessory P nerve?
 nerve XI, or simply CN XI, is a cranial nerve that supplies the nerve
sternocleidomastoid and trapezius muscles. It is classified as the T
eleventh of twelve pairs of cranial nerves because part of it was
formerly believed to originate in the brain. The sternocleidomastoid
muscle tilts and rotates the head, whereas the trapezius muscle,
connecting to the scapula, acts to shrug the shoulder.

2 To explain Hypoglossal Nerve : Explained P What are

mins about The hypoglossal nerve enables tongue movement. It controls the about P functions of
hypoglossal hyoglossus, intrinsic, genioglossus and styloglossus muscles. These hypoglossal T hypoglossal
nerve muscles help you speak, swallow and move substances nerve nerve ?
around in your mouth.
3 To explain The Sensory System Examination Explained L What are
mins about sensory The sensory exam includes testing for: pain sensation (pin prick), light about sensory E sensory system
system , touch sensation (brush), position sense and stereognosia. system , C functions,
cerebral For evaluation of balance & co-ordination the tests used are: cerebral T cerebral
function and function and U function and
reflexes reflexes R reflexes?
Cerebral Functions E
Finger to finger test: It is performed by instructing the patient to place C
her index finger on the nurse’s index finder. He is asked to repeat this U
for several times in succession on both sides M
.
Finger to nose test: Tell the patient to extend his index finger & then D
touch the tip of his nose several times in rapid succession. This test is I
done with patient’s eyes both open & closed. S
C
U
Romberg test: Here the nurse instructs the patient to stand with his feet
S
together with arms positioned at his sides. He is told to close his eyes. S
This position is maintained for 10 seconds. This test is considered I
positive only if there is actual loss of balance. O
 N
Tandom walking test: This is tested by having the patient assume a
normal standing position. He is then instructed to walk over heel on a
straight line. Any unsteadiness, lurching or broadening of the gait base
is noted.
Reflexes

Deep tendon reflexes

Biceps reflex C5/C6
Brachioradialis reflex C6
Triceps reflex C7
Patellar reflex L4
Achilles tendon S1
Plantar response
Reflexes tested in special situations
 Frontal release signs
 Spinal cord injury
 Posturing
Scale

0 = absent

1+= hypoactive

2+= normal

3+ = hyperactive

4+ = hyperactive with clonus

5+= sustained clonus

2 ,mi To explain Role ROLE OF NURSE : Explained role Ppt What is role of
ns of nurse  Provide a clam, suitable environment of nurse nurse in
 Collect the personal data with patient & family members neurological
examination?
 Set the equipment needed for neurological examination
 Assess the current level of consciousness, monitor vital
parameters temperature, pulse, respiration, blood pressure,
pupillary reaction, whether decerebrating or decorticating.
 Thorough mental status examination should be done & recorded
accurately.
 Assessment of cranial nerves should be done correctly &
recorded.
 Assessment of motor, sensory & cerebellar functions should be
done & be recorded accurately.
 During the examination, she should maintain a good support
with patient & family members
 She should instruct the procedure correctly & then they should
be asked to do it.
 Should be informed to the concerned unit doctors if there is any
change.

2 To summarize Summarization of the topic: Summarized - -

mins the topic Today we have discussed about the Neurological Examination under the topic
these headings
1. Levels of consciousness
2. Mental status examination
3. Special cerebral functions
4. Cranial nerve function
5. Sensory function
6. Cerebellar function
7. Reflexes

2 To recaptualize Recapitalization of the topic: Recapitualized - -

mins the topic the topic
 What do you understand Neurological examination ?
What are different aspects of neurological examination ?
What is the role of nurse in neurological examination ?

ABSTRACT:
Michael P.H. Stanley, MDKathryn E. Hall, DNP, ANP-BC, NE-BCWilliam J. Mullally, MD
For most of human history, diseases preying upon the nervous system could only be identified indirectly through neurological signs—making the
neurology clinician's examination the principal diagnostic tool. While advanced imaging and electrophysiology of today's practice provides
greater diagnostic precision, the wide array of tools available and their applications emphasizes the accuracy that the neurological examination
provides to localization, which in turn enables our technology's precision to effectively and efficiently aid one's diagnosis

References
1. The Mental Healthcare Act. 2017. [Last accessed on 2018 Jun 11]. Available from: http://www.prsindia.org/uploads/media/Mental
%20Health/Mental%20healthcare%20Act,%202017.pdf
.2. Draft Rules and Regulations under Mental Healthcare Act. 2017. [Last accessed on 2018 Jun 11]. Available from:
https://www.mohfw.gov.in/sites/default/files/Final%20Draft%20Rules%20MHC%20Act%2C%202017%20%281%29.pdf
.3. Kumar MT. Mental healthcare act 2017: Liberal in principles, let down in provisions. Indian J Psychol Med. 2018;40:101–7. [PMC free
article] [PubMed] [Google Scholar]
4. Mishra A, Galhotra A. Mental healthcare act 2017: Need to wait and watch. Int J Appl Basic Med Res. 2018;8:67–70. [PMC free article]
[PubMed] [Google Scholar]
5. Narayan CL, Shekhar S. The mental health care bill 2013: A critical appraisal. Indian J Psychol Med. 2015;37:215–9. [PMC free article]
[PubMed] [Google Scholar]
6. Duffy RM, Kelly BD. Concordance of the Indian mental healthcare act 2017 with the World Health Organization's checklist on mental
health legislation. Int J Ment Health Syst. 2017;11:48. [PMC free article] [PubMed] [Google Scholar]www.indiacode.nic.in
www.ncbi.nlm.nih.gov
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