NEUROLOGICA
L ASSESSMENT
LIJO JOSEPH
MSc. NURSING IST YR
ANATOMY & PHYSIOLOGY OF BRAIN
NEURON
Introduction
*When assessing the patient, always compare left to right
*Asymmetry is abnormal
*Do your exam the same way every time;
start at the top and work down
*Assess: LOC and Language,
Cranial Nerves
Motor Cerebellar
Sensory
ASSESSMENT
1. HEALTH HISTORY
2. PHYSICAL EXAMINATION
3. CLINICAL MANIFESTATION
4. DIAGNOSTIC EVALUATION
HEALTH HISTORY
HISTORY OF PRESENT ILLNESS
DETAILS OF SYMPTOMS
ONSET
CHARACTER
SEVERITY
LOCATION
DURATION
FREQUANCY OF SYMPTOMS
Cont……
PRECEPITATING,AGGRAVATING & RELIEVING
FACTORS
SIMILAR SYMPTOMS AMONG FAMILY MEMBERS.
FAMILY HISTORY OF GENETIC DISEASES
HISTORY OF HEAD & SPINAL CORD TRAUMA
HISTORY OF USE OF ALCOHOL & MEDICATION
PHYSICAL EXAMINATION
ASSESS
i. CEREBRAL FUNCTION
ii. CRANIAL FUNCTION
iii. MOTOR SYSTEM
iv. SENSORY SYSTEM
v. REFLEXES
ASSESSING CEREBRAL FUNCTION
Mental status
Intellectual
function
Emotional status
Thought content
Perception
Motor ability
Language ability
EXAMINIG CRANIAL FUNCTION
Olfactory
Optic
Oculomotor
Trochlear
Abducens
Trigeminal
Facial
Acoustic
Cont……
Glossopharyngeal
Vagus
Accessory
Hypoglossal
Neuro Assessment
CN I Olfactory: smell; skip except in facial trauma
CN II Optic:
vision
count fingers
Snellen eye chart
Visual fields
Ophthalmoscopy
CN III Oculomotor:
moves eyes in all
directions except
outward and down &
in; opens eyelid;
constricts pupil
CN IV Trochlear:
moves eyes down & in
Neuro Assessment
CN VI Abducens:
moves eyes outward
test for pupillary reflexes
Inspect eyelid for ptosis
CN V Trigeminal:
3 branches;
1. sensation to the face,
2. cornea and scalp;
3. opens jaw against resistance
Check sensation by sharp & dull ended instruments
Facial:
CN VII
Observe
Symmetry in facial movement
• Eg: smile , elevate eye brow
CN VIII Acoustic:
2 branches,
1. acoustic (hearing)
2. vestibular (balance)
Test for air & bone conduction(Rinne)
Test for lateralization(weber).
CN IX Glossopharyngeal:
Assess ability to discriminate
between sugar & salt on the
posterior third of the tongue
CN X Vagus:
Depress the tongue blade
on posterior tongue or
stimulate posterior pharynx
to elicit gag reflex.
CN XI Spinal Accessory:
turns head and elevates shoulders.
That is;
palpate & note the strength
of each stenocleidomastoid
muscles as patient turns
head against opposing pressure
of the examiner hand.
CN XII Hypoglossal:
moves tongue
That is
While patient protrudes the
tongue, any deviation or
tremors are noted.
The strength of the tongue
is tested by, move the protruded
tongue from side to side against
tongue depressor.
EXAMINING MOTOR SYSTEM
Muscle ●
Resistance test
●
Hanlon Nichols(rate muscle strength)
strength
●
Upper extremities test
Coordination ●
Lower extremities test
Balance ●
Romberg test
EXAMINIG THE REFLEXES
Superficial reflexes
Corneal Gag Babinski
reflex reflex response
REFLEXES BABINSKI REFLEX
EXAMINIG SENSORY SYSTEM
Tactile sensation
Superficial pain & vibration
Position test
DIAGNOSTIC STUDIES
RADIOLOGICAL ELECTROGRAPHIC
ULTRA SOUND
STUDIES STUDIES
CT scan Evoked potential
studies Transcranial
MRI
doppler
SPECT
Electro myography
PET
myelography Electro
cerebral angiography Encephalography
Radiological studies
CT SCAN USES
SYNONYMOUS To detect displacement of
CAT scan ventricles & cortical
Computed Axial Tomography atrophy.
WHAT IS IT ? To detect tumor and Brain
It is a noninvasive imaging infraction.
study by the uses x-rays. To visualize sections of
It produce images of the spinal cord (LP
internal parts of the body. Procedure).
Mainly brain and other
To identify herniated
structures in the head.
lumbar disk.
HOW CT WORKS ?
NURSING INTERVENTIONS
Preparation & monitoring of the patient.
Teach the patient about the need to lie quietly
throughout the procedure.
Use of relaxation technique (claustrophobic patients)
Assess for iodine allergy (if contrast agent is using)
Monitor the patient during and after the procedure for
allergic reaction
Nausea,vomiting,flushing.
MAGNETIC RESONANCE IMAGING (MRI)
USES
To reveal brain
abnormality.
To detect tumor and
artery clogging
To measure blood flow
To detect variety of
musculoskeletal, liver,&
kidney disorders.
Cont….
NURSING RESPONSIBILITY
Screen or removed all the metal parts & pacemaker in
the body(if present)
Patient history is obtained to determine the presence of
any metal object
Sedation may be necessary if patient is claustrophobic
MYELOGRAPHY
Nursing intervention
X-ray of spinal cord & Clear explanation & clarify
vertebral column after the doubt.
injection of contrast medium Patient lie in the bed with the
into subarachinoid space head of the bed elevated 30-
USES 45 degree(after myelogram)
Spinal lesions Increases patient fluid intake
Ruptured disk Check vital sign
Tumor
CEREBRAL ANGIOGRAPHY
Nursing responsibility
Serial x-ray study to Explain the procedure
visualization of intracranial & Administer pre medication(if
extra cranial blood vessel prescribed)
Contrast medium is using Maintain pressure dressing &
Uses ICE to injection sites
vascular disease Maintain patient bed rest
vascular lesions Report any changes in
tumor of brain neurological status.
POSITRON EMISSION
SPECT
TOMOGRAPHY
QUESTIONS
DON”T SHOUT OUT Please raise your
hand
Question 1
What’s the earliest and most reliable indicator of
increased intracranial pressure?
Question 2
Which cranial nerves control eye movements?
THANK YOU
