‫الفحص العصبي هو تقييم‬

‫االستجابة الحسية االستجابات الحركية‬

‫من األفضل إجراء الفحص بشكل منهجي‬

‫ بطريقة‬:-
‫الفحص البدني‬ ▪

INTRODUTION ‫مراجعة التاريخ الطبي للمريض‬

A Neurological examination is the assessment of

NEUROLOGICAL ASSESSMENT Sensory response▪

Motor responses▪

The examination is best performed in a systematic

:MODIFIED BY
-: manner by

ADULT CARE NURSING 2 FACULTY Physical examination ▪ ▪

Review of the patient's medical history▪
‫يشار إلى الفحص العصبي‬
‫عندما يشك الطبيب في أن املريض قد يكون لديه‬

‫ اضطراب عصبي‬.

‫أي أعراض جديدة ألي اضطراب عصبي قد‬

‫يكون مؤشرا ألداء الجهاز العصبي‬

▪
.examination
‫تشمل أغراض التقييم إنشاء تشخيص إلرشاد املمرضة في تخطيط وتنفيذ اإلجراءات التمريضية ملساعدة‬

‫املريض على التعامل بفعالية مع الحياة اليومية‬

▪

MANIFESTATIONS

INDICATION ‫املظاهر السريرية لألمراض العصبية هي‬

A neurological examination is indicated

The clinical manifestations of neurologic

whenever a physician suspects that a patient may have▪ disease are

. a neurological disorder Pain ●

Any new symptom of any neurological disorder may ▪ Seizures ‫ألم‬ ●

be an indication for performing a neurological

.examination Dizziness ‫النوبات‬

‫دوخة‬ ●

The purposes of the assessment include

Visual disturbances ‫اضطرابات بصرية‬
‫ضعف‬
●

establishing a diagnosis to guide the nurse in Weakness ‫أحاسيس غير طبيعية‬ ●

planning and implementing nursing measures to Abnormal sensations ●

.help the patient cope effectively with daily living

‫التقييم العصبي‬

NEUROLOGICAL ASSESSMENT

MENTAL STATUS ●

CRANIAL NERVES ●

‫الحالة العقلية‬
‫األعصاب الدماغية‬

MOTOR EXAM ● ‫امتحان املحرك‬

‫ريفلكسيس‬

‫إحساس‬
REFLEXES ●

SENSATION ●

Jermilyn Tiglao- Adriano, BSN, RN, MSN ٥

(1) ‫فحص الحالة العقلية‬

EQUIPMENTS 
MENTAL STATUS examination (1)

Snellen eye chart ▪

Level OF Consciousness (a
Penlight ▪ Language (b

Tongue depresser ▪ Memory (c

Tuning fork ▪ Orientation (d

Knee harmer ▪

Cotton ball ▪

Pen/pencil ▪

a) Level OF CONSCIOUSness

Assessment

c) memory ‫الذاكرة الفورية هي القدرة على تذكر كمية‬

b) Language ‫صغيرة من املعلومات خالل بضع ثوان‬

‫فوري‬
Immediate memory is the ability to remember a ●
small amount of information over a few seconds

Fluency ‫التحكم عن بعد‬ ‫الذاكرة البعيدة هي القدرة على تذكر األشياء‬

‫ ما حدث منذ سنوات‬.
‫طويل األمد‬
‫ تشريح الجهاز القلبي الوعائي‬:‫على سبيل املثال‬

Remote memory is the ability to remember things ●

Repitation immediate .that happened years ago

‫الطالقة‬ Eg: anatomy of cardio-vascular system

‫التكرار‬

‫قراءة‬ ، ‫نظام طويل املدى للتخزين الدائم‬

‫إدارة واسترجاع املعلومات الستخدامها الحقًا‬
‫جاري الكتابة‬

Reading
remote long term a system for permanently storing, ●
managing, and retrieving information for later use

long term

Writing ?=Eg: 3 2 ●


cranial nerves.2

d) orientation

person

place

time

I1(i) Olfactory Optic vision(II)

Client both eyes and one Examine the Optic (A) Visual acuity (B)

nostril are closed Fundi by using the Distance/Central vision: •

Place a strong smelling item ‫ض‬ Ophthalmoscope Snellen eye chart;

position patient 20 feet (6

(coffee, tobacco). under each meters) from the chart

nostril individually and ask

.the person to identify it

Test- one eye at a time •

Each nostril is tested

.separately

. Use other item

‫العميل كلتا العينني واحدة‬

‫فتحة األنف مغلقة ضع مادة ذات رائحة‬

‫ تحت كل فتحة على حدة‬.(‫ تبغ‬، ‫نفاذة )قهوة‬

‫واسأل‬

‫الشخص املراد التعرف عليه يتم فحص كل‬.

‫فتحة أنف‬

‫بشكل منفصل‬
‫ استخدم عنصرًا آخر‬.


i (iv ) Trochlear AND (vi)Abducens

Occulo motor ( iii) .Cardinal Gazes

Test pupil constriction ●

.using pen light Ask patient to follow)

Administer the Six
pen light as you move it

Ask patient to raise ● vertically up and then

and lower eyelids down, then diagonally

.(open and close eyes) from upper left to lower

right and upper right to

(.lower left

Trigeminal(v) Use fingertip or (Sensation) ●

Bilaterally palpate temporal ● penlight to lightly stroke

and masseter muscles while forehead and cheeks and ask
Facial (vii)

patient to identify where on

patient clenches teeth their face they are being
MixAsk patient to do the
following and observe facial

touched symmetry

Smile ➢

Show Teeth ➢
Raise Eyebrows ➢

Sensation/taste to front 2/3 of ➢

With the individual's eyes open and (Reflex) tongue

looking upward, the practitioner takes a strand

of cotton, approaches the cornea from the side,

ing, taste, sensation in the
ear

and touches it with the cotton. This should

initiate a blink response. Both eyes should be

.tested independently

Rinne test

Acoustic(viii) Compare time of air vs bone conduction o

Weber Test (by using a Place the base of the tuning fork on the client’s o

.tuning fork) .mastoid process and note the number of seconds

Whisper Test: Ask patient ●

to cover left ear. Stand to Then move the fork in front the external auditory o

right of patient, out of meatus (1-2 cm)

view, about a foot away,

and whisper. Have patient

repeat what you said. Same

.for other ear

Glossopharyngeal and (X) Vagus (ix) 


Spinal Accessory(xi)

Ask the client to open the mouth, ❑

depress the client’s tongue with Test the Trapezius muscle ❑

the tongue blade, ask the client to have the client shrug the
say ”ah” . Usually, the soft palate shoulders while you resist

raises and the uvula remains in with your hands

the midline Ask the client to try to ❑

touch the right ear to the

right shoulder without

raising the shoulder.

Repeat with the left

shoulder

3. ‫اختبار املحرك‬
1 ‫مراقبة املشية والتوازن‬

Hypoglossal(xii) 
Motor test .3 2. ‫القوة‬

Ask patient to protrude ❑ With your hand against ❑ Observation of gait and balance.1 ‫ إجراء اختبار اإلصبع‬3. ‫إدارة اختبار رومبرج‬

tongue and move it side to the patient's cheek, ask 4. ‫إلى األنف‬
5. ‫مراقبة العمل املتناوب السريع‬

them to push against Strength .2 ‫حركات‬

side. Assess for symmetry,
the inside of each cheek

.atrophy
with their tongue Administration of the Romberg test .3

Administration of the finger-to-nose test .4

Observation of rapid alternating action .5

movements
 
Observation of gait and balance.1 strength .2


Ask the client to walk across the room and return


Romberg’s test for balance. .3

.Finger-to-nose test (4)

 
4 ●
.Ask the patient to remain still and close their eyes (for about 20 seconds) Ask the client to extend both arms -
from the sides of the body and 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 and 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
 
Observation of rapid alternating action movements .5 PATELLAR (4

 BICEPS (1
-Ask the client to sit with the hands placed palms down on the 
reflexes .4
thighs.
-Ask the client to return the hands palms up.
-Ask the client to return the hands to a palms-down position.
.-Ask the client to alternate the movements at a faster pace triceps(2)
ACHILLES (5
.Testing rapid alternating movement, palms up. Testing rapid alternating movement, palms down

(3) PLANTAR (6
BRACHIORADIALSIS

.

.Testing the triceps reflex .2
Testing the biceps reflex
The patient's arm should be ●
Support

 the upper arm and ▪
let
 the patient's forearm
partially flexed at the elbow with
.hang free
.the palm down
Strike the triceps tendon ▪
Place your thumb or finger firmly ●
above the elbow with the
.on the biceps tendon .hammer
Strike your finger with the reflex ● observe contraction of the ▪
.hammer triceps muscle with
look for contraction of the biceps ● .extension of the lower arm
muscle and slight flexion of the
.forearm


.Testing the brachio radialis reflex .3
Have the patient rest the
forearm on the abdomen or
.lap
Strike the radius about 1-2
.inches above the wrist
Watch for flexion and
.supination of the forearm
.Testing the Achilles tendon reflex with client in a sitting position .5
Dorsriflex the foot at the ●
.ankle
Strike the Achilles tendon. ●
cord-like structure running
from the heel to the
.muscles of the calf
Watch and feel for plantar ●
.flexion at the ankle

.Testing patellar (knee) reflex, client in a sitting position .4
● -
Have the patient sit with the ●
.knee flexed
●
Strike the patellar tendon ●
.just below the patella
●
Note contraction of the ●
quadriceps muscle and
.extension of the knee

.Testing the plantar reflex .6
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
 .Evaluation of light touch .1

Sensory test .5
Use wisp of cotton to touch ●
Observation of light touch identification .1 the skin lightly on both sides
.simultaneously
Sharp, dull determination .2 Test several areas on both the ●
.upper and lower extremities
Ask the patient to tell you if ●
Stereognosis .3
there is difference from side
to side or other "strange"
Graphesthesia (Number identification) .4 .sensations



.Testing the client’s ability to identify sharp sensations .2 
Testing stereognosis using a coin(3)


-
Testing the client’s ability to identify dull
sensations
- the client to say “sharp” or ▪
Ask
“dull” when something sharp Use as an alternative to ●
.or dull is felt on the skin graphesthesia.
Touch the client using random ▪ -Place a familiar object in the
.locations patient's hand (coin, paper,
.pencil, etc.)
Testing the client’s ability to identify
sharp sensations Ask the patient to tell you what ●
.it is






Testing graphesthesia (Number identification) .4
-

With the blunt end of a pen or ●

pencil, draw a large number
.in the patient's palm
Ask the patient to identify the ●
.number