Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 101- HEALTH ASSESSMENT

NEUROLOGIC ASSESSMENT

Group E9:
So, Sej Andrei
Rusuena, Bon Jovi
Santiago, Trisha Sofia
Teo, Rosel Mae
Tobias, Roxanne
Oporto, Kyle Chloe
Salvacion, Jullana
Vidal, Rome Matthew

Facilitator: Mr. Jake Sanchez

Date Submitted: August 7, 2020
 TABLE OF CONTENTS
TITLE PAGE

Learning Outcome for 3

Neurologic Assessment
CLO#1: : Define the 4
following terms:
CLO#2: Briefly discuss the 5
anatomy and physiology of
the Nervous System with
emphasis on the following
aspects:
CLO#3: State the purposes 7
of neurologic assessment
CLO#4: Enumerate the 7
indications of neurologic
assessment.
CLO#5: manage resources 8
needed in conducting
physical assessment
appropriately.
CLO#6: obtain assessment 11
data through physical
assessment.
CLO#7: differentiate normal 17
from abnormal physical
assessment findings.

CLO#8: Identify the different 18

materials needed and its
uses in neurologic
assessment

CLO#9: State the nursing 19

responsibilities before, during
and after neurologic
assessment
CLO#10: Demonstrate 20
beginning skills in neurologic
assessment
References 21

2
 LEARNING OUTCOMES:
After [3] hours of various online class activities, the level I nursing students will
be able to:

[NEUROLOGIC ASSESSMENT]:

CLO#1: Define the following terms:..

CLO#2: Briefly discuss the anatomy and
physiology of the Nervous System with
emphasis on the following aspects:
CLO#3: State the purposes of
neurologic assessment.
CLO#4: Enumerate the indications of
neurologic assessment.
CLO#5: manage resources needed in
conducting physical assessment
appropriately.
CLO#6: obtain assessment data
through physical assessment.
CLO#7: differentiate normal from
abnormal physical assessment findings.
CLO#8: Identify the different materials
needed and its uses in neurologic
assessment
CLO#9: State the nursing
responsibilities before, during and after
neurologic assessment
CLO#10: Demonstrate beginning skills
in neurologic assessment

3
CLO#1: Define the following terms:

1.1 Spinal accessory 1.8 Vagus 1.15 Gag reflex

1.2 Glossopharyngeal 1.9 Abducens
1.3 Olfactory 1.10 Oculomotor
1.4 Facial 1.11 Trigeminal
1.5 Hypoglossal 1.12 Trochlear
1.6 Acoustic 1.13 Cerebrospinal fluid (include its purpose)
1.7 Optic 1.14 Hypothalamus (include its purpose)

1.1 Spinal accessory -either of a pair of motor nerves that are the 11th cranial nerves,
arise from the medulla and the upper part of the spinal cord, and supply chiefly the
pharynx and muscles of the upper chest, back, and shoulders. called also
accessorius, accessory, spinal accessory nerve. Comments on accessory nerve.
1. 2Glossopharyngeal -of or relating to both tongue and pharynx.
1.3 Olfactory -Olfaction, or the sense of smell, is the process of creating the perception of
smell. It occurs when an odor binds to a receptor within the nose, transmitting a signal
through the olfactory system. Olfaction has many purposes, including detecting hazards,
pheromones, and plays a role in taste.
1.4 Facial -The soft-tissue structures attached to the bones of the facial skeleton,
including epidermis, dermis, subcutaneous fascia, and mimetic musculature.
1.3 Hypoglossal -The hypoglossal nerve is the twelfth cranial nerve. ...
The hypoglossal nerve supplies the muscles of the tongue.
1.4 Acoustic -Having to do with sound or hearing. The acoustic nerve (the 8th cranial
nerve) is concerned with hearing and the sense of balance and head position.
1.5 Optic -optic in anatomy or biology textbooks, describing the parts of an eye, or
disorders involving the eye. Your optic disc is a tiny blind spot that all humans have on
their eyeballs, and optic neuritis is an inflammation of the optic nerve.
1.6 Vagus -The vagus nerve is responsible for the regulation of internal organ functions,
such as digestion, heart rate, and respiratory rate, as well as vasomotor activity, and
certain reflex actions, such as coughing, sneezing, swallowing, and vomiting
1.7 Abducens -he nerve in humans and most animals that governs the motion of the
lateral rectus muscle of the eye
1.8 Oculomotor -oculomotor nerve is responsible for the nerve supply to muscles
around the eye, including the upper eyelid muscle, which raises the eyelid; the extraocular
muscle, which moves the eye inward; and the pupillary muscle, which constricts the pupil.
1.9 Trigeminal -trigeminal nerve provides both sensory and motor innervation to the
face. More specifically, the sensory information conducted by this nerve includes touch,
pain, and temperature.
1.10 Trochlear–a. the articular surface on the medial condyle of the humerus that
articulates with the ulna.
B. the fibrous ring in the inner upper part of the orbit through which the tendon of the
superior oblique muscle of the eye passes.

4
1.11 Cerebrospinal fluid -primary function of CSF is to cushion the brain within the skull
and serve as a shock absorber for the central nervous system, CSF also circulates nutrients
and chemicals filtered from the blood and removes waste products from the brain.
1.12 Hypothalamus -The area of the brain that secretes substances that influence
pituitary and other gland function and is involved in the control of body temperature,
hunger, thirst, and other processes that regulate body equilibrium.

1.13 Gag reflex -contraction of the muscles of the throat caused especially by stimulation
(as by touch) of the pharynx.

CLO#2: Briefly discuss the anatomy and physiology of the Nervous System with
emphasis on the following aspects:
2.1 Classification of the Nervous System
2.1.1 Central Nervous System
2.1.2 Peripheral Nervous System
2.2 Major structures of the brain
2.3 Major types and functions of the 12 cranial nerves
2.4 Cross-section of the spinal cord

2.1 Classification of the Nervous System

The nervous system is divided into the central nervous system
(CNS) and the peripheral nervous system (PNS).
5
2.1.1 Central Nervous System
The (CNS) is the major division, and consists of the brain and the spinal cord.
The spinal canal contains the spinal cord, while the cranial cavity contains the brain.
The CNS is enclosed and protected by the meninges, a three-layered system of
membranes, including a tough, leathery outer layer called the dura mater.
The brain is also protected by the skull, and the spinal cord by the vertebrae.
2.1.2 Peripheral Nervous System
The peripheral nervous system (PNS) is a collective term for the nervous system
structures that do not lie within the CNS. The large majority of the axon bundles called
nerves are considered to belong to the PNS.
The PNS is divided into somatic and visceral parts:
The somatic part consists of the nerves that innervate the skin, joints, and muscles.
The cell bodies of somatic sensory neurons lie in dorsal root ganglia of the spinal cord.
The visceral part, also known as the autonomic nervous system, contains neurons
that innervate the internal organs, blood vessels, and glands. The autonomic nervous
system itself consists of two parts: the sympathetic nervous system and the
parasympathetic nervous system.

6
2.2 Major structures of the brain
The four major structures of the brain are Cerebrum, Cerebellum, Diencephalon, and Brain
stem.

7
A. CEREBRUM
The cerebrum is the largest brain structure and part of the forebrain (or
prosencephalon). Its prominent outer portion, the cerebral cortex, not only processes
sensory and motor information but enables consciousness, our ability to consider ourselves
and the outside world.
The cortex tissue consists mainly of neuron cell bodies, and its folds and fissures
(known as gyri and sulci) give the cerebrum its trademark rumpled surface.
The cerebral cortex has a left and a right hemisphere. Each hemisphere can be
divided into four lobes: the frontal lobe, temporal lobe, occipital lobe, and parietal lobe.
The lobes are functional segments. They specialize in various areas of thought and
memory, of planning and decision making, and of speech and sense perception.

B. CEREBELLUM
The cerebellum is the second largest part of the brain. It sits below the posterior
(occipital) lobes of the cerebrum and behind the brain stem, as part of the hindbrain.
The primary function of the cerebellum is to maintain posture and balance.
The cerebellum then sends signals to the cerebrum, indicating muscle movements
that will adjust our position to keep us steady.

C. BRAIN STEM
The brain stem connects the spinal cord to the higher-thinking centers of the brain.
It consists of three structures: the medulla oblongata, the pons, and the midbrain.
The structures of the brain stem direct involuntary functions.
The pons helps control breathing rhythms.
The medulla handles respiration, digestion, and circulation, and reflexes such as
swallowing, coughing, and sneezing.
The midbrain contributes to motor control, vision, and hearing, as well as vision- and
hearing-related reflexes.

D. DIENCEPHALON
The diencephalon is a region of the forebrain, connected to both the midbrain (part
of the brain stem) and the cerebrum.
The thalamus forms most of the diencephalon. The thalamus relays these messages
to the appropriate areas of the cerebral cortex. It determines which signals require
conscious awareness, and which should be available for learning and memory.
The hypothalamus is part of the diencephalon, a region of the forebrain that
connects to the midbrain and the cerebrum. The hypothalamus helps to process sensory
8
impulses of smell, taste, and vision. It manages emotions such as pain and pleasure,
aggression and amusement.

2.3 Major types and functions of the 12 cranial nerves

The 12 cranial nerves are classified into three types: Sensory, Motor, and
Parasympathetic.
The olfactory nerve (I) transmits sensory information to your brain regarding smells
that you encounter.
The optic nerve (II) is the sensory nerve that involves vision.
The oculomotor nerve (III) has two different motor functions: muscle function and
pupil response.
The trochlear nerve (IV) controls your superior oblique muscle. This is the muscle
that’s responsible for downward, outward, and inward eye movements.
The trigeminal nerve (V) has sensory functions to the face and teeth, and motor
functions to muscles of mastication.
The abducens nerve (VI) controls another muscle that’s associated with eye
movement, called the lateral rectus muscle. This muscle is involved in outward eye
movement.
The facial nerve (VII) provides sensory function to taste; motor function to muscles
of face expression; and parasympathetic function to salivary and tear glands.
The vestibulocochlear nerve (VIII) has sensory functions involving hearing and
balance.

9
 The glossopharyngeal nerve (IX) has sensory functions for taste and touch to back of
tongue, motor functions to pharyngeal muscle, and parasympathetic function to salivary
glands.
The vagus nerve (X) has sensory functions to pharynx, larynx, and viscera; motor
functions to palate, pharynx, and larynx; and parasympathetic functions to viscera of thorax
and abdomen.
The accessory nerve (XI) is a motor nerve that controls the muscles in your neck.
These muscles allow you to rotate, flex, and extend your neck and shoulders.
Your hypoglossal nerve (XII) is the 12th cranial nerve which is responsible for the
movement of most of the muscles in your tongue.
2.4 Cross-section of the spinal cord

A cross section of the spinal cord reveals white matter arranged around a butterfly-
shaped area of gray matter.
The white matter consists of myelinated fibres, or axons, that form nerve tracts
ascending to and descending from the brain.
The white matter is grouped into discrete sectors called funiculi.
The gray matter contains cell bodies, unmyelinated motor- neuron fibres, and
interneurons connecting the two sides of the cord. Gray-matter cells form projections called
horns. Fibres exiting the spinal cord from the dorsal and ventral horns join in paired tracts
to form the spinal nerves.
Information travels up the ascending tracts of neurons and is sorted by the brain.
10
 Responses are induced by nerve impulses traveling down the descending tracts that
stimulate motor neurons or that initiate glandular secretion.
3. State the purposes of neurologic assessment.

• Establish a nursing diagnosis to guide the nurse in planning and implementing nursing
measures
• Help the patient cope effectively with daily living activities
• Monitor progression of the condition
• Gauge the patient’s response to intervention.

A complete and thorough evaluation of a person's nervous system is important if there is

any reason to think there may be an underlying problem, or during a complete physical. Damage
to the nervous system can cause problems in daily functioning.

4. Enumerate the indications of neurologic assessment.

⚫ A neurological examination is indicated whenever a physician suspects that a patient may have
a neurological disorder.
⚫ Any new symptom of any neurological order may be an indication for performing a
neurological examination.
⚫ During a routine physical examination
⚫ 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

11
- Slurred speech

- Weakness

- Tremor

5. Discuss the following:

5.1 mental status assessment

➢ The mental status examination is an assessment of current mental capacity
through evaluation of general appearance, behavior, any unusual or bizarre
beliefs and perceptions (eg, delusions, hallucinations), mood, and all aspects of
cognition (eg, attention, orientation, memory).

5.2 Glasglow Coma Scale

➢ The Glasgow Coma Scale (GCS) is the most common scoring system used to
describe the level of consciousness in a person following a traumatic brain
injury.
➢ It is used to help gauge the severity of an acute brain injury. The test is simple,
reliable, and correlates well with outcome following severe brain injury.

5.3 Cranial nerve assessment

➢ is a type of neurological examination. It is used to identify problems with the
cranial nerves by physical examination

5.4 Sensory nerve assessment

- test for light touch sensation, pain sensation, temperature sensation
➢ This test will assess your light touch, pain, and temperature assessment. Each
test the client will be asked to close their eyes and they will experience some
sensations and that will tell what they feel and where they feel it.

- test for vibratory sensation, sensitivity to position

➢ In this test, the examiner places a finger under the patient’s distal
interphalangeal joint and presses a lightly tapped 128-cycle tuning fork on top
of the joint.
➢ The patient should note the end of vibration about the same time as the
examiner, who feels it through the patient’s joint.

12
 - assessing tactile discrimination (stereognosis, graphesthesia)
➢ Stereognosis or fine touch tests by instructing the clients to close their eyes.
➢ Place a familiar object and let them touch the object and let them identify
what object it is.
➢ Graphesthesia is tested by using the hand of your client and write the
numbers on their palms and asking the client to identify the number. Repeat
with another number on the other hand

- two-point discrimination, extinction and etc.

➢ Two-point discrimination can be determined on the fingertips, forearm, dorsal
hands, back, or thighs.
➢ Ask the client the number of points felt when touched with the EKG calibers.
➢ Extinction takes place by simultaneously touch the client in the same area on
both sides of the body at the same point and ask the client to identify the
area touched.

5.5 motor assessment and cerebellar assessment

- to evaluate balance (heel to toe, Romberg’s test)
➢ Asking the client to stand erect with arms on the side and feet together.
➢ This tests the balance that the client has.
➢ Note any unsteadiness or swaying.
13
 ➢ After, with the same position, ask the client to close their eyes for 20 seconds
and note any imbalance or swaying.

- to assess coordination (finger to nose test, test for rapid alternating movements, heel
to shin test)
➢ The finger to nose test
o assesses accuracy of movements, then ask the client to extend and hold
arms out of the side with open eyes.
o Instruct them to touch the tip of their nose first with your right index
finger, then with your left index finger and repeat it 3 times.
o Next is do the same procedure with eyes closed.

➢ The test for rapid alternating movements

o In this test patients must be seated.
o Ask the client to touch each finger to the thumb and to increase the
speed as the client progresses with the other side.
o Next test is to put client’s palms that are hands down on both of their
legs, then turn the palms up, and then turn the palms down again.
o Ask the client to increase speed.

➢ To test the heel to shin

14
 o The client must lie down in a supine position and to let them slide the
heel of the right foot down the left shin.
o Repeat with the other heel and shin.

5.6 reflex assessment

- deep tendon reflex
➢ Position the client in a comfortable sitting position. Using the reflex hammer to
elicit reflexes

- biceps reflex
➢ Ask the client to partially bend the arm at the elbow with the palm facing
upwards.
➢ Place your thumb over the biceps tendon and strike your thumb with the
pointed side of the reflex hammer. Repeat on the other side.

- brachioradialis reflex
➢ Flex the elbow of the client with their palms facing down and the hand resting on
the abdomen or lap.
➢ Use the flat side of the reflex hammer to tap the tendon at the radius about 2 in
above of the wrist. Repeat on the other side

15
- triceps reflex
➢ Asking the client to hang their arm freely, supported with your nondominant hand.
➢ With the elbow flexed, use the flat side of the reflex hammer to tap the tendon
above the olecranon process. Repeat on the other side.

- patellar reflex
➢ Let the client’s both legs hang freely off the side of the examination table.
➢ Using the flat side of the reflex hammer, tap the parietal tendon, which is located
just below the patella. Repeat on the other side.

- achilles reflex –
➢ On the client’s leg that is still hanging freely, dorsiflex the foot.
➢ Tap the Achilles tendon with the flat side of the reflex hammer. Repeat on the
other side.

- Plantar reflex –
➢ With the end of the reflex hammer, stroke the lateral aspect of the sole from the
heel to the ball of the foot, curving medially across the ball. Repeat on the other
side.
➢ With this test, it evaluates the function of spinal levels.

16
5.7 test for meningeal irritation or inflammation
- test for brudzinski’s sign
➢ As you flex the neck, watch the hips and knees in reaction to your manoeuvre.
➢ With this test normal findings results with the hip and knees remain relaxed and
motionless

- test for kernig’s sign

➢ The client’s leg must be flexed at both the hip and the knee, then straighten
the knee.
➢ Normal findings with this test that the client can’t feel any pain.
➢ Discomfort behind the knee during full extension occurs normal in many people.

17
6. Present the steps, normal and abnormal assessment findings in neurologic
assessment:

18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
8. Identify the different materials needed and its uses in neurologic assessment
General:
- Examination gloves

Cranial nerve examination:

- Cotton tipped applicators
- Newsprint to read
- Opthalmoscope
- Paper Clip
- Penlight
- Snellen chart
- Sterile cotton ball
- Substance to smell or taste such as soap, coffee, vanilla, salt, sugar, lemon juice
- Tongue depressor
- Tuning fork 19

Motor and Cerebellar Examination

- Tape measure

Sensory examination
- Cotton ball
- Objects to feel such as a quarter or key
- Paper clip
- Test tubes containing hot and cold water
- Tuning Fork (low pitched)

Reflex examination
- Cotton- tipped applicator
- Reflex (percussion) Hammer

41
 9. State the nursing responsibilities before, during and after neurologic
assessment

Before Neurological Assessment:

 The nurse should prepare and set the equipment needed for neurological examination.
 The nurse should complete an admission history and general admission assessment
to the patient.
 The nurse should provide a calm and suitable environment.
 The nurse should ensure to assess and evaluate the patient’s vital signs.
 The urse should instruct the procedure correctly.

During Neurological Assessment:

 The nurse tests the patient’s functioning of the nervous system.

 The nurse evaluates the patient’s level of consciousness, coordination, cranial
nerve examination, speech, facial symmetry, motor and sensory function, reflex
activity and pupillary reaction.
 The nurse records the patient’s data accurately.
 The nurse maintains a good support with the patient and the family member.
 The nurse must be alert for any misconceptions or misunderstandings held by the
patient or family.

After Neurological Assessment:

⚫ The nurse would critically analyze all the data obtained and synthesize the data.
⚫ The nurse would work in collaboration with a cooperative team to formulate
interdisciplinary care plan.
⚫ The nurse would compare the current data to previous assessment data to determine the
need for changes in intervention.
⚫ The nurse would determine the effects of nervous system dysfunction on ADLs and
independent function.
⚫ The nurse would detect life-threatening situations from the findings

42
 10. Demonstrate beginning skills in neurologic assessment

1. Introduce to the client. Explaining to the client what you are going to do, why it is
necessary and how he or she can participate.
2. Inquire to the client if he or she has any history of first signs of neurologic deterioration.
3. Assess your patient's attention span by how well he or she gets "back on track" during
conversations.
4. Assess cranial nerve function.
5. Assess muscle strength of the upper extremities of the patient.
6. Assess coordination of muscle movement by assessing point-to-point movements.
7. Assessing muscle strength of the lower extremities.
8. Assess your patient’s coordination.
9. Assess the patient’s pain sensation.
10. Assess the patient’s tendon reflexes.
11. Document findings in the client record.

43
 LIST OF REFERENCES:

Schulman, Jill. “12 Cranial Nerves: Nerves, Functions & Diagram of Locations.”
Https://Www.healthline.com/Health/12-Cranial-Nerves, 2019,
www.healthline.com/health/12-cranial-nerves.

Bhowmik, Suchana Roy. “(PDF) Neurological Assessment: Medical-Surgical Nursing Perspective.”

ResearchGate, Unknown, 9 Dec. 2019,
www.researchgate.net/publication/337830798_Neurological_Assessment_Medical-
Surgical_Nursing_Perspective.

Vanputte, C., et Al. (2019). Seeley’s Essentials of Anatomy & Physiology (10 th edition).
McGraw Hill Education
Weber, J. & Kelly, J. (2018). Health Assessment in Nursing (6th ed). William & Wilkins

Bhowmik, S. R. (2019). Neurological Assessment: Medical-Surgical Nursing Perspective.

Retrieved from
https://www.researchgate.net/publication/337830798_Neurological_Assessment_Medical-
Surgical_Nursing_Perspective

Themes, U. (2016). Neurological Assessment. Retrieved from

https://nursekey.com/neurological-
assessment/?fbclid=IwAR3ROlwCBaJMriRXAD0d1DJV0rlho6dXRdI0H4AZJvnTqCw6e5o2JUelDNU

Salmon, N. (2013). Neuro Assessment Made Easy. Retrieved from

https://www.rn.com/nursing-news/neuro-assessment-made-
easy/?fbclid=IwAR1X3eafZPqy9wFKlPYlpWnokgEflnIIV3YBIcYkMJ4OMqz_b_xJnoRyl0g

Berman, A., Frandsen, G., Synder, S. (2018). Kozier & Erb’s Fundamentals of Nursing.
(10th edition). Pearson

Arlene, B. n.d. Strengthening your neurologic assessment techniques. Retrieved from

https://www.nursingcenter.com/journalarticle?Article_ID=2451420&Journal_ID=606913&Issue_I
D=2451307

44