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Adventist University of the Philippines

College of Nursing
MNHA 510 – Advanced Health Assessment

Neurologic System
Equipment: penlight, tongue blade, sterile needles; 200 to 400 and 500 to 1,000 Hertz tuning
forks; familiar-feeling objects; cotton wisp; 5.07 monofilament; reflex hammer; vials of aromatic
substances to smell; vials of sweet, salty, sour, and bitter solutions to taste; test tubes of hot and
cold water

Physiological Examination Findings

Mental Status
Appearance and behavior (Grooming, emotional status Well-groomed. Well-behaved and was
and body language) very ready for the physical assessment.

Cognitive abilities (State of consciousness, memory, Knows the date, time, and where she
attention span, judgment) was.

Emotional stability (Moods and feelings, thought Emotionally stable. With good thought
process and content) process and content.

Speech and language (Voice quality, articulation, When talking, she was coherent and
comprehension, coherence, ability to communicate) articulate. Able to communicate well.

Coordination and Fine Motor Skills

Rapid Alternating Movement: Patient pats knees with Patient can pat her knees with both
both hands, alternating supination and pronation. hands, alternating supination and
pronation.
Rapid Alternating Movement: Patient touch thumb to Patient was able to touch thumb to each
each finger on same hand. finger on same hand, effortless.

Accuracy of Movement: Patient touches examiner’s
finger with own index finger.
Accuracy of Movement: Patient touches nose with
index finger.
Accuracy of Movement: Patient move heel up and
down shin.
Cerebellar (Proprioception)
Balance: Romberg test
Patient was able to accurately, without
any gap or pause touches examiner’s
finger with own index finger.
Patient was able to accurately, without
any gap or pause touches nose with
index finger.
Patient was able to accurately, without
any gap or pause move heel up and
down shin.
Negative Romberg test. She can
maintain posture and balance, although
there was a slight swaying.

Adapted from Seidel, H.; Ball, J.; Dains, J.; Flynn, J; Solomon, B.; & Stewart, R. (2011)Mosby’s
Guide to Physical Examination (7th edition). St. Louis: Mosby/Elsevier
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Physiological Examination Findings

Balance: Balance Recovery Can recover and balance well when
slightly pushed.
Balance: Standing and hopping in one place Can stand well, with postural control,
and has ability to maintain posture. Can
hop in one place. No problem observed.
Gait During her walk, her gait was smooth,
rhythmic, and effortless; the opposing
arm swing is coordinated; turns are
smooth.
Gait: Heel-toe walking (only if an unexpected gait is Can perfectly do this. Can walk straight
evaluated) and stay balanced.

Reflexes
Biceps Upon testing, I can both feel and see
the normal response of the patient,
which is flexion of the forearm.
Triceps Upon striking the triceps tendon,
patient’s forearm extended.
Brachioradials Upon assessing this, the patient’s
forearm produced flexion and
supination.
Abdominal By scraping the skin on the abdomen
towards the umbilicus, there was
muscle contraction of the abdominal
muscle.
Patellar Upon striking the tendon directly just
below the patella, extension of the
lower leg was the patient’s response.
Achilles Upon striking the Achilles tendon, the
patient’s foot plantar flexes against my
hand.
Plantar (Babinski sign) Upon doing the test, there was a plantar
flexion of the toes.
Clonus (only if the reflexes are hyperactive) NO hyperactive reflexes.

Primary Sensory Functions

Superficial touch sensation
Superficial pain sensation
Temperature and deep pressure sensation (only if
superficial pain sensation is not intact)
Touch was felt as claimed by the
patient when a wisp of cotton was
applied to the skin.
Superficial pain sensation was intact.
Can feel the sharp edge of the item used
when doing this test.
Intact superficial pain sensation.

Protective sensation-5.07 Monofilament (only if pt is Patient was not diabetic.

diabetic and/or has peripheral neuropathy)

Vibration sensation Upon doing this test, the patient was

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able to feel the vibration or a buzzing

sensation on distal areas.
Joint position sensation When holding the patients index finger,
and instructed her to close her eyes, and
identify if the movement of that
particular finger is either up or down,
she can identify.
Cortical Sensory Functions
Stereognosis Can able to identify and name the
object placed on her hands with her
fingers and with eyes closed.

Adapted from Seidel, H.; Ball, J.; Dains, J.; Flynn, J; Solomon, B.; & Stewart, R. (2011)Mosby’s
Guide to Physical Examination (7th edition). St. Louis: Mosby/Elsevier

Physiological Examination Findings

Two-points discrimination Can able to identify the two compass
points simultaneously. With about 3cm
minimal distance from each points,
where she cannot distinguish.
Extinction phenomenon The patient was be able to perceive two
touches when touched in two different
areas of the body.
Graphesthesia Can identify characters written on the
skin upon using dull pointed object.
Point location Upon doing this test, the patient was
able to determine the points touched in
the same place.
Cranial Nerves
I (olfactory) tested only if verbalization of decreased Was able to properly smell the iodine.
sense of smell and/or abnormality found

II (optic) No visual loss. Can read without

hesitancy and without moving the card
closer or farther away.
IV (trochlear) Can follow a moving target, by cardinal
positions of gaze.
V (trigeminal) Facial sensation felt with sharp or dull
object. Can blink normally, no
weakness noted.
VI (abducens) With intact abducens nerve function.
Eyes can follow movement without
moving her head.
VII (facial) sense of taste tested only if verbalization No unusualities noted. With complete
of decreased sense of taste and/or abnormality found closure of eyes when asked to close
eyes. No facial weakness overserved
and noted.
VIII (acoustic) No auditory problem known. Can hear
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words clearly even when whispering.

IX (glossopharyngeal) sense of taste tested only if No verbalization of decreased sense of
verbalization of decreased sense of taste and/or taste as claimed.
abnormality found

X (vagus) No problem in this nerve. Gag reflex

present.
XI (Spinal accessory) No verbalization of decreased sense of
taste as claimed.
XII (hypoglossal) No weakness noted upon doing this
test. Present strong resistance noted
when downward force applied on the
shoulders.
Practice Special Tests:Meningeal signs (Brudzinski Negative brudzinski and kernig signs.
sign and Kernig sign)

Adapted from Seidel, H.; Ball, J.; Dains, J.; Flynn, J; Solomon, B.; & Stewart, R. (2011)Mosby’s
Guide to Physical Examination (7th edition). St. Louis: Mosby/Elsevier