ASSESSMENT OF THE MUSCULAR AND

NEUROLOGIC 2 PERFORMANCE CHECKLIST

Instruction: Each indicator of performance below is followed by possible responses. Please answer
this performance checklist by checking any of the scales which best describe the student nurse’s
performance

LEVEL OF PERFORMANCE INDICATOR

4= Excellent- Performed the skills with excellent knowledge, organization,

Time management and professional.
3= Satisfactory - Performed skills with satisfactory knowledge, organization,
time management and professionalism.
2= Needs Improvement- Performed skills with limited knowledge, organization,
time management and professionalism.
1= Not performed- Performance of the needed skills is not evident

MUSCULOSKELETAL and Neurologic Assessment

Assessing the arm 4 3 2 1

Inspect: contour, symmetry, skin characteristics, and hair distribution

and nail integrity

Palpate: Perform a capillary time refill test and palpate radial and
brachial pulse and note for rhythm

Instruct the patient to close his/her eyes and ask the patient to say
“NOW” if he feel the touch of the cotton balls in the arms

Test sensory function of both arm by identifying the sensation if DULL

or SHARP using ballpen or pencil”

Test the vibration sensation using tuning fork at finger and wrist

Test position or kinesthesia of the finger. Instruct the client to close

his/her eyes. Ask the patient if he can identify the movement by UP or
DOWN.

Test the tactile discrimination. Put the coin at the palm of the patient
and let the patient identify the object.

Test the graphesthesia. Ask the client to close his/her eyes and the let
the client identify what number the examiner will draw (using blunt
object) at the palm of the patient
Test the point extinction. Touch the skin fo the patient at the arm and
withdraw immediately. Ask the patient how many sensation are felt
and where they are

Instruct the patient to walk across the room in his/her regular walk,
turn then walk back toward you, in heel- to- toe fashion

Ask the patient to walk on the toes for a few steps, then to walk on the
heels for a few steps

Elicit deep tendon reflex

1. Bicep reflex
2. Tricep reflex
3. Brachialradialis reflex

Assess the cerebellar function of the arm

Perform a rapid finger thumb opposition

Assess point to point localization. Finger to finger test (finger to nose

and vice versa)

Instruct the patient to close his eyes and ask the patient to touch his
nose using his/her index finger alternately gradually increasing the
speed

Stand close and check Romberg signs

Assessing the leg 4 3 2 1

Inspect: contour, symmetry, skin characteristics, and hair distribution

Palpate the leg temperature using the back of your hand from distal to
proximal

Flex the knee of the patient and palpate the calf muscle against the
tibia and perform dorsiflexion

Palpate pulses in the lower extremities

- Femoral
- Popliteal pulse
- Posterior tibialis pulse
- Dorsalis pedis
 Palpate the foot and test for presence of edema by pressing finger at
the tibia or at the foot for 5 seconds

Assess light, pain, vibration sensation

Assess patient deep tendon reflexes at the lower extremeties

- Quadriceps (knee jerk) reflex

- Achilles reflex
- Plantar reflex (Babinski)

Test a cerebellar function of the leg (heel to shin test)

Ask the patient to walk across the room in his/her regular walk, turn
then walk back toward you, in heel- to- toe fashion

Ask the patient to walk on the toes for a few steps, then to walk on the
heels for a few steps

Stand close and check Romberg signs

Remarks

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CLINICAL INSTRUCTOR

ASSESSMENT OF THE MUSCULOSKELETAL

PERFORMANCE CHECKLIST
Instruction: Each indicator of performance below is followed by possible responses. Please answer this
performance checklist by checking any of the scales which best describe the student nurse’s performance

LEVEL OF PERFORMANCE INDICATOR

4= Excellent- Performed the skills with excellent knowledge, organization,

Time management and professional.
3= Satisfactory - Performed skills with satisfactory knowledge, organization,
time management and professionalism.
2= Needs Improvement- Performed skills with limited knowledge, organization,
time management and professionalism.
1= Not performed- Performance of the needed skills is not evident

Remarks

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_____________________________________________________________________________________
_____________________________________________________________________________________

________________________
CLINICAL INSTRUCTOR