Neurologic Assessment

Introduction
- a very complex neurologic system is responsible for coordinating and regulating all
body functions. It consists of two structural components: the central nervous system
(CNS) and the periphe)ral nervous system.

CENTRAL NERVOUS SYSTEM (CNS)

● is referred to as “central” because it combines information from the entire body and
coordinates activity across the whole organism.

● The central nervous system consists of the brain and spinal cord. It controls thought,
movement, and emotion, as well as breathing, heart rate, hormones, and body
temperature.

1. Brain - it contains four (4) lobes such as temporal, occipital, parietal, and frontal.

2. Spinal cord - it carries messages back and forth between the brain and the nerves that
run throughout the body.

PERIPHERAL NERVOUS SYSTEM (PNS)

● The peripheral nervous system refers to parts of the nervous system outside the brain
and spinal cord. It includes the cranial nerves, spinal nerves and their roots and
branches, peripheral nerves, and neuromuscular junctions.

● It includes the receptors, nerves, ganglia, and plexuses.

1. Sensory input (afferent)

2. Motor output (efferent)

GATHERING SUBJECTIVE DATA

- Gather information about neurological symptoms, such as headaches, dizziness,

weakness, numbness, or tremors.

- Chief complaint
- Presenting symptoms
 Inquire about the onset, duration, and progression of current symptoms.

- Inquire any history of neurological issues

- Family history
Inquire about any neurological conditions or hereditary factors within the family.

- Past Medical History

Ask about any health issues, surgeries, or treatments that might affect the
nervous system.

- Psychosocial History
Ask about any lifestyle factors, alcohol, substances, or sedentary lifestyle.

Motor Function:
Inquire about any changes in muscle strength, coordination, or motor skills. Ask
about difficulties with balance or coordination.

Sensory Function:
Explore changes in sensation, such as numbness, tingling, or altered perception.

Reflexes Function
ask the patient about their experiences and any symptoms that might suggest
issues with coordination, balance, or fine motor skills.

GATHERING OBJECTIVE DATA

● Types of Examination
- CRANIAL NERVES EXAMINATION

- SENSORY EXAMINATION

- MOTOR & CEREBELLAR EXAMINATION

-
- REFLEX EXAMINATION

Tools/Equipment for the assessment

General Equipment
 ● Gloves

CRANIAL NERVES TESTING

*Neurologic Assessment
OBJECTIVES:
● Define neurological assessment
● Identify the purpose mo of performing the neurological examination
● Know on how to obtain level of consciousness
● Identify different parameters in assessing a limb movement.
● Learn on how to fill up the neurological observation form.

*Neurologic Assessment
OUTLINE:

-Definition of Neurological Examination

-Nursing Assessment
-Level of Consciousness
-Neurological Observation Form
-Recommendations
-References

Neurologic Assessment (3rd slide)

WHY PERFORM A NEUROLOGICAL ASSESSMENT?

-Evaluation of the patient's neurological status

-Record a baseline data
-Monitor and detect early changes Successfully manage and treat

Neurologic Assessment (4th slide)

Level of consciousness is the most indicator of neurological condition.

Using the Neurological Observation Form, check the patient's level of consciousness.
LEVELS OF CONSCIOUSNESS:

A - Alert

V - Verbal Stimuli

P - Painful Stimuli

U - Unresponsive

Neurologic Assessment (5th slide)

Obtain Level of Consciousness by using:

-Adult Glasgow Coma Scale for adult patients.
-Pediatric Glasgow Coma Scale for pediatric patients.

Neurologic Assessment (6th slide)

The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired
consciousness in all types of acute medical and trauma patients. The scale assesses patients
according to three aspects of responsiveness: eye-opening, motor, and verbal responses.
GLASGOW COMA SCALE-used to record the neurological observation.

Interpretation:

best score = 15

worst score = 3
8 or less generally indicates coma; changes in baseline are most important.

A change in GCS of two or more points may be significant. If patient demonstrates deterioration,
as evidenced by a change in neurologic examination, notify immediately the doctor and
reevaluate the neurological status.

7th slide
PAINFUL STIMULI

Types of Stimuli include:

● Peripheral painful stimuli (LoC/Eye Opening)

● Central painful stimuli (Movement/Motor)

Central Painful Stimuli

● used to elicit a motor response
 ● Done by stimulating a cranial nerve, thus avoiding the possibility of eliciting a spinal
reflex.

Recommended Methods are:

● Trapezius twist (cranial nerve XI)

● Supra-orbital pressure (cranial nerve V)

● Jaw margin pressure (cranial nerve V)

8th slide
Trapezius Twist (Cranial Nerve XI)

● Using the thumb and two fingers as pincers.

● Take hold of about two inches of the muscle located at the angle where the neck and
shoulder meet.
● Twist and gradually apply increasing pressure for 10 to 20 seconds to elicit a response.
● NOTE: high level spinal cord injuries may interfere with assessment using Trapezius
twist.

9th slide
Supra-orbital Pressure (Cranial Nerve V)

● Place the flay of the thumb on the supra-orbital ridge (small notch below the inner part of
eyebrow). While the hand rests on the head of the patient.
● Apply gradually increasing pressure for 10 to 20 seconds to elicit a response.
● NOTE: supra-orbital pressure is NOT to be used with orbital, skull, facial fractures, or
frontal craniotomies.

10th slide

Jaw Margin Pressure (Cranial Nerve V)

● Place the flat of the thumb at the angle of the jaw at the maxilla-mandibular joint.
● Apply gradually increasing pressure for 10 to 20 seconds to elicit a response.
● NOTE: apply with caution in patient with intracranial pressure (ICP), as this may
increase ICP if venous return is compromised due to compression of jugular vein.
● NOTE: sternal rub is NOT recommended due to potential for severe bruising and
residual pain and discomfort.

11th slide

Neurologic Assessment:
EYE OPENING - assesses the function of the reticular activating system (RAS) extending from
brainstem through the thalamus to the cerebral cortex.

Pupillary Response:

1. PERRLA:

Pupils are Equal,

Round and -Reactive to -Light and Accommodation

2. Pupil size
3. Response to light
● Brisk
● Sluggish
● Nonreactive/fixed

ABNORMALITIES IN NEUROLOGICAL ASSESSMENT

1. Epilepsy - is a disorder of the brain characterized by repeated seizures. A seizure is

usually defined as a sudden alteration of behavior due to a temporary change in the
electrical functioning of the brain. Normally, the brain continuously generates tiny
electrical impulses in an orderly pattern.

2. Alzheimer's - is a type of dementia that affects memory, thinking and behavior.

Symptoms eventually grow severe enough to interfere with daily tasks.

3. Stroke - also called a brain attack. It occurs when something blocks blood supply to part
of the brain or when a blood vessel in the brain bursts.
n either case, parts of the brain become damaged or die. A stroke can cause lasting
brain damage, long-term disability, or even death