Unit # ll

ASSESSMENT OF THE MENTAL

STATUS AND SENSORY NEURO
SYSTEM
Amanullah khan
Generic BSN
Instructor In
Rehman Institute of Nursing of
Nursing And Health Sciences
 Objectives
• By the end of the unit, learners will be able to
– Structure and function of Nervous System.
– Perform mental status examination of a client.
– Assess cranial nerve, sensory, sense of
proprioception and cerebellar functions and deep
tendon reflexes.
– Document findings.
– List the changes in the nervous system that are
characteristics of the aging process.

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• Structure and Function
• Subjective Data—Health
History Questions
• Objective Data—The Physical
Exam
• Abnormal Findings
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Structure and Function
Nervous system- divided into 2 structural
parts:
Central Nervous System (CNS)- brain &
spinal cord . Foraman magnum to the L1/L2
Peripheral Nervous System – cranial nerves
(carry impulses to and from brain) & spinal
nerve (carry messages to and from spinal
cord
Central Nervous System (CNS) • Hypothalamus
stem

Cerebral
cortex • Cerebellum
– Frontal lobe
• Brainstem
– Parietal lobe
– Occipital – Midbrain
lobe – Pons
– Wernicke
’s area – Medulla
– Broca’s • Spinal cord
area
• Thalamus
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 Neurons – The Building Blocks of Our
Mental Computer

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 Basic Anatomy
• Impulses transmitted by:
• Neurons- Basic structures for receiving and
sending signals.
• Dendrites – receive signals
• Axons – send signals
• Synapse is space between axon and
dendrite.

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 Brain
• Cerebrum
– Largest part of the brain, composed of 2 hemispheres
and 4 lobes. Frontal, parietal, temporal and occipital.
• Cerebrum
• Frontal - Conceptualization, motor ability and
judgment, thought process, emotions.
• Parietal – Interpretation of sensory information,
ability to recognize body parts.
• Temporal – memory storage, integration of
auditory stimuli.
• Occipital – Visual Center.
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 Components of CNS

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 Cerebellum
• Cerebellum- Keeps person oriented in space,
balance. Doesn’t initiate movement but
coordinates it
• Controls skeletal muscles
• Controls voluntary movements

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 Diencephalon
• Area between cerebral hemispheres and the
brainstem it contains:
• Thalamus –relay station for the nervous
system, sorts out impulses and directs them to
the cerebral cortex
• Hypothalamus –maintains homeostasis by
controlling vital functions: temperature, heart
rate, BP, pituitary regulator, emotions

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 Sensory Pathway

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 Motor Pathway

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 Brain Stem
• Brain stem – central core of the brain,
• contains midbrain, pons and medulla.
• Midbrain- contains many neurons and tracts
• Pons – Controls rhythmicity of respiration,
contains motor and sensory pathways.
• Medulla – Cardiac, respiratory, vasomotor
control. Swallow, gag and cough reflex.
• Motor and sensory fibers cross here.
• Spinal Cord – continues with the brain stem.
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 Cerebral Circulation
• Originates from carotid and vertebral arteries.

• Blood Brain Barrier: Prevents diffusion of toxic

substances and large molecules.

• Cerebrospinal fluid: Contains: no RBC’s, few

• WBC’s, Glucose 45-75mg/dl, Protein 15-45

mg/dl.
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 Structure and Function, cont.

Peripheral Nervous System

• Cranial nerves
• Spinal nerves
• Autonomic nervous system
• Reflex arc

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 Subjective Data—
Health History Questions
• Headache • Incoordination
• Head injury • Numbness or tingling
• Dizziness/vertigo • Difficulty swallowing
• Seizures • Difficulty speaking
• Tremors • Significant past history
• Weakness • Environmental/
• Syncope occupational hazards

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 Mental Status Assessment

• Level of Consciousness (LOC): alert,

Lethargic, somnolent, stuporous,
comatose.
• Orientation: person, place, time =
A&O x 3.
• Memory:

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 Cognitive Assessment
• Thought process
• Calculations
• Current events
• Proverbs
• Judgment & problem solving ability
• Communication abilities
• Emotion- Mood and affect
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 Health Maintenances
Activities
Sleep
Diet
Exercise
Use safe device
Health check up
Objective Data— The Physical Exam
• Preparation
– Screening neurologic examination
– Complete neurologic examination
– Neurologic recheck
• Equipment needed
– Penlight
– Tongue blade
– Cotton swab
– Cotton ball
– Tuning fork (128 Hz or 256 Hz)
– Khan
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 Objective Data—
The Physical Exam, cont.
• Cranial nerves – 12 pairs, motor,
sensory, mixed function. • VII—Facial
Test Cranial Nerves – Motor function: facial expressions
• I—Olfactory (sensory) – smell. – Sensory function: - taste

• II—Optic (sensory) – sight. • VIII—Acoustic (vestibulocochlear) –

hearing
• III— Oculomotor, (motor) – eye
movements • IX— Glossopharyngeal, – swallowing
• IV— Trochlear, (motor) – eye movements • X— Vagus – swallowing, gag
• V—Trigeminal (motor & sensory) chewing – Motor function
and pain sensations of face. – Sensory function
– Motor function • XI—Spinal accessory – trapezius,
– Sensory function
sternomastoid muscles

– Corneal reflex VI
• XII—Hypoglossal, – motor –
tongue.
• VI — Abducens (motor) eye movements
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 Cranial Nerve Assessment
• Trigeminal Nerve V
– sensory function
– Corneal Reflex Test
– Cotton ball light touch & Sharp and dull test on
Face

• Facial Nerve VII

– motor function
– Eye Blinking
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 Conti…
• Trigeminal Nerve
• : Motor Test

PERRLA 30
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 Objective Data—
The Physical Exam, cont.
• CEREBELLAR FUNCTION
Motor System—Inspect and
– Balance tests
Palpate • Gait – steady gait with arm swing, balance
• Muscles maintained.
– Size • Tandem walking
• Romberg test– Have pt. stand, feet
– Strength
together, arms side, eyes closed.
– Tone • Shallow knee bend
– Involuntary movements – Coordination and skilled movements
• Rapid alternating movements (RAM)
• Finger-to-finger test
• Finger-to-nose test – Eyes closed touch his
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finger to nose. Have pt. touch his fingertip
to your fingertip, alter position.
• Heel-to-shin test

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 Objective Data—
The Physical Exam, cont.
SENSORY SYSTEM • POSTERIOR COLUMN TRACT
• Person is alert, cooperative, – Vibration – tuning fork to bony
prominence
and comfortable
– Position (kinesthesia) – Grasp toe or
• Guidelines for sensory testing finger and move it up/down or side/
• Spinothalamic tract side.
– Pain – Tactile discrimination
– Temperature (fine touch)
• Stereognosis– place object in hand to
– Light touch
identify (coin, paperclip).
• Graphesthesia – trace letter or
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number on palm to identify.
• Two-point discrimination
• Extinction
• Point location
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 •Stereognosis
Graphesthesia

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 Finger-to-Nose Test

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 Rapid Alternating Heel to shin test
Movement

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 Objective Data—
The Physical Exam, cont.
• Test the stretch or deep
tendon reflexes (DTRs)
– Technique • Test the superficial reflexes
– Abdominal reflex
– Grading
– Cremasteric reflex
– Reinforcement – Plantar reflex
– Biceps reflex
– Triceps reflex
– Brachioradialis
reflex
– Quadriceps reflex
– Achilles reflex
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 –Biceps reflex
C5,C6.
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 Triceps reflex
C6, C7.
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 Brachioradialis reflex
C5,C6

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Khan
Let the Lower Legs Dangle Freely to Flex the Knee and
Stretch the Tendons. Strike the Tendon Directly Just
Below the Patella. L2,L3,L3. Quadriceps fomoris
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 Achilles reflex (“ankle jerk”)
S1 S2

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 Test the reflexes
• Copare right and left
• The response should be equal
– 4+ Very brisk, hyperactive with clonus (short
jerking contraction of the same muscle), indicative
of disease
– 3+ Brisker than average, may indicate disease
– 2+ average, normal
– 1+ diminished, low normal
– 0 no response
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 Objective Data—
The Physical Exam, cont.
• Neurologic recheck
• Level of consciousness
– Person
– Place
– Time
• Motor function
• Pupillary response
• Vital signs
Glasgow coma scale (GCS)
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Fully alert- 15, a score of 7 or less reflects coma. (Kozier p. 703-704)

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 Decorticate Rigidity (abnormal flexion)

Decerebrate Rigidity (abnormal rigidity)

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 Abnormal Findings
Abnormalities in Muscle Movement
Paralysis
• Loss or impairment of the ability to
move a body part, usually as a
result of damage to its nerve supply.
• Loss of sensation over a region of the
body.
Hemiplegia
• paralysis of one side of the body
Paraplegia
• paralysis of both lower limbs
due
to spinal disease or injury
Quadriplegia
• paralysis of all four limbs or
Paresis
of the entire body below the
• Partial motor Paralysis
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neck
Fasciculations
Rapid, continuous
twitching of resting
muscle
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 Repetitive twiching of
a muscle group

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 Myoclonus
Rapid, sudden jerk at a
fairly regular intervals
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 Tremor
Involuntary
contraction of
opposing muscle
groups

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 Chorea
Sudden, rapid, jerky,
purposeless movement
involving limbs, trunk, or
face
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  Athetosis

Slow, twisting,
writhing,
contiuous
movement,
resembling a
snake or worm

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 Abnormal Findings
Abnormal Gaits

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• Cerebellar ataxia
• Parkinsonian (festinating)
• Scissors
• Steppage or footdrop
• Waddling
• Short leg
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 Abnormal Findings
Common Patterns
of Sensory Loss

• Peripheral neuropathy
• Individual nerves or roots
• Spinal cord hemisection (Brown- Séquard
syndrome)
• Complete transection of spinal cord

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 Abnormal Findings
Abnormal Postures

• Decorticate rigidity
• Decerebrate rigidity
• Flaccid quadriplegia
• Opisthotonos

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 References

1. Bickley, L. S., Szilagyi, P. G., & Bates, B.

(2007). Bates' guide to physical
examination and history taking (11th Edi).
Philadelphia: Lippincott Williams &
Wilkins. Chapter No.06 & 07 p.n 171-250
2. Incredibly visual!
2nd Edition
3. Weber, Kelley's. (2007). Health Assessment
in Nursing, 3rd Ed: North American
Edition. Lippincott Williams & Wilkins.
Chapter No.14 &15 p.n 239-294
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