Nursing Care of patient with Neurological Problem

1. PRESENTATION ON
NEUROLOGICAL EXAMINATION
MR.VEERABHADRA.B.B
ASST PROFESSOR DEPT OF MEDICAL SURGICAL
NSG

2. THE OBJECTIVE OF A NEUROLOGICAL EXAM
 To identify an abnormality in the nervous system.
 To differentiated peripheral from central nervous
system lesions.
 To establish internal consistency, i.e
Does the patient cooperate fully?
The findings in a specific patient only a variant
of normality?

3. ARTICLES REQUIRED
 Flashlight
 Newspaper (or other printed material)
 Otoscope / Opthalmoscope.
 Sterile needle
 Tape measure
 Tongue depressor
 Various objects of different shapes (key, marble,
coin)
 Vials (stoppered) containing coffee or other familiar
aromatic substances, salt, vinegar, and hot and
cold water

4. REQUIRED TOOLS ARE

5. PREPARING THE PATIENT AND
YOURSELF FOR THE EXAM
 Explain the procedure
 The patient should be awake and alert,
 The room should be quiet and adequately
illuminated.
 Pt is sitting on the examining table facing the
examiner
 Privacy should be provided
 Keep necessary articles near the examination table
 Wash the hands
 Warm up the hands

6. A COMPREHENSIVE HISTORY
1. DEMOGRAPHICAL DATA
2. CURRENT HEALTH
1. Chief complaints
2. Symptom analysis
3. PAST HISTORY
a.Childhood infectious diseases,
Immunization
b. Major illness
c. Growth and development
4. PSYCHO- SOCIAL HISTROY:
5. REVIEW OF SYSTEMS (Head to toe assessment)

7. 6. FAMILY HEALTH HISTORY
Diseases and conditions influenced
by genetic factors
 • Alzheimer’s disease
 • Amyotrophic lateral sclerosis (ALS)
 • Duchenne muscular dystrophy
 • Epilepsy
 • Friedrich ataxia
 • Huntington disease
 • Myotonic dystrophy
 • Neurofibromatosis type I
 • Parkinson’s disease
 • Spina bifida
 • Tourette syndrome

8. COMMON MALFUNCTIONS
Central Nervous System.
In the brain
 There can be interference of nerve impulses,
 Impairment of autonomic functions,
 Impairment of thinking processes,
 Impairment of visual function, hearing, and
speaking
 Impairment of muscle coordination.

9. .
continued
In the spinal cord,
possible problems include
 impairment of the spinal cord reflex arc,
 impairment of touch
 impairment of movement.
Peripheral Nervous System.
 Problems in the range of motion of a body part.
 Another possible malfunction in this system is nerve
paralysis.

10. GENERALIZED NEUROLOGICAL
EXAMINATION COMPONENTS
As the patient enters the room, check the following:
a. Posture and motor behavior.
b. Dress, grooming, and personal hygiene.
c. Facial expression.
d. Speech.
e. Manner, mood, and relation to persons and things
around him.

11. DETAILED NEUROLOGIC
EXAMINATION
Mental Status.
(1)Level of consciousness.
Determine the patient's level of consciousness -- alert, lethargic,
stupor, semicoma, or coma.
(2) Calculations in basic mathematics.
(3) Affect/mood: verbal and nonverbal behavior.
(4) Memory (recent and remote).
(5) Knowledge (normal intellect). Idioms

12. CEREBELLAR FUNCTIONS.
These include tests for balance and coordination.
 The cerebellum controls the skeletal muscles and
 coordinates voluntary muscular movement.
includes
(1)Finger-to-nose test.
(2) Rapid alternating movements test.
(3) Romberg test. To examine cerebellar ataxia or vestibular
dysfunction.)
(4) Normal gait and heel-toe-heel walking.

13. COORDINATION TEST
1. Romberg test
Stand with feel together and arm at the
Side, both with eye closed and eye open
stand for 20-30 sec.

14. MOTOR FUNCTION.
(1)Check for mild weakness. Have the patient stand
with his arms outstretched, palms upward, eyes
closed for 20 to 30 seconds. If one arm drops and
the hand turns over slightly, he has mild weakness
called the pronator sign.
 (2) Check muscle tone. If the patient is in bed, lift
one of his limbs from the bed and watch it fall.

15. .
 (3) Check muscle strength

16. CRANIAL NERVES.
Instruct the patient to smile and raise his eyebrows.
Movement of both eyebrows.
Sensory Function.
(1)Test for pain.
(2) Test for touch.

17. REFLEXES.
1. BICEPS REFLEX
2. TRICEPS REFLEX
3. BRACHIO RADIALIS REFLEX
4. PATELLAR REFLEX
5. ANKLE REFLEX
6. CLONOUS
7. SUPERFICIAL REFLEX

18. 1. Biceps reflex
Response is flexion at the elbow and
contraction of the biceps

19. 2. Triceps reflex
*Tap to triceps brachii tendon directly above the
olecranon process.
*Response is extension of the elbow and
contraction of the triceps muscle

20. 3. Brachio radialis reflex.
*Strike over the Brachioradialis tendon
*Response is flexion and supination of the
fore arm

21. 4. Patellar reflex
*Tap the tendon directly.
*Response is contraction of the quadriceps
and knee extension are normal

22. 5. Ankle reflex (achilles reflex)
*Achilles tendon
*Response is plantar flexion

23. 6. Clonus reflex
Clonus is a serious of involuntary rhythmic
, muscular contraction.
Unsustained clonus is normal

24. 7. Corneal reflex
Blink and tearing are normal

25. 8. Gag reflex
Equal elevation of the uvula and gag
with stimulation

26. 9. Plantar reflex
*Sole of the foot is stimulated using sharp
objects.
*Flexion of the toe is normal response

27.  THANK YOU…………..