Neurological examination


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Neurological examination

  2. 2. INTRODUCTION…• The purpose of neurologicalexamination is to determine thepresence or absence of disease in thenervous system.• Nurses are involve in examining theneurological & physical status of thepatient as part of the total
  3. 3. Aspects of NeurologicalExamination…1. Levels of consciousness2. Mental status examination3. Special cerebral functions4. Cranial nerve function5. Motor function6. Sensory function7. Cerebellar function8.
  4. 4. 1. Levels of consciousness:Assessment of levels of consciousnessincludes following categories:a. Alertness: Patient is awake, respondsimmediately & appropriately to allverbal stimuli.b. Lethargic: Patient is drowsy &inattentive but arouses easily,frequently off to sleep.c. Stuporous: He arouses with greatdifficulty & co-operates minimally whenstimulated.
  5. 5. Count…d. Semi-comatose: The patient has lost hisability to respond to verbal stimuli.There is some response to painfulstimuli. Little motor function is seen.e. Comatose: When the patient isstimulated there is no response toverbal or painful stimuli, no motoractivity is seen. The Glasgow coma scaleis widely used to measure the patient’slevel of
  6. 6. 2. Mental status examination:• The components of mental statusexamination include the assessment forfollowing categories; Generalappearance, speech, thought process,mood, cognitive functions, attention,concentration, orientation, memory,general knowledge, abstract reasoning,judgment &
  7. 7. 3. Special cerebral functions:• Assess for agnosia, apraxia & aphasia.• Agnosia – inability to recognizecommon objects through the senses• Apraxia – patient cannot carry outskilled act in the absence of paralysis.• Aphasia – inability to
  8. 8. 4. Cranial nerve examinationCranial nerve (CN) examination provides informationabout the brainstem & related pathways.• Olfactory nerve (CN I)• Optic nerve (CN II)• Oculomotor (CN III)• Trochlear (CN IV)• Trigeminal (CN V)• Abducens (CN VI)• Facial nerve (VII)• Vestibulocochlear orAcoustic nerve (CN VIII)• Glossopharyngeal (CN IX)• Vagus (CN X)• Spinal accessory nerve (CNXI)• Hypoglossal nerve (CN XII)
  9. 9. 5. Motor function:• Assessment of motor function involvesassessing for muscle size, muscle strength,muscle tone, muscle co-ordination, gait &movement.Muscle size: Inspect all major musclegroups bilaterally for symmetry,hypertrophy, & atrophy.Muscle Strength: Assess the power inmajor muscle groups against resistance.Assess & rate muscle strength on a 5-pointscale in all four extremities, comparingone side with
  10. 10. Count…Muscle tone: Assess muscle tone whilemoving each extremity through itsrange of passive motion. When tone isdecreased (hypotonicity), the muscleare soft, flabby, or flaccid; when tone isincreased (hypertonicity), the musclesare resistant to movement, rigid, orspastic. Note the presence of abnormalflexion or extension posture.Muscle coordination: Disorders relatedto coordination indicate Cerebellar orposterior column
  11. 11. Count…Gait & station: Assess gait station by havingthe patient stand still, walk & in tandem(one foot in front of the other in a straightline). Walking involves the functions ofmotor power, sensation & coordination. Theability to stand quietly with the feettogether requires coordination & intactproprioception (sense of body position).Movement: Examine the muscles for fine &gross abnormal movements. Move all thepoints through a full range of passivemotion. Abnormal findings include pain,joint contractures, & muscle
  12. 12. 6. Sensory function:• Sensory assessment involves testing fortouch, pain, vibration & discrimination.• A complete sensory examination is possibleonly on a conscious & co-operative patient.• Always test sensation with patient’s eyeclosed.• Help the patient relax & keep warm.• Conduct sensory assessment systematically.• Test a particular area of the body, & thentest the corresponding are on the
  13. 13. 7. Assessment of cerebellar function:• For evaluation of balance & co-ordination thetests used are:a. Finger to finger test: It is performed byinstructing the patient to place her indexfinger on the nurse’s index finder. He is askedto repeat this for several times in successionon both sides.b. Finger to nose test: Tell the patient to extendhis index finger & then touch the tip of hisnose several times in rapid succession. Thistest is done with patient’s eyes both open &
  14. 14. Count…c. Romberg test: Here the nurse instructsthe patient to stand with his feet togetherwith arms positioned at his sides. He istold to close his eyes. This position ismaintained for 10 seconds. This test isconsidered positive only if there is actualloss of balance.d. Tandom walking test: This is tested byhaving the patient assume a normalstanding position. He is then instructed towalk over heel on a straight line. Anyunsteadiness, lurching or broadening ofthe gait base is
  15. 15. 8. Reflex activity:• Reflex testing evaluates the integrity ofspecific sensory & motor pathways.• Reflex activity assessment, always a partof neurologic assessment, providesinformation about the nature, location,& progression of neurologic disorders.• Normal reflexes: Two types of reflexesare normally present:I. Superficial or cutaneous reflexesII. Deep tendon muscle-stretch
  16. 16. Count…I. Superficial(cutaneous)reflexes: Abdominal reflex Plantar reflex Corneal reflex Pharyngeal (Gag)reflex Cremasteric reflex Anal reflexII. Deep tendon (muscle-stretch) reflexes: A biceps jerk (forearmflexion) A triceps jerk (forearmextension) A brachioradial jerk A knee jerk, quadricepsjerk or patellar reflex An ankle jerk(plantiflexion of thefoot)
  17. 17. Count…Abnormal reflexes:Babinski’s reflexJaw reflexPalm-chin (Palmomental) reflexClonusSnout reflexRooting reflexSucking reflexGlabella reflexGrasp reflexChewing
  18. 18. Nurses role in neurologicalexamination…• Provide a clam, suitable environment• Collect the personal data with patient &family members• Set the equipment needed for neurologicalexamination• Assess the current level of consciousness,monitor vital parameters – temperature,pulse, respiration, blood pressure, pupillaryreaction, whether decerebrating ordecorticating.• Thorough mental status examinationshould be done & recorded
  19. 19. Count…• Assessment of cranial nerves should bedone correctly & recorded.• Assessment of motor, sensory & cerebellarfunctions should be done & be recordedaccurately.• During the examination, she shouldmaintain a good support with patient &family members• She should instruct the procedure correctly& then they should be asked to do it.• Should be informed to the concerned unitdoctors if there is any
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