Chapter 60 Neuro

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Chapter 60
Assessment of Neurologic
Function

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Structure and Function of the Nervous
System
Central nervous system
o Brain and spinal cord
Peripheral nervous system
o Includes cranial and spinal nerves
o Autonomic and somatic systems
Basic functional unit—neuron
Controls all motor, sensory, autonomic, cognitive,
and behavioral activities

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Question #1
Is the following statement true or false?
The spinal cord is part of the central nervous system.

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Answer to Question #1
True
Rationale: The nervous system consists of two major
parts: the central nervous system (CNS), including
the brain and spinal cord, and the peripheral nervous
system, which includes the cranial nerves, spinal
nerves, and autonomic nervous system.

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Neuron

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Neurotransmitters
Communicate messages from one neuron to another
or to a specific target tissue
Neurotransmitters can potentiate, terminate, or
modulate a specific action or can excite or inhibit a
target cell
Many neurologic disorders are caused by an
imbalance in neurotransmitters
Refer to Table 60-1

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Brain

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Medial View of the Brain

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Bones and Sutures of the Skull

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Meninges and Related Structures

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Arterial Blood Supply of the Brain

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Cross-Section of the Spinal Cord Showing
the Major Spinal Tracts

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Cranial Nerves

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Dermatome Distribution

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Autonomic Nervous System
Functions to regulate activities of internal organs
and to maintain and restore internal homeostasis
Sympathetic nervous system
o “Fight-or-flight” responses
o Main neurotransmitter is norepinephrine
Parasympathetic nervous system
o Controls mostly visceral functions
o Main neurotransmitter is acetyl chlorine
Regulated by centers in the spinal cord, brainstem,
and hypothalamus

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Anatomy of the Autonomic Nervous
System

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Neurologic Assessment: Health History
Pain
Seizures
Dizziness (abnormal sensation of imbalance or
movement) and vertigo (illusion of movement,
usually rotation)
Visual disturbances
Weakness
Abnormal sensations
Past health, family, social history

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Neurologic Assessment
Consciousness and cognition: mental status,
intellectual function, thought content, emotional
status, language ability, impact on lifestyle
Cranial nerves
Motor system: muscle size, muscle tone and
strength, coordination and balance, Romberg test
Sensory system: tactile sensation, superficial
pain, temperature, vibration and position sense
(proprioception)
Reflexes: DTRs, biceps, triceps, brachioradialis,
patellar Achilles, superficial, pathologic, plantar
(Babinski)

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Figure Used to Record Muscle Strength

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Question #2
How many cranial nerves does the nurse have to
assess?
A. 10
B. 11
C. 12
D. 13

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Answer to Question #2
C. 12
Rationale: There are 12 pairs of cranial nerves that
emerge from the lower surface of the brain and pass
through the foramina in the skull.

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Gerontologic Considerations
Important to distinguish normal aging changes from
abnormal changes
Structural and physiologic changes
Motor and sensory alterations
Temperature regulation and pain perception
o Hypothalamus
Determine previous mental status for comparison.
Assess mental status carefully to distinguish
delirium from dementia

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Diagnostic Tests
 Computed tomography (CT)
 Positron emission tomography (PET)
 Single-photon emission computed tomography (SPECT)
 Magnetic resonance imaging (MRI)
 Cerebral angiography
 Myelography
 Noninvasive carotid flow studies
 Transcranial Doppler
 Electroencephalography (EEG)
 Electromyography (EMG)
 Nerve conduction studies, evoked potential studies
 Lumbar puncture, Queckenstedt test, and analysis of cerebrospinal
fluid

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Question #3
Is the following statement true or false?
Cerebral angiography is a radiograph of the spinal
subarachnoid space taken after the injection of a
contrast agent into the spinal subarachnoid space
through a lumbar puncture.

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Answer to Question #3
False
Rationale: Myelography is a radiograph of the spinal
subarachnoid space taken after the injection of a
contrast agent into the spinal subarachnoid space
through a lumbar puncture. Cerebral angiography is a
radiography study of the cerebral circulation with a
contrast agent injected into a selected artery.