Part 1: Neurological history and physical


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This is a power point presentation that a student completed for an independent study in his BSN program. It covers the basics of the nurse driven neurological history and physical.

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  • Neuroscience of Nursing Ellen Barker, pg 53
  • Barker pg 54
  • Advanced Health Assessment, Jarvis Chapter 23, pg 660-662
  • Advanced Health Assessment, Jarvis pg 656
  • Advanced Health Assessment, Jarvis pg. 657
  • Advanced Health Assessment, Jarvis pg 657
  • Advanced Health Assessment, Jarvis pg 657 and pg 662
  • Cranial Nerves website
  • Cranial Nerve Website
  • Neurological Examination Website
  • Patty Noah, RN MSN CNRN, Neurological Assessment: Refresher,, published online: September 1, 2004
  • Hickey
  • Part 1: Neurological history and physical

    1. 1. Assessment, Interventions, & Outcomes By: Ryan Lueck
    2. 2. Assessment is one of the key factors that provides the information a nurse needs to provide good, quality health care. Key Points: Purpose for Assessment, Assessment Guidelines, Intervention options, and Possible Outcomes Advanced Assessment Practices Specified to Neurological System on Adult Population
    3. 3. Important information to know prior to assessment • Location, nature, and effect of the lesion or area of the nervous system. • After assessment the clinician will be able to identify trouble areas affecting the nervous system, abnormal signs and symptoms of the patient, and be able to select proper interventions
    4. 4.  Level of Consciousness (LOC) • Arousal Level • Orientation  Glascow Coma Scale (GCS) • Eye Response • Verbal Response • Motor Response  Cranial Nerves • 12 pairs of Cranial Nerves  Motor Function • Commands • Body Movements  Reflexes • Superficial Reflexes • Pathologic • Visceral • Deep Tendon Reflexes  Autonomic Responses • Sympathetic Nervous System • Parasympathetic Nervous System  Pain Stimuli • Central • Peripheral  Vital Signs
    5. 5.  Central Nervous System • Cerebral Cortex • Cerebellum • Basal Ganglia • Hypothalamus • Thalamus • Brain Stem • Spinal Cord  Peripheral Nervous System • Reflex Arc • Cranial Nerves • Spinal Nerves • Autonomic Nervous System
    6. 6.  Cerebral Cortex • Responsible for highest functioning behaviors  Thought  Reasoning  Sensation  Voluntary Movement • Divided into two hemispheres and four lobes  Left and Right hemisphere  95% of the population is Left Dominant  Four Lobes  Frontal: Behavior, Emotions, Intellectual Function  Temporal: Auditory, Taste, Smell  Parietal: Sensory  Occipital: Vision
    7. 7.  Cerebellum • Controls motor coordination of voluntary muscle movements, muscle tone, and equilibrium  Basal Ganglia • Controls automatic associated movements of the body  Hypothalamus • Control over many vital functions: Temperature, heart rate, and blood pressure control. Also regulates sleep center, pituitary gland hormonal release, and coordination of autonomic nervous system activity and emotional status
    8. 8. Thalamus • “Main Relay Station” for the nervous system; Sensory pathways of the spinal cord and brainstem form synapses; conduction of nerve impulses to the appropriate areas.
    9. 9.  Brain Stem • Composed of: Midbrain, Pons, and Medulla  Midbrain: merges spinal cord transmissions to the thalamus and hypothalamus; it contains many motor neurons and tracts  Pons: enlarged area containing fiber tracts, ascending and descending.  Medulla: continuation of spinal cord, contains fiber tracts that control autonomic functions (i.e. respiration, heart rate, GI function); also location pyramidal decussation: the crossing of nerve fibers (Left to Right motor movement=Inverse relations ship L and R hemisphere).
    10. 10. Spinal Cord • Responsible for sending nerve impulses from spinal nerves to the brain; allowing a link from the brain to the body. • Dermatome Chart: A chart that displays correlations between certain areas of skin to particular spinal cord segments. (see pg. 662)
    11. 11. Dermatome – a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve. Dermatome assessment involves sensation to particular parts of the body in regards to spinal cord involvement. Usually assessed when injury to spinal cord occurs. Each level assessed can pinpoint the level of injury.
    12. 12. 12 pairs of Cranial Nerves: Labeled I-XII (use of Roman Numerals)  I – Olfactory Nerve • Travels through the Cribiform plate • Sensation Tested: Smell  II – Optic Nerve • Travels through the optic canal • Sensation Tested: Sight  III – Oculomotor • Travels through the Superior Orbital Fissure • Somatic Motor Tested: Movement of superior, medial, inferior rectus and inferior oblique muscle attached to the eye (Extraocular Movements: EOM’s) • Visceral Motor Tested: Sphincter Pupillae (Dilation and constriction of pupils to light
    13. 13.  IV – Trochlear Nerve • Travels through the Superior Orbital Fissure • Somatic Motor Tested: Movement of superior oblique muscle movement (EOM’s)  V – Trigeminal Nerve • Composed of several nerves labeled V1, V2, and V3 • V1 travels through the superior orbital fissure • V2 travels through the foramen rotundum • V3 travels through the foramen ovale • Somatic Motor Tested: Mastication (chewing), Tensor Tympani (located in auditory canal: Dampens extra sounds), and Tensor Palati (assists with chewing) • Sensation Tested: Feeling to the Face
    14. 14.  VI – Abducens Nerve • Travels through the superior orbital fissure • Somatic Motor Tested: Lateral Rectus (Lateral EOM’s)  VII – Facial Nerve • Travels through the Internal Auditory Canal • Somatic Sensory Tested: Posterior External Ear Canal • Special Sensory Tested: Taste (involves 2/3 of the anterior tongue) • Somatic Motor Tested: Facial movement and expressions • Visceral Motor Tested: Salivary Glands and Lacrimal Glands  VIII – Vestibulocochlear Nerve • Travels through the Internal Auditory Canal • Special Sensory Tested: Auditory and Balance
    15. 15. IX – Glossopharyngeal Nerve • Travels through the Jugular Foramen • Somatic Sensory Tested: 1/3 of the posterior tongue and Middle Ear • Visceral Sensory Tested: Carotid body and sinus • Special Sensory Tested: Taste (Posterior 1/3 of the tongue • Somatic Motor Tested: Stylopharyngeas (dilates esophagus to facilitate swallowing large food bolus) • Visceral Motor Tested: Parotid Gland (salivation)
    16. 16. X – Vagus Nerve • Travels through the Jugular Foramen • Somatic Sensory Tested: External Ear • Visceral Sensory Tested: Aortic Arch/Body • Special Sensory Tested: Taste over the Epiglottis • Somatic Motor Tested: Soft palate, pharynx, and Larynx (vocalization and swallowing) • Visceral Motor Tested: Bronchoconstriction, Peristalsis, Bradycardia, and Vomitting
    17. 17. XI – Spinal Accessory Nerve • Travels through the Jugular Foramen • Somatic Motor Tested: Trapezius and Sternocleidomastoid movement (shoulder shrug) XII – Hypoglossal Nerve • Travels through the Hypoglossal Canal • Somatic Motor Tested: Tongue Movement
    18. 18.  Tools Needed to perform assessment • Pen light • Cotton swabs with wooden handle • Reflex Hammer • Tuning Fork  Breakdown of Exam • Mental Status (Level of Consciousness and Orientation) • Cranial Nerves • Motor (Fine Motor and Gross Motor movements) • Coordination and Gait • Reflexes • Sensory (Dermatomes) • Special Tests (snellen chart and tuning fork)
    19. 19. Level of Consciousness Terms Full Level of Consciousness: Awake, Alert, and Attentive; if patient is sleeping, easily awaken to minor external stimulus Lethargy: Awake but Drowsy, not fully attentive, slow response Obtunded: Not easily awaken, requires repeated stimulus to keep attention, slow to answer questions, will drift to sleep frequently, difficulty following simple commands Stupor: Constant stimulus needed, usually painful stimuli needed, no commands, no attention span, minimal response from patient Coma: No response from patient on cognitive level, even with constant painful stimuli, no motor movement unless spinal reflex; unable to arouse patient Glascow Coma Scale: Assessment tool that checks patient arousal, orientation, and motor function
    20. 20.  Arousal Level • Arousal to stimuli or no stimuli  Opens eyes spontaneously (No stimulus needed)  Auditory Stimuli (voice)  Tactile Stimuli (gentle touch or shake)  Painful Stimuli (Peripheral or Central) • Response to Stimuli  Purposeful (moves away from stimuli, location of stimuli)  Non-purposeful (Spontaneous movements disregard of stimuli or posturing: Decerebration or Decortication)  Unresponsive (no response to any stimuli) • Orientation  Ability to answer questions regarding memory  Name  Place (Location)  Time (time, day, month, or year)  Situation (why patient is needing exam)