Neurological Assessment

• Central Nervous SystemBrain Spinal Cord

• Peripheral Nervous System12 pairs of Cranial Nerves31 pairs of Spinal Nerves & Branches

1 11

http://www.bbc.co.uk/science/humanbody/index.shtml?game

spring 2012

2 22spring 2012

Spinal Nerves *

3 33spring 2012

Health History

• Headaches• Head Injury• Dizziness/ Vertigo/ Paresthesia• Seizures• Tremors, Weakness• Incoordination• Difficulty Swallowing and Speaking• Past History, Medications• Environmental Occupational Hazards

4 44spring 2012

Neuro Exam Equipment

• Penlight• Tongue Blade• Cotton Ball• Tuning Fork• Percussion Hammer• Tube of Hot & Cold Water

5 55spring 2012

Components of Mental Status Examination *

• Consciousness• Orientation• Language• Mood and Affect• Memory• Calculation Skills• Abstract Reasoning• Judgment• Thought Process & Perceptions

6 66spring 2012

Mental Examination Tools

• Mini-Mental Status Exam• Denver II Screening Test• Behavioral Checklist• Glasgow Coma Scale

7 77spring 2012

MMSE maximum score = 30

• 24 - 30 normal, depending on age, education, complaints20 - 23 mild 10 - 19 moderate1 - 9 severe0 profound

8spring 2012

9

Glasgow Coma Scale *

99spring 2012

Neuro Recheck

• Pupillary Response?

• Strength of extremities?

• LOC?

• Orientation?

101010spring 2012

Increased Intracranial Pressure*

Cushings Triad: • Sudden Elevation of SBP• Widening Pulse Pressure• Slow Bounding Pulse

111111spring 2012

Cranial Nerves

121212spring 2012

Sensory Assessment *

• ASSESSMENT:– Compare Distal to Proximal– Client’s Eyes are Closed– Explain Tests– Can Be Fatiguing

• Pain and Temperature

• Position and Vibration

• Light Touch

• Discriminative Sensations

131313spring 2012

Motor Assessment• Assessment

– Muscle size

– Strength and Mobility

– Tone

– Involuntary Movements• Cerebellar Function Assessment

• Observe Gait, Balance, Coordination• Perform Romberg Test• Finger to Nose Test• Rapid Alternate Movements• Heel to Shin Test

141414spring 2012

Motor Assessment

• Abnormal Gaits:– Ataxic (Cerebellar)– Hemiplegic– Parkinsonian – Scissors– Steppage (Foot Drop)– Waddling

151515spring 2012

Abnormal Muscle Movements

• Paralysis

• Fasciculation's

• Tic

• Myoclonus

161616spring 2012

Reflexes

• DTRs• Superficial Reflexes:

– Abdominal Reflex– Cremasteric Reflex

171717spring 2012

Speech Problems (APHASIAs)

• Global Aphasia

• Wernicke’s Aphasia

• Broca’s Aphasia

181818spring 2012

Health Promotion

• Identify Risk Factors for CVA

• Safe Travel

• Safe Recreation

191919spring 2012

Nursing Diagnoses

• Decreased Cerebral Perfusion

• Impaired Verbal Communication

• Unilateral Neglect

202020spring 2012