prepare for neural assessment

Prepare For Neural Assessment

NEUROLOGICAL EXAMINATION

This is a type of patient assessment which aims at detecting the functions of the cranial nerves in
relation to the five senses.

  •  Sight
  •  Hearing
  •  Smell
  •  Taste
  •  Touch or feeling

It is also an evaluation of a person’s nervous system. The nervous system consists of the brain, the spinal cord, and the nerves from these areas. There are many aspects of this exam, including an assessment of motor and sensory skills, balance and
coordination, mental status (the patient’s level of awareness and interaction with the environment),
reflexes, and functioning of the nerves.

Indications of a neurological exam

A complete neurological exam may be done:
1. During a routine physical
2. Following any type of trauma
3. To follow the progression of a disease
4. If the person has any of the following complaints:

  •  Headaches
  •  Blurry vision
  •  Change in behavior
  •  Fatigue
  •  Change in balance or coordination
  •  Numbness or tingling in the arms or legs
  •  Decrease in movement of the arms or legs
  •  Injury to the head, neck, or back
  •  Fever
  •  Seizures
  •  Slurred speech
  •  Weakness
  •  Tremor

5. Assess the level of consciousness.
6. Determine the extent of paresthesia (loss of senses in a body part).
7. Assess the function of the cranial nerves.

IMPORTANTS POINTS TO NOTE
 When carrying out this assessment, the substances used for example for sense of taste, smell,
touch or feeling should not be visualized by the patient so that they do not mention or describe
something because they had already seen, this is because it interferes with real findings.

EQUIPEMENT FOR THE PROCEDURE

Tray with

  •  Ophthalmoscope or torch to assess for pupil dilatation and constriction(eye reaction)
  •  Senelles chart to assess for visual acuity.
  •  Autoscope for viewing into the ear.
  • Tuning fork to evaluate for the hearing sense.
  • Pins or needles for sense of touch e.g pain or loss of sensensation in an area.
  • Cotton wool in a gallipot for tactile sensation
  •  A bottle of hot or cold water to assess for the sense of touch or even taste.
  • A bottle of salt and sugar for taste.
  • A bottle of coffee or lemon for sense of smell
  • Nasal speculum to inspect the nose.
  • Tape measure to measure areas that have lost senses of touch.
  • Skin pencil to demarcate areas of no sense of touch or feeling.
  • A patellar hammer to assess for tendon and motor reflexes.
    NB: If patients gait is to be assessed, then it requires one to walk so that the movements are
    well observed.
  • On the Bed-side
  • Hand washing equipment
    >Screen
    >Safety box
    >A good source of light at
    the bedside
Components of a neurological exam

The following is an overview of some of the areas that may be tested and evaluated during a neurological
exam:
Mental status:
These include the following
1. Level of awareness: may be assessed by conversing with the patient and establishing his or her
awareness of person, place, and time
2. Attentiveness: Is the patient paying attention to you and your questions or is he distractible and
requiring re-focusing?
3. Orientation: to self, place, time. Disorientation to time typically occurs before disorientation to
place or person. Disorientation to self is typically a sign of psychiatric disease.
4. Speech & language: includes fluency, repetition, comprehension, reading, writing, naming.
5. Memory: includes registration and retention.
6. Higher intellectual function: includes general knowledge, abstraction, judgment, insight and
reasoning.
7. Mood and affect: The primary purpose of assessing mood and affect in the neurological exam is
to determine if psychiatric disease may be interfering with the neurological assessment.

cranial nerves
Evaluation of the cranial nerves:

There are 12 cranial nerves. During a complete neurological exam, most of these nerves are evaluated
to help determine the functioning of the brain:

  1.  Cranial nerve I (olfactory nerve): This is the nerve of smell. The patient may be asked to identify
    different smells with his or her eyes closed.
  2.  Cranial nerve II (optic nerve): This nerve carries vision to the brain. A visual test may be given and
    the patient’s eye may be examined with a special light.
  3.  Cranial nerve III (oculomotor): This nerve is responsible for pupil size and certain movements of
    the eye. The patient’s healthcare provider may examine the pupil (the black part of the eye) with
    a light and have the patient follow the light in various directions.
  4.  Cranial nerve IV (trochlear nerve): This nerve also helps with the movement of the eyes.
  5.  Cranial nerve V (trigeminal nerve): This nerve allows for many functions, including the ability to
    feel the face, inside the mouth, and move the muscles involved with chewing. The patient’s
    healthcare provider may touch the face at different areas and watch the patient as he or she
    bites down.
  6.  Cranial nerve VI (abducens nerve): This nerve helps with the movement of the eyes. The patient
    may be asked to follow a light or finger to move the eyes.
  7.  Cranial nerve VII (facial nerve): This nerve is responsible for various functions, including the
    movement of the face muscle and taste. The patient may be asked to identify different tastes
    (sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.
  8.  Cranial nerve VIII (acoustic nerve): This nerve is the nerve of hearing. A hearing test may be
    performed on the patient.
  9.  Cranial nerve IX (glossopharyngeal nerve): This nerve is involved with taste and swallowing. Once
    again, the patient may be asked to identify different tastes on the back of the tongue. The gag
    reflex may be tested.
  10.  Cranial nerve X (vagus nerve): This nerve is mainly responsible for the ability to swallow, the gag
    reflex, some taste, and part of speech. The patient may be asked to swallow and a tongue blade
    may be used to elicit the gag response.
  11. Cranial nerve XI (accessory nerve): This nerve is involved in the movement of the shoulders and
    neck. The patient may be asked to turn his or her head from side to side against mild resistance,
    or to shrug the shoulders.
  12.  Cranial nerve XII (hypoglossal nerve): The final cranial nerve is mainly responsible for movement
    of the tongue. The patient may be instructed to stick out his or her tongue and speak.
Cranial Nerves Mneumonic to help you easily remember the cranial nerves
cranial-nerves-mnemonic
Nurses role in neurological examination
  1.  Provide a clam, suitable environment
  2.  Collect the personal data with patient &family members
  3. Set the equipment needed for neurological examination
  4. Assess the current level of consciousness, monitor vital parameters – temperature, pulse,
    respiration, blood pressure, pupillary reaction, whether decelerating or decorticating.
  5. Thorough mental status examination should be done & recorded
  6. Assessment of cranial nerves should be done correctly & recorded.
  7. Assessment of motor, sensory & cerebellar functions should be done & be recorded accurately.
  8. During the examination, she should maintain a good support with patient &family members.
  9. She should instruct the procedure correctly& then they should be asked to do it.
  10. Should be informed to the concerned un it doctors if there is any.

GLASSGOW COMA SCALE MONITORING

EYE OPENINGVERBAL RESPONSEMOTOR RESPONSESCORE
NoneNone None1
Eyes open to painIncomprehensible speech or soundsAbnormal Extension2
Eyes open to verbal CommandInappropriate responses Abnormal Flexion3
Eyes open spontaneouslyConfused conversationWithdrawals from pain4
Oriented Localizes pain5
Obeys Commands6

GRADING

A score of 13 above mild Level of Consciousness

A score between 9-12 moderate Level of Consciousness

A score below 8 severe Level of Consciousness

glassgow-coma-scale
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