Neurological Assessment Lecture

Jun 24, 2024

Neurological Assessment Lecture

Introduction

  • Nurse Nancy from Harper College conducting assessment
  • Patient: Mr. Ruffman

Initial Questions

  • Stroke: No
  • Coordination/Brain Issues: No, including no meningitis or MS

Assessment Components

  1. Cranial Nerves
  2. Coordination
  3. Sensation
  4. Deep Tendon Reflexes

Mental State

  • Behavior: Awake, alert, cooperative, responsive
  • Cognition: Oriented to person, place, time, and situation
    • Questions: Month (August), Favorite President (Ronald Reagan), Current President (Obama), Name of Nurse (Nancy)
  • Appearance: Dress, affect, facial expressions appropriate
  • Depression/Suicide Screening: Required, state of Illinois
    • Questions: Felt like hurting yourself? (No), Depressed/unhappy (No)

Cranial Nerves

  1. Cranial Nerve II: Visual Acuity
    • Using Snellen Chart: 20/25 vision in both eyes
    • Confrontation Test: Peripheral vision intact
    • Tools: Card, Fingers
  2. Cranial Nerves III, IV, VI: Eye Movement
    • Six cardinal positions of gaze
    • Pupil response to light
    • Documentation: PERLA (Pupils Equal, Round, Reactive to Light and Accommodation)
  3. Cranial Nerve V: Facial Sensation and Movement
    • Test facial muscles: Smile, frown, show teeth, clench teeth
    • Sensory test: Cotton swab (Close eyes, identify when touched)
  4. Cranial Nerve VII: Facial Expressions
    • Lift eyebrows, smile, frown, squint eyes
  5. Cranial Nerve VIII: Hearing
    • Whisper test: “Green wall,” “The Cubs are going to win”
  6. Cranial Nerves IX, X: Mouth and Throat
    • Say “Ah”; observe uvula and soft palate movement
  7. Cranial Nerve XI: Neck and Shoulder Movement
    • Turn head, shrug shoulders against resistance
  8. Cranial Nerve XII: Tongue Movement
    • Stick out tongue (Look for midline)

Muscle Strength

  • Upper Extremities:
    • Arm lift (NIH Stroke Scale)
    • Finger squeeze (two fingers)
  • Lower Extremities:
    • Leg lift
    • Press down and pull up against resistance

Coordination Tests

  • Upper Extremities:
    • Touch each finger to thumb
    • Touch nose then nurse’s finger
  • Lower Extremities:
    • Heel-to-shin test
  • Romberg’s Test: Stand with feet together, hands at sides, eyes closed (Count to 20 seconds for balance)
  • Walk Test: Normal walk and heel-to-toe walk

Sensation Tests

  • Sharp/Dull Test: Use a paper clip or cotton swab
    • Close eyes, identify sharp or dull
  • Light Sensation: Cotton ball test
    • Close eyes, say “Now” when touched
  • Object Identification: Place object in hand, identify with eyes closed (e.g., coin)

Deep Tendon Reflexes

  • Biceps Reflex:
    • Relax arm, identify tendon, use reflex hammer
    • Look for finger twitch
  • Patellar Reflex:
    • Relax leg, identify location, use reflex hammer
    • Look for leg kick
  • Babinski Reflex:
    • Draw “J” on foot
    • Normal: Curling toes
    • Abnormal: Fanning of toes (Positive Babinski)

Conclusion

  • Completion of all components of a neurological assessment