NSG 316 Health Assessment: Neurologic System

Learning Objectives

• Describe techniques for neurological assessment.
• Identify neurological and cranial nerve assessment techniques based on age, development, and psychosocial/environmental variables.
• Differentiate between normal and abnormal neurological findings.
• Document health history and key assessment components in client records.

Neurological Changes with Aging

• Brain Atrophy: Normal in healthy aging; symmetric and generalized.
• Nerve Conduction: Slows by 5-10%; reaction time decreases.
• Sensory Diminishment: Touch, pain, taste, and smell may reduce.
• Motor Function: Slowing of movements, muscle strength, and agility decreases.
• Cerebral Blood Flow: Decreases causing dizziness and balance issues.
• Abnormalities in Younger Adults: Muscle bulk and strength loss considered abnormal in youth.

Cultural and Genetic Considerations

• Stroke risk higher in black and Hispanic/Latino individuals.
• Stroke Belt: High stroke mortality in the Southeast U.S, particularly North Carolina, South Carolina, and Georgia.
• Risk Factors: Include socioeconomic factors, traditional stroke risks, and systemic inflammation.

Neurological Assessment Components

1. Screening: Basic assessment for all patients.
2. Complete Examination: For those with neurological concerns.
3. Recheck Examinations: For patients with established deficits requiring periodic assessment.

Cranial Nerve Assessment

• Cranial Nerve 1 (Olfactory): Test sense of smell; asymmetry or anosmia can indicate issues.
• Cranial Nerve 2 (Optic): Visual acuity and fields.
• Cranial Nerve 3-6 (Ocular): Eye movements and pupil reactions (PERLA).
• Cranial Nerve 5 (Trigeminal): Motor (chewing) and sensory (facial touch).
• Cranial Nerve 7 (Facial): Facial expressions and symmetry.
• Cranial Nerve 8 (Acoustic): Hearing acuity.
• Cranial Nerve 9-10 (Glossopharyngeal & Vagus): Gag reflex and palate movement.
• Cranial Nerve 11 (Accessory): Shoulder shrug and head rotation strength.
• Cranial Nerve 12 (Hypoglossal): Tongue movement.

Motor and Sensory System Assessment

• Muscle Strength and Tone: Compare bilaterally.
• Cerebellar Function: Balance tests and coordination assessments.
• Abnormal Movements: Paralysis, tics, seizures, and tremors.
• Gait Abnormalities: Parkinsonian, scissor walking, foot drop.
• Sensory Testing: Pain, temperature, and light touch.
• Peripheral Neuropathy: Common in diabetes; affects distal nerves.

Reflex Testing

• Deep Tendon Reflexes: Graded on a 4-point scale.
• Common Reflexes: Biceps, triceps, patellar, and Achilles.
• Clonus: Rapid muscular contractions.

Special Considerations for Older Adults

• Slower Response: Decreased reflexes and muscle bulk.
• Gait and Balance: May deviate from midline path.
• Reflex Diminishment: Especially in ankles and knees.

Glasgow Coma Scale

• Measures eye opening, motor, and verbal response.
• Score range: 3 (deep coma) to 15 (fully alert).
• Important for documenting changes in neurological status.

Examination Sequence

1. Mental Status
2. Cranial Nerves
3. Motor Function
4. Sensory Function
5. Reflexes

Note: This sequence is essential for a complete neurological assessment. Document findings accurately and analyze them in the context of the patient's overall health status.

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Please review the slides and additional resources provided for further understanding. Reach out to instructors for any questions or clarifications needed.