Neurological Assessment Overview

Greetings and Introduction

  • Instructor: Ms. Summercamp

  • Subject: Assessing the Neurological System

  • Learning objectives:

    • Review anatomy and physiology related to neurological assessment, including the central and peripheral nervous systems.

    • Discuss risk factors for strokes and ways to minimize them.

    • Conduct a nursing history interview for neurological assessment.

    • Perform neurological assessments, including cranial nerve and neuromotor function assessments.

    • Describe common neurological findings in older adults.

    • Analyze subjective and objective data to form clinical judgments.

Anatomy and Physiology of the Nervous System

Overview

  • Neurological system coordinates and regulates all body functions.

  • Divided into:

    • Central Nervous System (CNS)

    • Composed of the brain and spinal cord.

    • Peripheral Nervous System (PNS)

    • Comprises 12 pairs of cranial nerves and 31 pairs of spinal nerves.

Central Nervous System

  • Brain: Covered with meninges (protects and nourishes CNS).

  • Spinal Cord: Also covered with meninges.

  • Neurons: Key components; govern electrical activity and transmit impulses in sensory and motor pathways.

Parts of the Brain

  1. Cerebrum:

    • Divided into four lobes:

      • Frontal Lobe: Voluntary movements, communication, emotions, judgment, intellect, behavior. Broca's area (speech).

      • Parietal Lobe: Tactile sensation (touch, pain, temperature), two-point discrimination.

      • Occipital Lobe: Visual reception, reading comprehension.

      • Temporal Lobe: Processes and interprets auditory information.

  2. Diencephalon:

    • Thalamus: Integration center for emotions and creativity.

    • Hypothalamus: Controls vital functions (temperature, heart rate, blood pressure, sleep, appetite, sexual function, pain perception).

  3. Brainstem:

    • Consists of midbrain, pons, and medulla oblongata.

    • Controls vital functions (respiratory, cardiac, and gastrointestinal systems).

    • Damage can be life-threatening, particularly to the respiratory center.

  4. Cerebellum:

    • Contains two hemispheres; responsible for motor coordination, equilibrium, and muscle tone.

Spinal Cord

  • Located within the vertebral canal, extends from the medulla to the first lumbar vertebra.

  • Conducts nerve impulses to/from the brain.

  • Cross Representation: Left cerebral cortex controls right side of the body and vice versa.

Peripheral Nervous System

  • Composed of:

    • Somatic Nervous System: Controls voluntary skeletal muscles; mediates conscious activities.

    • Autonomic Nervous System: Controls involuntary functions (smooth muscles, glands).

    • Divided into:

      • Sympathetic Nervous System: Fight or flight response, activated during stress (T1 to L2 levels).

      • Parasympathetic Nervous System: Rest and digest, restores body functions.

Cranial Nerves

  • Assessment guidance found in the textbook (pp. 586-592).

  • Memory aid: Mnemonics for cranial nerves:

    • "On Old Olympus Towering Tops, A Finn And German Viewed Some Hops".

      • Includes olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, hypoglossal.

  • Impulse types mnemonic: "Some Say Marry Money, But My Brother Says Bad Business Marries Money" (S=sensory, M=motor, B=both).

  • Functions of cranial nerves binary:

    • CN I: Smell

    • CN II: Vision

    • CN III: Pupil constriction, eyeball movement, eyelid raising

    • CN IV: Eye movement downward and inward

    • CN V: Chewing, facial sensation

    • CN VI: Eye lateral movement

    • CN VII: Facial expression, tongue movement

    • CN VIII: Hearing, balance

    • CN IX: Gag reflex, swallowing

    • CN X: Swallowing, autonomic functions

    • CN XI: Shoulder shrug, head rotation

    • CN XII: Tongue movement

Spinal Nerves

  • Comprised of:

    • 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal.

  • Named by the vertebrae below where they exit the spinal cord.

  • Sensory nerves enter through the dorsal route; motor nerves exit through the ventral route.

Study Tips for Spinal Nerves

  • Mnemonic for spinal levels: "Breakfast at Eight, Lunch at Twelve, Dinner at Five" (cervical, thoracic, lumbar).

Dermatomes

  • Graphic depiction of skin areas innervated by spinal nerves.

  • Helpful for assessing return of sensation post-anesthesia and in spinal injuries.

Factors Affecting Neurological Assessment

Biological, Genetic, and Cultural Factors

  • Cardiovascular disease is linked to risk factors for stroke.

  • Familiarity with the 'stroke belt' of southern states is crucial for risk assessment.

  • Understanding colloquial expressions like "bad nerves" may indicate anxiety or mental health issues.

Considerations for Older Adults

  • Common sensory declines (hearing, vision, taste, smell).

  • Mention of assistive devices (e.g., hearing aids, glasses).

  • Observable tremors during voluntary actions, reduced muscle mass, and altered gait patterns.

  • Reaction time may be slower, and deep tendon reflexes often remain intact unless pathological conditions are present.

Obtaining Nursing Health History

  • Important questions regarding:

    • Headaches, seizures, dizziness

    • Numbness, tingling, dysphagia, muscle control issues

    • Memory loss, prior neurological history (TIA, strokes)

    • Lifestyle and health practices for risk factor identification

General Routine Neurological Assessment

Overview

  • Importance of basic assessments in clinical settings.

  • Focus on level of consciousness (orientation to person, place, date, time, situation).

  • Observations should include behavior, grooming, facial expressions, speech, posture, gait, balance, involuntary movements, and sensory function.

Focused Specialty Assessment

  • Assess thought process (memory, judgment, abstract reasoning) if neurological impairment is suspected.

  • Comprehensive cranial nerve testing, including the Romberg test to assess balance.

  • Assessment of coordination and sensory functions (vibrations, pain, temperature).

Neuro Check Components

  • Assessing mental status, cranial nerves, motor function, reflexes, and vital signs.

  • Regular neuro checks often prescribed in healthcare settings for monitoring.

Tools and Equipment for Assessment

  • Essential tools include:

    • Penlight with pupil gauge

    • Tongue blade

    • Cotton applicators

    • Tuning fork

    • Reflex hammer

  • Smell and taste tests (varied scents/flavors).

Assessment Summary

Components

  • Comprehensive neurological assessments include:

    • Mental status

    • Cranial nerve function

    • Motor & sensory function

    • Reflex assessment

  • Rating strength on a scale (0 to 5) and reflexes (0 to 4).