HEALTH
ASSESSMENT
Assessing Neurologic System
__________
EDNA U. ROBLES, RN MAN
St. Luke’s College of Nursing
NERVOUS SYSTEM
2 TYPES OF CELLS IN THE NERVOUS
SYSTEM
NEURONS
NEURONS
• GRAY AND WHITE MATTER?
• AXON, WHITE MATTER AND NERVES?
• CORTEX, NUCLEUS AND GANGLIA?
2 TYPES OF CELLS IN THE NERVOUS
SYSTEM
NEUROGLIAL
CELLS
FUNCTIONS OF THE NERVOUS
SYSTEM?
Telencephalon
Diencephalon
Brain Mesencephalon
Metencephalon
Central Nervous
Myelencephalon
System
Ventral Horn
Spinal Cord Lateral Horn
Nervous System
Dorsal Horn
Motor
12 Cranial Nerves
Peripheral
and 31 Spinal
Nervous System
Nerves
Sensory
Vision, olfaction,
Special senses taste. hearing,
equilibrium/balance
Sensory
Deeper part of the
Visceral Sensation
body
General Sensation
Skin , sq tissue &
Somatic Sensation
locomotor system
Somatic
Nervous System
Motor Sympathetic
Autonomic
Nervous System
Parasympathetic
CENTRAL NERVOUS
SYSTEM
BRAIN
CEREBRUM
Dr. Mike Tai
Involved in processing
visual & auditory
information
Relays sensory information Coordinates movement,
to cebellum and thalamus balance & posture
Respiratory, cardiac and
vasomotor centers
DIENCEPHALON
DIENCEPHALON
Temperature
regulation, thirst,
satiety, fear, anger, sex
SPINAL CORD
PERIPHERAL NERVOUS
SYSTEM
CRANIAL NERVES
CRANIAL NERVES
CRANIAL NERVES
CRANIAL NERVES
DERMATOME OF NERVES
Actions of the spinal nerves
Level Motor Function
C1-C6 Neck flexors
C1-T1 Neck extensors
C3, C4, C5 Supply diaphragm (mostly C4)
Shoulder movement, raise arm(deltoid); flexion of elbow
C5, C6
(biceps); C6 externally rotates the arm (supinates)
Extends elbow and wrist(triceps and
C6, C7
wrist extensors);pronates wrist
C7, T1 Flexes wrist; supply small muscles of the hand
T1 -T6 Intercostals and trunk above the waist
T7-L1 Abdominal muscles
L1, L2, L3,L4 Thigh flexion
Thigh adduction; Extension ofleg at the knee (quadriceps
L2, L3, L4
femoris)
Thigh abduction; Flexion of legat
L4, L5, S1 the knee (hamstrings);Dorsiflexion of foot (tibialis
anterior); Extension of toes
Extension of leg at the hip(gluteus
L5, S1, S2
maximus); Plantarflexion of foot and flexion oftoes
OTHER STRUCTURES OF
THE NERVOUS
SYSTEM
Anterior Common
Circulation Carotid Artery
Blood Supply of
the Brain Brachiocephalic
Artery
Posterior
Circulation
Subclavian
Artery
SIGNIFICANCE?
CEREBRAL VENOUS DRAINAGE
CRANIAL FOSSA
Falx Cerebri
Tentorium
Dura Mater
Cerebelli
Diaphragma
sellae
Meninges of the
Brain Arachnoid
trabeculae
Arachnoid Mater
Arachnoid
granulations/Villi
Pia Mater
DURA MATER
ARACHNOID MATER
PIA MATER
CSF FLUID
• 0.3 – 0.4ml per min/500 ml per day
• 150 ml is present
• Appearance – clear, colorless
• Pressure 8 -15mmHg
• CHON – 0.2 – 0.4
• Glucose – ½ to 2/3 of blood glucose
• WBC – 0-3/microL
CSF FLUID
FUNCTIONS:
1. Cushion & Protection
2. Chemical stability
3. Reservoir & control of intracranial mass
4. Nourishing fluid
5. Removes wastes
6. Bouyancy
Lateral Foramen 3rd Aqueduct
Ventricles of Monroe Ventricle of Sylvius
Foramen of
Subarachnoid
Lushka &
Space
Magendie
4th Ventricle
Spinal Canal Spinal Roots
BLOOD BRAIN BARRIER
HEALTH ASSESSMENT
1. History of Present Health Concerns
• Headaches
• Seizures
• Dizziness
• Numbness and Tingling
• Senses
• Difficult speaking
• Difficult swallowing
• Muscle control
• Memory loss
HEALTH ASSESSMENT
2. Past Health History
• Injury
• Infections
• Diseases
3. Family History
• Diseases
• Lifestyle and Health Practices
COLLECTING OBJECTIVE DATA
1. Physical Examination (Neurologic
Examination)
• Level of Consciousness
• Cranial Nerves
• Motor and Cerebellar Systems
• Sensory System
• Reflexes
INTERPRETATION
•Mild injury
13 - 15
•Moderate injury
9 - 12
•Severe disabilty
3–8
LEVEL OF CONSCIOUSNESS
1. Alert – responds to minimal external stimuli, aware
of environment
2. Confused – disoriented to time or place but
oriented to person, impaired judgment/decision
making, decreased attn span
3. Delirious – disoriented to 3 spheres, loss contact w/
reality, w/ hallucinations
4. Lethargic – severe drowsiness
5. Obtunded – dull indifference to external stimuli
6. Stuporous – deep sleep, continous, vigorous
stimuli, withdrawal/localize
7. Comatose – fails to produce any response
MOTOR AND CEREBELLAR SYSTEMS
MOTOR
1. Condition and movement
2. Symmetry
3. Involuntary movement
MOTOR AND CEREBELLAR SYSTEMS
Lovett’s Muscle Strength
MOTOR AND CEREBELLAR SYSTEMS
Cerebellar Functions
1. Tandem walking
(Walks in heel to toe fashion)
1. Romberg’s Test & pronator drift
2. Finger to nose test
3. Heel to knee - shin test
SENSORY SYSTEM
1. Assess light touch, pain and temperature
sensations
– Wisp of cotton
– Paper clip
– Test tubes
2. Test for vibratory sensation
3. Tactile discrimination
REFLEXES
1. Deep tendon reflexes
– Biceps C5 – C6
– Brachioradialis C5 – C6
– Triceps C6 – C8
– Patellar L2 – L4
– Achilles S1 – S2
2. Ankle clonus
3. Superficial Reflexes
– Plantar reflex L4 – S2
– Abdominal reflex T8 – T12
– Cremasteric reflexes T12 – L2
4. Brudzinski’s sign
5. Kernig’s Sign
Thank You!
