ASSESSING THE SENSORYNEUROLOGICAL SYSTEM

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ASSESSING THE SENSORY-NEUROLOGICAL SYSTEM
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Outcomes

• Identify pertinent neuro/sensory history
  questions.
• Obtain a neuro/sensory history.
• Perform a neuro/sensory physical assessment.
• (Continued)

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Outcomes

• Document pertinent neuro/ sensory assessment
  findings.
• Identify actual/potential health problems
  stated as nursing diagnosis.
• Differentiate between normal and abnormal
  findings.

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Structures

• Cerebrum ? Cortex
• Frontal lobe ? Temporal lobe
• Limbic system ? Parietal lobe
• Occipital lobe ? RAS
• Thalamus ? Hypothalamus
• Cerebellum ? Brainstem
• Midbrain ? Medulla
• Meninges ? Ventricles

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FunctionsWhat are the functions of

• Cerebrum
• Largest part of brain
• Cortex
• Outer layer of cerebrum controls most
  conscious processes
• Frontal Lobe
• Emotional expression, Brocas area (expressive
  language) (Continued)

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FunctionsWhat are the functions of

• Temporal lobe
• Hearing, taste, smell, memory, Wernikes
  (language comprehension)
• Limbic system
• Emotions, sexual arousal, behavioral expression,
  recent memory (Continued)

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FunctionsWhat are the functions of

• Parietal
• Sensory input
• Occipital lobe
• Vision and spatial relationships
• RAS
• Wakefulness
• (Continued)

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FunctionsWhat are the functions of

• Thalamus
• Clusters multiple sensory stimuli
• Hypothalamus
• Controls autonomic nervous system and pituitary
  gland
• Cerebellum
• Coordination, equilibrium
• (Continued)

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FunctionsWhat are the functions of

• Brainstem
• Involuntary survival behaviors
• includes midbrain, medulla and pons
• Midbrain
• Visual, auditory, pupils, and eye movements
• (Continued)

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FunctionsWhat are the functions of

• Medulla
• Regulates heart, respiratory rates, B/P, and
  protective reflexes
• Pons
• Helps with respiratory function, facial
  sensation and movement
• (Continued)

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FunctionsWhat are the functions of

• Meninges
• 3 layers (pia, arachnoid, dura) protect brain
  and spinal cord
• Ventricles
• 4 cavities capillaries produce and reabsorb
  CSF
• (Continued)

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Relationship to Other Systems

• What is the relationship of the neurologic/
  sensory system to other systems?
• Integumentary ? Respiratory
• HEENT ? Musculoskeletal
• Lymphatic ? Genitourinary
• Cardiovascular ? Endocrine
• Hematological ? Gastrointestinal

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DevelopmentalVariations

• What developmental variations of the
  neurologic/sensory system might you seen with
• Children
• Pregnant clients
• Older adults

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Cultural Variations

• What cultural variations of the
  neurologic/sensory system might be seen with
• African Americans
• Irish
• Native Americans

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HistoryWhat can the history tell you about the
neurologic/sensory system?

• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history

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SymptomsWhat symptoms would signal a problem
with the neurologic/sensory system?

• Headache
• Mental status change
• Dizziness, vertigo, syncope
• Numbness or loss of sensation
• Deficits of the 5 senses

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Physical Assessment

• Approach inspection, palpation, and auscultation
  
• Position sitting
• Tools stethoscope, B/P cuff, penlight, gloves,
  cotton, sharp object, coin, fragrance, sweet and
  sour substance, tongue blade, test tubes, reflex
  hammer, ophthalmoscope
• General Survey and head-to-toe scan

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Cerebral Function

• Behavior
• Level of consciousness time, place, person
• Glasgow Coma Scale
• Memory immediate, recent, remote
• Mathematical ability
• Thought process ? Judgement
• General knowledge ? Communication

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Sensory Function

• Superficial sensations
• Light touch
• Pain
• Temperature
• Deep sensations
• Vibratory sensations
• Kinesthetics
• (Continued)

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Sensory Function

• Discriminatory sensations
• Stereognosis
• Graphesthesia
• 2 point discrimination
• Point localization
• Extinction

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Deep Tendon Reflexes

• Biceps
• Triceps
• Brachioradialis
• Patellar
• Achilles

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Superficial Reflexes

• Plantar
• Abdominal
• Anal
• Cremasteric
• Bulbocavernosus

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Protective Reflexes

• Gag
• Cough
• Swallow
• Blink
• Corneal

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Primitive Reflexes

• Babinski
• Sucking
• Grasp
• Rooting
• Snout
• Glabellar

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Meningeal Signs

• Nuchal rigidity
• Kernigs Sign
• Brudzinskis Sign

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Motor Function

• Finger-to-nose
• Heel-to-shin
• Rapid alternating movements
• Romberg
• Gait heel-to-toe