The document discusses assessment of the neurological system in adults. It outlines important information to gather prior to assessment, such as the location and effect of any lesions. The assessment examines level of consciousness, cranial nerves, motor function, reflexes, and more. Tests include the Glascow Coma Scale and evaluating responses of the central nervous system, peripheral nervous system, and specific areas like the cerebral cortex. The goal is to identify any abnormal signs or symptoms and select proper interventions.

1. Assessment, Interventions, &
Outcomes
By: Ryan Lueck

2. Assessment is one of the key factors that
provides the information a nurse needs to
provide good, quality health care.
Key Points: Purpose for Assessment,
Assessment Guidelines, Intervention
options, and Possible Outcomes
Advanced Assessment Practices Specified
to Neurological System on Adult
Population

3. Important information to know prior to
assessment
• Location, nature, and effect of the lesion or area of
the nervous system.
• After assessment the clinician will be able to
identify trouble areas affecting the nervous
system, abnormal signs and symptoms of the
patient, and be able to select proper interventions

4.  Level of Consciousness
(LOC)
• Arousal Level
• Orientation
 Glascow Coma Scale (GCS)
• Eye Response
• Verbal Response
• Motor Response
 Cranial Nerves
• 12 pairs of Cranial Nerves
 Motor Function
• Commands
• Body Movements
 Reflexes
• Superficial Reflexes
• Pathologic
• Visceral
• Deep Tendon Reflexes
 Autonomic Responses
• Sympathetic Nervous System
• Parasympathetic Nervous
System
 Pain Stimuli
• Central
• Peripheral
 Vital Signs

5.  Central Nervous
System
• Cerebral Cortex
• Cerebellum
• Basal Ganglia
• Hypothalamus
• Thalamus
• Brain Stem
• Spinal Cord
 Peripheral Nervous
System
• Reflex Arc
• Cranial Nerves
• Spinal Nerves
• Autonomic Nervous
System

6.  Cerebral Cortex
• Responsible for highest functioning behaviors
 Thought
 Reasoning
 Sensation
 Voluntary Movement
• Divided into two hemispheres and four lobes
 Left and Right hemisphere
 95% of the population is Left Dominant
 Four Lobes
 Frontal: Behavior, Emotions, Intellectual Function
 Temporal: Auditory, Taste, Smell
 Parietal: Sensory
 Occipital: Vision

7.  Cerebellum
• Controls motor coordination of voluntary muscle
movements, muscle tone, and equilibrium
 Basal Ganglia
• Controls automatic associated movements of the body
 Hypothalamus
• Control over many vital functions: Temperature, heart
rate, and blood pressure control. Also regulates sleep
center, pituitary gland hormonal release, and
coordination of autonomic nervous system activity and
emotional status

8. Thalamus
• “Main Relay Station” for the nervous system;
Sensory pathways of the spinal cord and
brainstem form synapses; conduction of nerve
impulses to the appropriate areas.

9.  Brain Stem
• Composed of: Midbrain, Pons, and Medulla
 Midbrain: merges spinal cord transmissions to the thalamus
and hypothalamus; it contains many motor neurons and
tracts
 Pons: enlarged area containing fiber tracts, ascending and
descending.
 Medulla: continuation of spinal cord, contains fiber tracts that
control autonomic functions (i.e. respiration, heart rate, GI
function); also location pyramidal decussation: the crossing
of nerve fibers (Left to Right motor movement=Inverse
relations ship L and R hemisphere).

10. Spinal Cord
• Responsible for sending nerve impulses from
spinal nerves to the brain; allowing a link from the
brain to the body.
• Dermatome Chart: A chart that displays
correlations between certain areas of skin to
particular spinal cord segments. (see pg. 662)

11. Dermatome – a circumscribed skin area
that is supplied mainly from one spinal
cord segment through a particular spinal
nerve.
Dermatome assessment involves
sensation to particular parts of the body in
regards to spinal cord involvement. Usually
assessed when injury to spinal cord
occurs. Each level assessed can pinpoint
the level of injury.

12. 12 pairs of Cranial Nerves: Labeled I-XII (use of Roman
Numerals)
 I – Olfactory Nerve
• Travels through the Cribiform plate
• Sensation Tested: Smell
 II – Optic Nerve
• Travels through the optic canal
• Sensation Tested: Sight
 III – Oculomotor
• Travels through the Superior Orbital Fissure
• Somatic Motor Tested: Movement of superior, medial, inferior
rectus and inferior oblique muscle attached to the eye
(Extraocular Movements: EOM’s)
• Visceral Motor Tested: Sphincter Pupillae (Dilation and
constriction of pupils to light

13.  IV – Trochlear Nerve
• Travels through the Superior Orbital Fissure
• Somatic Motor Tested: Movement of superior oblique
muscle movement (EOM’s)
 V – Trigeminal Nerve
• Composed of several nerves labeled V1, V2, and V3
• V1 travels through the superior orbital fissure
• V2 travels through the foramen rotundum
• V3 travels through the foramen ovale
• Somatic Motor Tested: Mastication (chewing), Tensor
Tympani (located in auditory canal: Dampens extra
sounds), and Tensor Palati (assists with chewing)
• Sensation Tested: Feeling to the Face

14.  VI – Abducens Nerve
• Travels through the superior orbital fissure
• Somatic Motor Tested: Lateral Rectus (Lateral EOM’s)
 VII – Facial Nerve
• Travels through the Internal Auditory Canal
• Somatic Sensory Tested: Posterior External Ear Canal
• Special Sensory Tested: Taste (involves 2/3 of the anterior
tongue)
• Somatic Motor Tested: Facial movement and expressions
• Visceral Motor Tested: Salivary Glands and Lacrimal
Glands
 VIII – Vestibulocochlear Nerve
• Travels through the Internal Auditory Canal
• Special Sensory Tested: Auditory and Balance

15. IX – Glossopharyngeal Nerve
• Travels through the Jugular Foramen
• Somatic Sensory Tested: 1/3 of the posterior
tongue and Middle Ear
• Visceral Sensory Tested: Carotid body and sinus
• Special Sensory Tested: Taste (Posterior 1/3 of
the tongue
• Somatic Motor Tested: Stylopharyngeas (dilates
esophagus to facilitate swallowing large food
bolus)
• Visceral Motor Tested: Parotid Gland (salivation)

16. X – Vagus Nerve
• Travels through the Jugular Foramen
• Somatic Sensory Tested: External Ear
• Visceral Sensory Tested: Aortic Arch/Body
• Special Sensory Tested: Taste over the Epiglottis
• Somatic Motor Tested: Soft palate, pharynx, and
Larynx (vocalization and swallowing)
• Visceral Motor Tested: Bronchoconstriction,
Peristalsis, Bradycardia, and Vomitting

17. XI – Spinal Accessory Nerve
• Travels through the Jugular Foramen
• Somatic Motor Tested: Trapezius and
Sternocleidomastoid movement (shoulder shrug)
XII – Hypoglossal Nerve
• Travels through the Hypoglossal Canal
• Somatic Motor Tested: Tongue Movement

18.  Tools Needed to perform assessment
• Pen light
• Cotton swabs with wooden handle
• Reflex Hammer
• Tuning Fork
 Breakdown of Exam
• Mental Status (Level of Consciousness and Orientation)
• Cranial Nerves
• Motor (Fine Motor and Gross Motor movements)
• Coordination and Gait
• Reflexes
• Sensory (Dermatomes)
• Special Tests (snellen chart and tuning fork)

19. Level of Consciousness Terms
Full Level of Consciousness: Awake, Alert, and Attentive; if patient is
sleeping, easily awaken to minor external stimulus
Lethargy: Awake but Drowsy, not fully attentive, slow response
Obtunded: Not easily awaken, requires repeated stimulus to keep
attention, slow to answer questions, will drift to sleep frequently, difficulty
following simple commands
Stupor: Constant stimulus needed, usually painful stimuli needed, no
commands, no attention span, minimal response from patient
Coma: No response from patient on cognitive level, even with constant
painful stimuli, no motor movement unless spinal reflex; unable to
arouse patient
Glascow Coma Scale: Assessment tool that checks patient arousal,
orientation, and motor function

20.  Arousal Level
• Arousal to stimuli or no stimuli
 Opens eyes spontaneously (No stimulus needed)
 Auditory Stimuli (voice)
 Tactile Stimuli (gentle touch or shake)
 Painful Stimuli (Peripheral or Central)
• Response to Stimuli
 Purposeful (moves away from stimuli, location of stimuli)
 Non-purposeful (Spontaneous movements disregard of stimuli or posturing:
Decerebration or Decortication)
 Unresponsive (no response to any stimuli)
• Orientation
 Ability to answer questions regarding memory
 Name
 Place (Location)
 Time (time, day, month, or year)
 Situation (why patient is needing exam)