LESSON PLAN

ON
NEUROLOGICAL ASSESSMENT

Submitted to : Submitted by :

Submitted on :
 IDENTIFICATION DATA

Name of the student teacher : Mr. saravanan

Class : M.Sc Nursing1styear

Name of the subject : mental health nursing

Name of the Topic : neurological assessment

Size of the group :

venue :

Date&Time :

Duration of teaching : 45 mins

Method of discussion : lecture and demonstration

Audio visual aids :

Name of the evaluator :

PREVIOUS KNOWLEDGE:
The student have adequate knowledge regarding central nervous system in their B.Sc nursing first year (anatomy and physiology)
GENERAL OBJECTIVE :
At the end of the class the students will be able to develop skill and in depth knowledge of neurological examination and will be able to apply
this knowledge in clinical fields.
SPECIFIC OBJECTIVES

At the end of the session the group will be able to-

 define neurological examination

 enlist the purpose of neurological assessment
 list out the equipment's required for the assessment
 enumerate different components of neurological examination
 explain the assessment of level of consciousness.
 describe the cranial nerves assessment
 demonstrate the motor function assessment.
 discuss the sensory function assessment.
 demonstrate the assessment of reflexes
 discuss the role of nurse in neurological examination.
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OBJECTIVE
Introduction:
A neurological examination is a comprehensive assessment of
the nervous system, including the brain, spinal cord, and
peripheral nerves. It is an essential tool for healthcare
professionals to diagnose and manage neurological disorders
The teacher
is explaning
Definition:
1. the definition The students Define
define Neurological assessment is "a systematic evaluation of the
of are listening neurological
structure and function of the nervous system, including the
neurological
brain, spinal cord, and peripheral nerves." neurological assessment
examination
assessment
Purposes:
Evalute the function of the nervous system
2. enlist the purpose The teacher List out the
Detect nervous system dysfunction) The students
of neurological Monitor response to treatment is explaning are listening purpose of
assessment Evaluate patient outcomes the purpose neurological
Determine highest level of functional ability of examination
neurological
assessment
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Indication
1.A neurological examination is indicated whenever a
physician suspects that a patient may have a neurological
disorder.
2. Any new symptom of any neurological order may
be an indication for performing a neurological examination
Equipment needed:
A tray containing- The teacher The students What are the
listout the
Reflex hammer , teaching are listening articles needed
equipment's
tuning fork. about for
3. required for the
equipment neurological
Torch 128-Hz
assessment
Lemon, salt, sugar. needed for assessment

Pocket eye chart (for near vision testing) the

Cotton swabs assessment

tongue depressor
safety pins
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Components of neurological Examination

enumerate The teacher The students What are the
4. 1. Levels of consciousness
different teaching are listening components of
2. Mental status examination
components of about neurological
3. Special cerebral functions
neurological components examination
4. Cranial nerves functions
examination of
5. Motor system
neurological
6. Sensory system
examination
7. Cerebellar function
8. Reflexes
LEVELS OF CONSCIOUSNESS
explain the Assessment of levels of consciousness Describe the
4. The teacher The students
assessment of includes following categories: level of
teaching are listening
level of a. Alertness: Patient is awake, responds immediately & consciousness
consciousness. about levels
appropriately to all verbal stimuli
of
b. Lethargic: Patient is drowsy & inattentive but
consciousness
arouses easily,frequently off to sleep.
c. Stuporous: He arouses with great difficulty & co-
operates minimally when stimulated.
d. Semi-comatose: The patient has lost his ability to
respond to verbal stimuli.
There is some response to painful stimuli. Little motor
function is seen.
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e. Comatose: When the patient is stimulated there is no

response to verbal or painful stimuli, no motor
activity is seen. The Glasgow coma scale is widely
used to measure the patient’slevel of consciousness.
Glasgow Coma Scale
Quick and easy way to describe baseline LOC Tests
• Eye Opening (4)
• Verbal (5)
• Motor Response (6)
Highest score possible: 15
Lowest score possible 3
Mental status examination:
1. Level of awareness
2. General appearance and behaviour
3. speech
4. Mood and affect
5. Thought process
6. Perception
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7. Cognitive function
 . Consciousness
 . Orientation
 Attention
 . Concentration
 . Memory
 . Intelligence
 Abstraction
 . Judgement
8.. Insight
Cranial nerve examination The teacher The students How will you

Nerve Type teaching are listening assess the

describe the cranial
5. Olfactory Nerve (1) about cranial cranial nerve
nerves assessment
Function nerve

Olfaction (Sensory) assessment

The patient is exposed to aromatic substances (e.g..

coffee) and asked to identify the odor.
Nerve Type
Optic Nerve (II)
Function
Vision (Sensory)
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The patient is asked to identify objects/letters from

predefined distances.
Visual field
The examiner wags a finger towards the patient's visual
field from all sides
Nerve Type
Oculomotor nerve (III), trochlear nerve (IV). abducens
nerve (VI)
Function
Eye Movement (Motor)
Patients are asked to follow a finger moving up, down,
laterally, and diagonally with they eyes. Observe if
paresis, nystagmus, or alterations of smooth pursuit
appear
Visual accommodation
The physician moves a finger towards the patient. If
visual accommodation is intact, the finger is clearly
visualized by the patient at all times.
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Eyelid Ptosis
The patient is asked to open and close the eyes.
Nerve Type
Trigeminal Nerve(V)
Function
Facial sensation
The examiner lightly touches three distinct facial areas
(the forehead, cheek, and jaw). Normally, light touch
should be felt by the patient in all three areas. If this is
not the case, tests for abnormalities of other sensory
modalities (e.g.. pain, temperature) should be performed.
Muscle function (muscles of mastication)
The patient is asked to open and close his/her mouth; at
the same time, the examiner palpates the masseter
muscle.
Nerve Type
Facial Nerve (VII)

.
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Function
Motor function (muscles of expression)
If motor function is intact, the patient should be able to
perform the following: Forehead wrinkling Closing the
eyes tightly Nose wrinkling Inflate the cheeks Smiling
(showing teeth) Whistling
Taste
If the sense is intact, the patient should be able to taste
sweet, salty, and sour food/drinks
Nerve Type
Vestibulocochlear Nerve (VIII)
Function
Hearing
Basic hearing test: normally, the patient should be able to
hear two fingers rubbing together before the external
acoustic meatus (car canal). The Weber test and Rinne
test allow sensorineural hearing loss to be differentiated
from conductive hearing loss (see ENT diagnostic
testing).
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Nerve Type
Glossopharyngeal nerve (IX) and vagus nerve (X)
Function
Palatal movement
The physician performs a visual inspection of the uvula
and soft palate: asymmetry and uvula deviation indicate
impaired innervations.
Sense of taste
The patient is given a bitter substance to taste: no sense
of taste indicates impaired innervation.
vocalization
In case of lesion, the patient would have hoarseness or
bovine cough
Nerve Type
Accessory Nerve (XI)
Function
Trapezius muscle and sternocleidomastoid muscle (motor
function
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Trapezius muscle: the patient's shoulder is elevated

against resistance Sternocleidomastoid muscle: the
patient's head is rotated against resistance
Nerve Type
Hypoglossal Nerve (XII)
Function
Tongue muscles (motor function)
The tongue should be pressed against the cheek from the
inside, while the examiner tests the strength by pushing
from the outside. Hypoglossal nerve paralysis; when the
patients stick out the tongue, it moves towards the
impaired side

demonstrate the MOTOR FUNCTION ASSESSMENT The teacher The students Explain about
6. Muscle size: Inspect all major muscle groups bilaterally
motor function demonstrating are listening motor function
assessment. for symmetry, hypertrophy, & atrophy. motor assssment
Muscle Strength:Assess the power in major muscle function
groups against resistance. Assess & rate muscle strength assessment
on a 5-point scale in all four extremities, comparing one
side with other
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Muscle tone: Assess muscle tone while moving each

extremity through its range of passive motion.
hypotonicity -When tone is decreased, the muscle are
soft, flabby, or flaccid;
hypertonicity- when tone is increased, the muscles are
resistant to movement, rigid, or spastic.
Note the presence of abnormal flexion or extension
posture.
Examination of posture
• Decerebrate
• Decorticate
• Hemiparetic
Muscle coordination: Disorders related coordination
indicate Cerebellar or posterior column lesions.
Gait & station: Assess gait station by having the patient
stand still, walk & in tandem (one foot in front of the
other in a straight line). Walking involves the
functions of motor power, sensation & coordination. The
ability to stand quietly with the feet together requires
coordination & intact proprioception
(sense of body position).
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Movement: Examine the muscles for fine

& gross abnormal movements. Move all
the points through a full range of
passive motion. Abnormal findings include
pain, joint contractures, & muscle
resistance.

7. discuss the Sensory function assessment The teacher The students Explain the
sensory function Sensory assessment involves testing for touch, pain, discuss about are listening sensory
assessment. vibration & discrimination. the sensory and taking function
• A complete sensory examination is possible only on a function notes assessment
conscious & co-operative patient. assessment
• Always test sensation with patient’s eye closed.
• Help the patient relax & keep warm.
• Conduct sensory assessment systematically.
• Test a particular area of the body, & then test the
corresponding are on the other side.
Assessment of cerebellar function
For evaluation of balance & co-ordination the tests used
are:

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a. Finger to finger test: It is performed by instructing the
patient to place her index finger on the nurse’s index
finder. He is asked
to repeat this for several times in succession on both
sides.
b. Finger to nose test: Tell the patient to extend his index
finger & then touch the tip of his nose several times in
rapid succession. This test is done with patient’s eyes
both open & closed.
c. Romberg test: Here the nurse instructs the patient to
stand with his feet together with arms positioned at his
sides. He is told to close his eyes. This position is
maintained for 10 seconds. This test is considered
positive only if there is actual loss of balance.
d. Tandom walking test: This is tested by having the
patient assume a normal standing position. He is then
instructed to walk over heel on a straight line. Any
unsteadiness, lurching or broadening of the gait base is
noted
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demonstrate the ASSESSMENT OF REFLEXES

8. assessment of Reflex testing evaluates the integrity of The teacher The students How to assess
reflexes specific sensory & motor pathways. demonstrate are observing the reflex?
• Reflex activity assessment, always a part the reflex the
of neurologic assessment, provides assessment assessment
information about the nature, location,
& progression of neurologic disorders.
• Normal reflexes: Two types of reflexes
are normally present:
I. Superficial or cutaneous reflexes
II. Deep tendon muscle-stretch reflexes
I. Superficial(cutaneous)reflexes:
Abdominal reflex
Plantar reflex
Corneal reflex
Pharyngeal (Gag)reflex
Cremasteric reflex
Anal reflex
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II. Deep tendon (muscle stretch)reflexes:

A biceps jerk (forearm flexion)
A triceps jerk (forearm extension)
A brachioradial jerk
A knee jerk, quadriceps jerk or patellar reflex
An ankle jerk(plantarflexions of the foot)
Abnormal reflexes:
Babinski’s reflex
Jaw reflex
Palm-chin (Palmomental) reflex
Clonus
Snout reflex
Rooting reflex
Sucking reflex
Glabella reflex
Grasp reflex
Chewing reflex
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9. discuss the role of Nurses role in neurological

nurse in Examination…
neurological • Provide a clam, suitable environment The teacher The students What is the

examination • Collect the personal data with patient & family discuss the are listening role nurse in

members role of nurse neurological

• Set the equipment needed for neurological examination in examination?

• Assess the current level of consciousness, monitor vital neurological

parameters – temperature, pulse, respiration, blood examination

pressure, pupillary reaction, whether decerebrating or

decorticating.
• Thorough mental status examination should be done &
recorded accurately.
Assessment of cranial nerves should be done correctly &
recorded.
• Assessment of motor, sensory & cerebellar functions
should be done & be recorded accurately.
• During the examination, she should maintain a good
support with patient & family members
• She should instruct the procedure correctly & then they
should be asked to do it.
• Should be informed to the concerned unit doctors if
there is any change.
SUMMARIZE THE TOPIC:
So,today we discussed about definition, purpose, components, cranial nerves, motor assessment, sensory assessment, reflex assessment and
nurse’s role in neurological assessment.
RECAPTULIZATION:
What is neurological assessment?
What are the purposes of neurological assessment?
What are the components of neurological assessment?
What do you know about components of neurological assessment?
What do you know about motor system examination?
REFERENCES :
1. Brunner & Siddartha's Medical Surgical Nursing. 10th edition, Lippincott Williams and willikins, 1904-1908.
2. Chintamani, medical &surgical nursing, Elsevier, 1466- 1469.
3. Kozier, Fundamentals of nursing, 7th edition, 640-650.
4. Joyce M. block et al, medical surgical clinical management for positive outcomes 7th edition, 2005, 1189-1192
5. Dewitt Susan C. Essentials of medical surgical nursing 4th edition, Philadelphia, w.b sunders company, 1998, 882-890, 6. Phipps, medical
surgical nursing a nursing process approach 7th edition, 265-230.
6. Linton introduction to medical surgical nursing 1th edition, 465-479.