1. ASSESSING THE SENSORY- NEUROLOGICAL SYSTEM

2. Outcomes 4 Identify pertinent neuro/sensory history questions. 4 Obtain a neuro/sensory history. 4 Perform a neuro/sensory physical assessment. (Continued)

3. Outcomes 4 Document pertinent neuro/ sensory assessment findings. 4 Identify actual/potential health problems stated as nursing diagnosis. 4 Differentiate between normal and abnormal findings.

4. Structures 4 Cerebrum  Cortex 4 Frontal lobe  Temporal lobe 4 Limbic system  Parietal lobe 4 Occipital lobe  RAS 4 Thalamus  Hypothalamus 4 Cerebellum  Brainstem 4 Midbrain  Medulla 4 Meninges  Ventricles

5. Functions What are the functions of… Cerebrum: Largest part of brain Cortex: Outer layer of cerebrum; controls most conscious processes Frontal Lobe: Emotional expression, Broca’s area (expressive language) (Continued)

6. Functions What are the functions of… Temporal lobe: Hearing, taste, smell, memory, Wernike’s (language comprehension) Limbic system: Emotions, sexual arousal, behavioral expression, recent memory (Continued)

7. Functions What are the functions of… Parietal: Sensory input Occipital lobe: Vision and spatial relationships RAS: Wakefulness (Continued)

8. Functions What are the functions of… Thalamus: Clusters multiple sensory stimuli Hypothalamus: Controls autonomic nervous system and pituitary gland Cerebellum: Coordination, equilibrium (Continued)

9. Functions What are the functions of… Brainstem: Involuntary survival behaviors; includes midbrain, medulla and pons Midbrain: Visual, auditory, pupils, and eye movements (Continued)

10. Functions What are the functions of… Medulla: Regulates heart, respiratory rates, B/P, and protective reflexes Pons: Helps with respiratory function, facial sensation and movement (Continued)

11. Functions What are the functions of… Meninges: 3 layers (pia, arachnoid, dura); protect brain and spinal cord Ventricles: 4 cavities; capillaries produce and reabsorb CSF (Continued)

12. Relationship to Other Systems What is the relationship of the neurologic/ sensory system to other systems? 4 Integumentary  Respiratory 4 HEENT  Musculoskeletal 4 Lymphatic  Genitourinary 4 Cardiovascular  Endocrine 4 Hematological  Gastrointestinal

13. Developmental Variations What developmental variations of the neurologic/sensory system might you seen with: 4Children 4Pregnant clients 4Older adults

14. Cultural Variations What cultural variations of the neurologic/sensory system might be seen with: 4 African Americans 4 Irish 4 Native Americans

15. History What can the history tell you about the neurologic/sensory system? 4Biographical data 4Current health status 4Past health history 4Family history 4Review of systems 4Psychosocial history

16. Symptoms What symptoms would signal a problem with the neurologic/sensory system? 4Headache 4Mental status change 4Dizziness, vertigo, syncope 4Numbness or loss of sensation 4Deficits of the 5 senses

20. 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

21. Cerebral Function 4 Behavior 4 Level of consciousness: time, place, person 4 Glasgow Coma Scale 4 Memory: immediate, recent, remote 4 Mathematical ability 4 Thought process  Judgement 4 General knowledge  Communication

24. Sensory Function Superficial sensations: 4Light touch 4Pain 4Temperature Deep sensations: 4Vibratory sensations 4Kinesthetics (Continued)

25. Sensory Function Discriminatory sensations: 4Stereognosis 4Graphesthesia 42 point discrimination 4Point localization 4Extinction

26. Deep Tendon Reflexes 4Biceps 4Triceps 4Brachioradialis 4Patellar 4Achilles

27. Superficial Reflexes 4Plantar 4Abdominal 4Anal 4Cremasteric 4Bulbocavernosus

28. Protective Reflexes 4Gag 4Cough 4Swallow 4Blink 4Corneal

29. Primitive Reflexes 4Babinski 4Sucking 4Grasp 4Rooting 4Snout 4Glabellar

30. Meningeal Signs 4Nuchal rigidity 4Kernig’s Sign 4Brudzinski’s Sign

31. Motor Function 4Finger-to-nose 4Heel-to-shin 4Rapid alternating movements 4Romberg 4Gait: heel-to-toe