IDENTIFICATION DATA

NAME OF THE STUDENT TEACHER – Maj Sheetal

NAME OF THE GUIDE - Lt Col Shiny Joseph

GROUP OF STUDENTS - III Yr B.Sc(Nursing)

SUBJECT - Mental Health Nursing

TOPIC - Neurological Examination

DURATION OF CLAS - 60 Min

VENU - III Yr Classroom

METHOD OF TEACHING - Lecture and Demonstration

LANGUAGE USED - English

AV AIDS USED -

DATE OF SUBMISSION -

DATE OF PRESENTATION -
PREVIOUS KNOWLEDGE OF THE GROUP
The group have basic knowledge about neurological examination from

 I and II year academic and clinical experience

 Had a departmental class on the topic

GENERAL OBJECTIVES
After the session the group will develop skill and in depth knowledge of
the topic 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
 Explain the purpose of neurological assessment
 Enlist the indications of neurological examination
 Enlist the equipments required for the assessment
 Enumerate different components of neurological examination
 Demonstrate the assessment of level of consciousness.
 Demonstrate the assessment of level of consciousness.
 Demonstrate the assessment of mental status examination
 Demonstrate the assessment of special cerebral functions.
 Demonstrate the assessment of cranial nerves.
 Demonstrate the motor function assessment.
 Demonstrate the sensory function assessment.
 Demonstrate the assessment of cerebellar function
 Demonstrate the assessment of reflexes
 Discuss the role of nurse in neurological examination.
S TIME SPECIFIC OBJECTIVE CONTENT TEACHING AV EVALUATION
N LEARNING AIDS
O ACTIVITY
1. - INTRODUCTION

2. To define neurological DEFINITION How will you define

examination A neurological examination is the assessment Teacher will define neurological
of sensory neuron and motor responses, neurological examination?
especially reflexes, to determine whether examination using
the nervous system is impaired.

This typically includes a physical examination and

a review of the patient's medical history, but not
deeper investigation such as neuroimaging.

3. To explain the purpose PURPOSE Teacher will explain What are the main
of neurological 1.To screen for major neurological disease. the purpose of purposes of
assessment 2.To evaluate the performance decrements in neurological neurological
patients without identifiable neurologic disorders. assessment by assessment?
 4. To enlist the INDICATION Teacher will enlist Enlist the indications
indications of 1.A neurological examination is indicated whenever a the indications of of neurological
neurological physician suspects that a patient may have neurological examination.
examination a neurological disorder. examination using
2. Any new symptom of any neurological order may
be an indication for performing a neurological
examination.

5. To enlist the EQUIPMENT NEEDED: Teacher will enlist Enlist the equipments
equipments required A tray containing- the equipments required for the
for the assessment Reflex hammer ,Torch required by showing assessment.
128-Hz tuning fork. the articles
Lemon,salt,sugar.
Pocket eye chart (for near vision testing)
Cotton swabs
tongue blades
safety pins

6. To enumerate COMPONENTS OF NEUROLOGICAL Teacher will Enumerate the

different components EXAMINATION enumerate different different components
of neurological 1. Levels of consciousness components of of neurological
examination 2. Mental status examination neurological examination.
3. Special cerebral functions examination using
4. Cranial nerves functions
5. Motor system
6. Sensory system
7. Cerebellar function
8. Reflexes

7. To demonstrate the LEVELS OF CONSCIOUSNESS Teacher will How to assess the

assessment of level of Assessment of levels of consciousness demonstrate the level of
consciousness. includes following categories: assessment of level consciousness?
a. Alertness: Patient is awake, responds of consciousness.
immediately & appropriately to all
verbal stimuli.
 b. Lethargic: Patient is drowsy &
inattentive but 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.

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’s
level of consciousness.

8. To demonstrate the MENTAL STATUS EXAMINATION: Teacher will What are the steps to
assessment of mental 1. Level of awareness demonstrate the perform mental status
status examination 2. General appearance and behaviour assessment of mental examination?
3. speech status examination
4. Mood and affect
5. Thought process
6. Perception
7. Cognitive functions
8. Consciousness
9. Orientation
10. Attention
11. Concentration
12. Memory
13. Intelligence
14. Abstraction
15. Judgement
16. Insight
9. To demonstrate the SPECIAL CEREBRAL FUNCTIONS Teacher will What are the 3 special
assessment of special Agnosia demonstrate the cerebral functions to
cerebral functions. Apraxia assessment of special be assessed?
Aphasia cerebral functions.

10. To demonstrate the CRANIAL NERVE EXAMINATION Teacher will Demonstrate the
assessment of cranial demonstrate the cranial nerve
nerves. I Olfactory Nerve- Smell (use coffee, lemon, assessment of cranial examination.
vanilla, etc; avoid peppermint, menthol, and nerves
ammonia since they may stimulate taste buds or
trigeminal nerve endings and do not specifically test
smell)

II Optic Nerve - Visual fields, visual acuity

(Snellen chart)

III Oculomotor, IV Trochlear, VI Abducens- Eye

movements, pupillary reaction to light and
accommodation, convergence

V Trigeminal- Facial sensation, jaw movements,

corneal reflex (afferent limb)

VII Facial- Facial movements-both spontaneous

and to command (raising eyebrows, closing eyes,
smiling), taste (e.g., salt, sugar, lemon)

VIII vestibulocochlear/ Acoustic- Hearing (finger

rub or whisper-not tuning fork)

IX glossopharyngeal, X vagus- Palate movement,

pharyngeal sensation, voice, swallowing; gag not
usually necessary

XI accessory- Shrugging shoulders, turning head

against resistance

XII hypoglossal- Tongue position and movements

11. To demonstrate the MOTOR FUNCTION ASSESSMENT Teacher will How to assess the
motor function  Muscle size: Inspect all major muscle demonstrate the motor functions of the
assessment. groups bilaterally for symmetry, motor function body?
hypertrophy, & atrophy. assessment.
 Muscle Strength: Assess the power in
major muscle groups against resistance.
Assess & rate muscle strength on a 5-point
scale in all four extremities, comparing
one side with other
 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).
 Movement: Examine the muscles for fine
& gross abnormal movements. Move all
the points through a full range of
passivemotion. Abnormal findings include
pain, joint contractures, & muscle
resistance.

12. To demonstrate the SENSORY FUNCTION ASSESSMENT Teacher will How to perform the
sensory function • Sensory assessment involves testing for demonstrate the sensory function
assessment. sensory function assessment?
touch, pain, vibration & discrimination.
assessment.
• A complete sensory examination is possible
only on a conscious & co-operative patient.
• 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.

13. To demonstrate the Teacher will How to perform the

ASSESSMENT OF CEREBELLAR FUNCTION
assessment of demonstrate the assessment of
cerebellar function For evaluation of balance & co-ordination the assessment of cerebellar function?
tests used are: cerebellar function
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.

14. To demonstrate the

ASSESSMENT OF REFLEXES Demonstrate the
assessment of reflexes Teacher will
Reflex testing evaluates the integrity of assessment of reflexes.
demonstrate the
specific sensory & motor pathways. assessment of
• Reflex activity assessment, always a part reflexes.
of neurologic assessment, provides
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
II. Deep tendon (musclestretch)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(plantiflexion 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

15. To discuss the role of NURSES ROLE IN NEUROLOGICAL Teacher will discuss
nurse in neurological EXAMINATION… the role of nurse in
examination. • Provide a clam, suitable environment neurological
• Collect the personal data with patient & examination using
family members
• Set the equipment needed for neurological
examination
• Assess the current level of consciousness,
monitor vital parameters – temperature,
pulse, respiration, blood 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.

SUMMARY
16. We have covered the
topic under
following headings
 Definition
 Purpose
 Indications
 Articles required
 Components of
NE
 Demonstration of
various
components

CONCLUSION
17. Performing a
neurologic
assessment can be
scary. But if you
take your time and
use the proper
resources, you can
perform a solid
neurologic
assessment no
matter what.
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OTHERS
https://www.medicalnewstoday.com/articles/7624.php
https://www.mayoclinic.org/
https://en.wikipedia.org
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