Neurological Function, Assessment, and Therapeutic
Measures
Review of Normal Anatomy
 CNS- brain and spinal cord (transmits impulses to and
from the brain)
 PNS- Peripheral Nervous System- contains
 SNS- 12 cranial nerves
 ANS- controls involuntary bodily functions, contains
Sympathetic (Fight or Flight) and
 Parasympathetic NS (rest and digest)
Cross Section of Spinal Cord
Impulse Transmission
 Nerve tissue consist of neurons (have a cell body with
axons and dendrites) Myelin sheath electrically
insulates the neurons. Neurotransmitters
(acetylcholine, norepinephine, dopamine, serotonin)
carry nerve impulses at the synapse and there
generates an electrical impulse that is carried on.
Brain
Brain
 Brain stem- consists of Medulla- controls HR, R,
sneezing, swallowing, vomiting, coughing. Pons-
resp center. Midbrain controls motor coordination,
visual/auditory
 Cerebellum-muscle movement/tone
 Hypothalamus-regulates ANS, production of
hormones
 Thalamus-sensations
 Cerebrum- R and L hemisphere, 4 lobes
Meninges
 Dura mater- thick outermost fibrous layer
 Arachnoid- middle web-like strands of connective
tissue
 Subarachnoid space- contains CSF
 Pia Mater- very thin membrane on surface of brain and
spinal cord.
Cranial Nerves
 Olfactory
 Facial
 Optic
 Acoustic
 Oculomotor
 Glossopharyngeal
 Trochlear
 Vagus
 Trigeminal
 Accessory
 Abducens
 Hypoglossal
Aging
Basic Neurological Assessment
 Glasgow Coma Scale- LOC
 Vital Signs
 Pupil Response to Light
 Extremity Strength and Movement
 Sensation
Subjective Data
 Symptoms
 Medication use
 Surgical History
 Family History
 Life style/ memory
 Pain
Physical Assessment
 Level of Consciousness
 Mental State Examination
 Pupillary Response
 Muscle Function
 Cranial Nerve Function
Glasgow Coma Scale
 Eye Opening
 Verbal Response
 Motor Response
 Decorticate posturing- legs rotated inward, elbows and
fingers flexed
 Decerebrate posturing- forearms pronated, wrists and
fingers flexed.
 Flaccid posturing posturing- pt shows no motor
response in any extremity
Abnormal Posturing
Pupil Assessment
 Pupils
 Equal
 Round
 Reactive to
 Light and
 Accommodation
Diagnostic Tests
 Laboratory Tests
 Thyroid
 ESR
 WBC
 Electrolytes
 Cortisol
 Prolactin
 Liver Function
 Renal Function
Lumbar Puncture
 Needle inserted into Arachoid space between L3
andL4 vertebrae, withdraw 8-10 ml. Not done on pts
with increased ICP.
 CSF- normal is clear, watery (yellow halo)
 Blood- indicates hemorrhage
 Protein- degenerative disease/ brain tumor
 Glucose decreased- bacterial infection
 WBC’s- infection
Lumbar Puncture
 Pre-Procedure Nursing Care
 Verify Informed Consent, have pt void
 Assist with Positioning (side-lying)
 Post-Procedure Care
 Maintain Flat Bedrest 6 – 8 Hours
 Encourage Fluids
 Monitor Puncture Site
 Monitor Vs, Movement, Sensation, HA, I&O
Lumbar Puncture
CT Scan
 Pre-Procedure
 Administer Contrast if
Ordered


Check Allergies
Check BUN, Cr
 Request order for
sedation if indicated
 Instruct must lie still
and flat, hold head still
 Teach
 Contrast may cause
feeling of warmth
 S&S of allergic reaction
to report
 Post Procedure
 Encourage Fluids if
Dye Used
MRI
 Test uses magnetic energy to visualize internal parts.
 Pre-Procedure Nursing Care
 Assure no pacemaker or metal on patient
 Administer analgesic or sedative as ordered
 Teach relaxation
 Post-Procedure Care
 No Special Care
Angiogram
 Injects contrast through femoral artery into
carotid arteries to visualize cerebral arteries, will
detect vascular lesions of the brain
 Pre-Procedure Nursing Care
 Verify Informed Consent, must lie still
 Give Clear Liquid Diet
 Insert IV Needle
 Check BUN/Cr, PT and PTT
 Administer Sedation as Ordered
Angiogram Continued
 Post-Procedure Care
 Keep Flat in Bed 6 – 8 hr
 Monitor



VS
Catheter Insertion Site- pressure dsg, keep affected leg
straight
Pulses
 Encourage Fluids
Myelogram
 Injection of dye or air into subarachnoid spaces to
detect abnormalities of cord or vertebrae
 Pre-Procedure Nursing Care
 Check Allergies to Contrast
 Assess History of Seizures
 Verify Informed Consent
 Post-Procedure Care
 Bedrest with head elevated
 Encourage Fluids, VS, neuro checks
Electroencephalogram
 Records brain electrical activity
 Pre-Procedure Nursing Care
 Assure Hair Clean and Dry
 Check Medication Orders- no stimulants or depressants
before test
 Post-Procedure Care
 Wash Hair- adhesive will harden
Therapeutic Measures
 Moving and Positioning
 Maintain Functional
Positions
 Avoid Injury
 Prevent Contractureoften complications of
neuro conditions
 Mobilize ASAP
Communication
 Problems
 Dysarthria-difficulty
speaking
 Expressive Aphasiainability to express self
 Receptive Aphasiainability to understand
 Interventions
 Use Care with Yes-No
Questions
 Correct Substituted
Words
 Anticipate Needs
 Use Gestures
 Be Patient!
Nutrition
 Evaluate Swallowing
 Interventions for Impaired Swallowing
 Thicken Liquids
 Position Upright for Eating- prevent aspiration
 Monitor Meals
 Tube Feedings