NEUROLOGIC SYSTEM
RETURN DEMONSTRATION
Introduction
Good Afternoon Doc. Nika, I am John
Linuel Tulliao, a student nurse from WUP and for today’s return demonstration, I
will be performing the assessment of
neurologic system. So maam can I
proceed now?
Goal
The goal of this assessment is to assess
the function of cranial nerves and detect
any abnormalities.
Introduce yourself
The first thing we’re going to do is to
introduce yourself, and verify the client’s
identity. Identifying the patient ensures
the right patient receives the intervention
and helps prevent errors.
Hand Hygiene
Next is to perform hand hygiene and
observe other appropriate infection
prevention procedures.We should also
wear some PPEs in order to prevent the
spread of microorganisms.
Client Privacy
We should provide client privacy by
closing the curtains, doors, or windows.
Inquire
Inquire if the client has any history of the
following:
Sir did you have a presence of pain in the head,
back, and extremities, as well as onset and
aggravating and alleviating factors, problems in
speech, loss of consciousness, fainting,
convulsion, trauma, tingling or numbness, tremors
or tics, limping, paralysis, uncontrolled muscle
movements, loss of memory, mood swings or
problems with smell, vision, taste, touch, or
hearing.
Mental Status
Level of Consciousness:
Opens eyes spontaneously oriented
Cognitive Function
I have here some few questions that you’re
going to answer.
Sir can you tell what is today’s date? When is
your birthday? What did you have for lunch?
Patient is able to answer questions regarding
recent, remote and intermediate memory.
Cranial Nerves
CN I (Olfactory):
Can you close your eyes and identify
different mild aromas?
Cranial Nerves
CN II (Optic):
Can you read Snellen’s chart, and I’m
going to check your visual fields by
confrontation.
Can you cover your left eye?
How about your right eye?
Cranial Nerves
CN III and IV (Oculomotor and
Trochlear):
I’m going to assess six ocular movements
and pupil reaction. Can you stare at the
tip of this pen and follow its movements?
Cranial Nerves
CN V (Trigeminal):
a. Can you look upward, I’m going to lightly
touch lateral sclera of eye with sterile gauze to
elicit blink reflex.
b. To test light sensation, Can you close your
eyes and I’m going to touch your forehead and
paranasal sinuses by using a wisp of cotton.
c. To test deep sensation, I’ll use alternation
blunt and sharp ends of a safety pin over the same
area.
Cranial Nerves
CN VI (Abducens):
I’m going to assess direction of gaze.
(We’ve already done this a while ago)
Cranial Nerves
CN VII (Facial):
Can you smile, raise your eyebrows,
frown, puff out your cheeks, close your
eyes tightly. Can you identify various
taste placed on tip and sides of tongue.
Cranial Nerves
CN VIII (Auditory):
We’re going to do a whisper test, I’ll whisper
some words and you’re going to repeat it.
Can you cover your left ears, your right ears.
Now, we’re going to use the tuning fork and
please tell me if you hear the vibrations.
Cranial Nerves
CN IX (Glossopharyngeal):
I’m going to apply tastes on posterior
tongue for identification. Can you move
your tongue from side to side and up and
down.
Cranial Nerves
CN X (Vagus):
I’m going to assess your speech for
hoarseness. Can you please speak and say
your name?
Cranial Nerves
CN XI (Accessory):
Can you shrug your shoulders? Now, I’m
going to apply some force and can you please
resist it? and can you turn your head to the
right and I’m going to apply some force again
then you’re going to resist it. Can you turn
your head to the left?
Cranial Nerves
CN XII (Hypoglossal):
Can you stick your tongue out or protrude
it at midline, then move it side to side
Can you say “light, tight, dynamite,” and
I’m gonna note that lingual speech
(sounds of letters l, t, d, n) if it is clear
and distinct.
Motor Function
Fine Motor Test for the Upper Extremities
Motor Function
Finger-to-nose Test
Can you repeatedly and rhythmically
touches your nose using your finger?
Motor Function
Finger-to-nose-and-to- the nurse’s finger
Can you repeatedly touch you nose and my
finger using your finger? Performs with
coordination and rapidly able to perform with
ease.
Motor Function
Fingers to fingers
Can you repeatedly touch your finger?
Performs with accuracy and rapidly
Motor Function
Fingers to thumb (Opposition)
Can you touch each finger with your
thumb with each of your hand rapidly?
Motor Function
Heel Down Opposite Shin
Can you place the heel of one foot just
below the opposite knee and run the heel
down the shin to the foot. Repeat it with
the other foot. You may also use a sitting
position for this test.
Gross Motor and Balance Tests
Walking Gait
Can you stand and walk without support?
Gross Motor and Balance Tests
Romberg Test
Sways and able to maintain upright
posture and foot stance
Gross Motor and Balance Tests
Standing on One Foot with Closed Eyes
Can you please stand on one foot with
your eyes closed?
Able to maintain stance for 5 seconds
Gross Motor and Balance Tests
Heel-toe Walking
Can you walk with your other foot’s heel
on top of your foot’s toe?
The patient was able to maintain heel-totoe walking around a straight line.
Gross Motor and Balance Tests
Toe or Heel Walking
Can you walk with your toes? How about
your heels?
able to walk several steps on toes or heels
Secure patient’s comfort and
safety.
Document all the findings
Dispose PPEs
Now, I’m going to dispose my gloves and
put another spray of alcohol to prevent
the spread of microorganisms.
Thank you
Thank you sir for cooperating and thank
you Maam Nika for listening and for your
time.