The University of Jordan
Faculty of Nursing
Evaluation Form
Day/Date: ……………………............
Student Name: ……………………………………..
Section: ……………….……………...
Course Name: ………………………………………
Evaluator Name:…………………….
Instructor Name: …………………………………..
Procedure: Assessment: Neurological System
Task
1.
Perform hand hygiene
2.
Verify the correct client using
two identifiers.
Ensure that the examination area
was adequately lighted, private,
and sufficiently warm.
Assess the client’s
developmental stage and mental
abilities.
Assess client’s level of
consciousness & responses to
person, place, and time as
“Oriented × 3.”
Assess the cranial nerves CN.
Olfactory ( I ).
3.
4.
5.
6.
1. Use aromas, familiar, and non-toxic
substances such as coffee, soap, and
vanilla.
2. Ask client to close eyes, occlude one
nostril, and identify an odor on each
side.
7. Optic (CN II)
1. Examined client’s distance
vision using the Snellen chart.
2. Examined the client’s near
vision using the Held hand
chart.
3. Assess visual fields by
Score
Student
Score
Comments
confrontation
8. Oculomotor (CN III), trochlear
(CN IV), abducens (CN VI):
Measured Extra Ocular Muscles
(EOM).
1. Asked the client to follow
Assess pupils Size, regularity,
equality, pupillary reaction,
and accommodation.
2. Assess six ocular directions
by six cardinal gaze, cover
test, and corneal light reflex
9. Trigeminal (CN V):
1. Palpate the temporal & masseter
muscles, While the client to
clenching the teeth. Note the
strength of muscle contraction.
2. Using a fine wisp of cotton. Ask
the client to respond whenever
you touch the skin.
10. Facial (CN VII):
1. Observed face for symmetry.
Had the client frown, smile,
show teeth, puff cheeks, raise
eyebrows and close eyes
tightly. Then close against
resistance.
2. Assess the client's taste
11. Acoustic CN Vlll): Assess the
hearing with the whispered voice
test, Rinne test, and Weber test.
12. Glossopharyngeal (CN IX),
vagus (CN X),
1. Assessed speech, observed
swallowing.
2. Asked the client to say “ahh”
while holding the tongue
down with a tongue blade
and observing the uvula with
a penlight.
3. Checked for midline uvula
and rise of uvula and soft
palate.
4. Using the tongue blade,
pressed on posterior tongue
to elicit a gag reflex.
5. Assess the bitter taste.
13. Accessory (CN XI)
1. Had the client sit upright and
shrug shoulders while
applying resistance with
hands on shoulders.
2. Had the client turn head left
& right while applying
resistance with hands on the
side of the head.
14. Hypoglossal (CN XII):
1. Instructed the patient to open
his or her mouth and move
the tongue side to side. Note
the forward thrust in the
midline.
2. Ask the client to say "Light tight
Dynamite". Note lingual
speech.(sound of letters I, t, d, &
n) is clear & distinct.
15. Assessed motor and cerebellar
function.
Gait: Ask the client to walk 1020 ft. turns and return to the
starting point.
16. Tandem walk: Ask the client to
walk a straight line, placing the
heel of one foot directly in front
of the toes of the other foot.
17. Shallow bend knee: Ask the
client to close eyes and stand
on one foot, then the other.
18. Heel-to-Shin- test
Ask the client to place one heel
on the opposite knee, and then
run it down the shin to the big
toe. Note the smoothness and
accuracy of the movements.
Repeat on the other side.
19. Romberg test: Ask the client to
stand with feet together and
arms resting at the sides, first
with eyes open, and then closed.
Note any swaying.
20. Alternating Supination and
Pronation of Hands on Knees:
Ask the client to pat both knees
with the palms of both hands
and then with the backs of
hands, alternately, at an everincreasing rate.
21. Finger-to-finer Test: Ask the
client to abduct and extend arms
at shoulder height and rapidly
touch nose alternately with one
index finger and then the other.
Have the client repeat the test
with eyes closed if the test is
performed easily.
22. Finger to Nose and to the
Nurse’s Finger: Ask the client to
touch nose and then your index
finger, held at a distance at about
45 cm (18 inches), at a rapid and
increasing rate.
23.
Opposition( Fingers to Thumb ):
Ask the client to touch each
finger of one hand to the thumb
of the same hand as rapidly as
possible
24. Assessed extremities for
sensation.
Pain sensation.
Ask the client to close his eyes and to say
“sharp,” “dull,” or “don’t know” when the
sharp or dull end of the broken tongue
depressor is felt.
Alternately, use the sharp and dull end of
the sterile pin or needle to lightly prick
designated anatomic areas at random.
Allow at least two seconds between each
test.
25. Light-touch sensation:
1. Ask the client to close eyes and
to respond by saying “yes” or
“now” whenever the client feels
the cotton wisp touching skin.
2. With a wisp of cotton, lightly
touch one specific spot and then
the same spot on the other side
of the body.
3. Test areas on the forehead,
cheek, hand, lower arm,
abdomen, foot, and lower leg.
Check a distal area of the limb
first.
26. Temperature Sensation:
1. Touch skin areas with test tubes
filled with hot or cold water.
2. Have the client respond say
saying “hot,” “cold,” or “don’t
know.”
27. Vibration sensation:
1. Applied the stem of a vibrating
tuning fork to distal joints of
toes and fingers.
2. Client to indicate when the
vibration starts and stopped.
28. Position(Kinesthetic)
1. Grasp the client’s a middle finger or a
big toe firmly between your
thumb and index finger, and exert
the same pressure on both sides of
the finger or toe while moving it.
2. Use a series of brisk up-and-down
movements before bringing the
finger or toe suddenly to rest in
one of the three positions.
29. Stereognosis: Place familiar
objects—such as a key, paper
clip, or coin—in the client’s
hand, and ask the client to
identify them.
30. Graphesthesia: write a number
or letter on the client’s palm,
using a blunt instrument, and ask
the client to identify it.
31. Assess the deep tendon
reflexes:
Test reflexes using a percussion
hammer, comparing one side of
the body with the other to
evaluate the symmetry of
response.
32. Biceps Reflex( C5 – C6):
1.Partially flex the client’s arm at
the elbow, and rest the forearm
over the thighs, placing the palm
of the hand down.
2.Place the thumb of your
nondominant hand horizontally
over the biceps tendon and strike
a blow on the thumb.Note slight
flexion of the elbow.
33. Triceps Reflex ( C7 - C8).
1.Flex the client’s arm at the elbow,
and support it by holding the
upper arm.
2.Palpate the triceps tendon just
above the elbow and strike with
the percussion hammer directly to
the tendon. Note slight extension
of the elbow.
34. Brachioradialis Reflex(C5 C6).
1. Rest the client’s arm in a relaxed
position on your forearm or on
the client’s own leg.
2. Deliver a blow with the
percussion hammer directly on
the radius 2–5 cm (1–2 inches)
above the wrist or the styloid
process, the bony prominence on
the thumb side of the wrist. Note
flexion and supination of the
forearm with the fingers extend
slightly.
35. Patellar Reflex ( L2. L3).
1. Ask the client to sit on the edge
of the examining table so that
legs hang freely.
2. Locate the patellar tendon
directly below the patella.
3. Deliver a blow with the
percussion hammer directly to
the tendon. Note extension leg
36. Achilles Reflex (S1 – S2)
1. With the client in the same
position as for the patellar reflex
test, Hold the foot in
dorsiflexion
2. . Deliver a blow with the
percussion hammer directly to
the Achilles tendon just above
the heel. Note plantar flexion
(downward jerk) of the foot.
37. Plantar (Babinski’s)
Position the thigh in slight
external rotation. Use the handle
of the percussion hammer, draw
Stroke the lateral border of the
sole of the alight stroke up
lateral side of the sole of the foot
inward across the ball of the
foot toward the big toe, like
upside- down J. Note toes bend
downward.
38.
Performed hand hygiene.
39.
Document or report findings of
the client.