physical assessment of CNS

1. BY
G.VIDHYA
PBBSC II yr
VCCON

2. NERVOUS SYSTEM
The nervous system consists of
1. The central nervous system (CNS)
2. The peripheral nervous system
3. The autonomic nervous system

3. NURSING ASSESSMENT
History collection
Physical examination
Diagnostic evaluation

4. HISTORY COLLECTION
Past history
Fall or trauma that may have involved the head or
spinal cord.
Family history
Alzheimer’s disease, epilepsy, parkinson’s disease,
spina bifida, etc.
Personal history
Alcohol, medications and illicit drugs.

5. NEUROLOGICAL ASSESSMENT
A complete neurological assessment consists of five
steps:
1. Consciousness and cognition assessment
2. Cranial nerve assessment
3. Reflex testing
4. Motor system assessment
5. Sensory system assessment .

6. CONSCIOUSNESS AND COGNITION
ASSESSMENT
Cerebral abnormalities may cause disturbances in
mental status, intellectual functioning, thought
content and emotional status.

8. CRANIAL NERVES ASSESSMENT

9. EQUIPMENTS NEEDED FOR CNS
ASSESSMENT
Tongue depressor
Flash light
Sugar and salt samples
Watch
Cotton – tipped swab
Snellen chart
Opthalmoscope
Samples of familiar odours
Tuning fork
Knee hammer

10. CRANIAL NERVE I (Olfactory )

11. CRANIAL NERVE II (optic)

12. CRANIAL NERVE III (Occulomotor)

13. CRANIAL NERVE IV (Trochlear)

14. CRANIAL NERVE (Trigeminal)

15. CRANIAL NERVE VI (Abducens)

16. CRANIAL NERVE VII (Facial)

17. CRANIAL NERVE VIII(Acoustic)

18. ROMBERG TEST

19. CRANIAL NERVE IX
(Glossopharyngeal)

20. CRANIAL NERVE X (Vagus)

21. CRANIAL NERVE XI (Spinal
accessory)

22. CRANIAL NERVE XII (Hypoglossal)

23. REFLEX TESTING
Biceps reflex
Triceps reflex
Brachioradialis reflex
Patellar reflex
Achilles reflex

24. BICEPS REFLEX
1- Have the patient's elbow at about a
90° angle of flexion with the arm
slightly bent down as shown in
figure 2-6 .
2- Grasp the elbow with your left
hand so the fingers are behind the
elbow and your abductee thumb
presses the biceps brachial tendon .
3- Strike your thumb a series of blows
with the rubber hammer, varying
your thumb pressure with each
blow until the most satisfactory
response is obtained .
4- Normal reflex is elbow flexion
(bending(

25. TRICEPS REFLEX
Grasp the patient's wrist with
your left hand and pull his
arm across his chest so the
elbow is flexed about 90° and
the forearm is partially bent
down .
Tap the triceps brachial
tendon directly above the
olecranon process. The
normal response is elbow
extension .
Triceps reflex
Triceps jerk with
one arm flexed
Triceps
jerk with
arms
folded

26. BRACHIORADIALIS REFLEX
With the patient’s forearm resting on the lap or across
the abdomen, the brachioradialis reflex is assesses.
A gentle strike of the hammer 2.5 to 5 cm above the
wrist results in flexion and supination of the forearm.

27. PATELLAR REFLEX
The patellar reflex is elicited by
striking the patellar tendon just
below the patella. The patient
may be in a sitting or a lying
position.
If the patient is supine, the
examiner supports the legs to
facilitate relaxation of the
muscles.
Contraction of the quadriceps
and knee extension are normal
responses.

28. ACHILLES REFLEX
To elicit an achilles reflex, the
foot is dorsiflexed at the ankle
and the hammer strikes the
stretched achilles tendon.
This reflex normally produces
flexion

29. Deep tendon reflexes should be
graded on a scale of 0-4
as follows:
=0 absent despite reinforcement
=1 present only with reinforcement
=2 normal
=3 increased but normal
=4 markedly hyperactive, with clonus

30. EXAMINING THE MOTOR SYSTEM
Motor ability
Muscle strength
Balance and coordination

31. MOTOR ABILITY
The patient is instructed to walk across the room, if
possible while the examiner observes posture and
gait. the muscles are inspected and palpated if atrophy
or involuntary movements is noted.

32. Muscle strength
Ask client to flex muscle and then resist when you apply
opposing force against the muscles
Compare contralateral sides
Neck, Trapezius, arms (Biceps, Triceps), wrists, fingers, hips,
legs, ankles and feet

34. Balance and coordination
Seat the patient. Instruct him to pat his knees with his
hands, palms down then palms up. Have him alternate
palms down and palms up rapidly.
Watch the patient to notice if his movements are stiff, slow,
nonrhythmic, or jerky.
The movements should be smooth and rhythmic as he does
the task faster.

35. EXAMINING THE SENSORY SYSTEM
Tactile sensation
Superficial pain
Temperature
Vibration and position sense

36. DIAGNOSTIC EVALUATIONS
Computed tomography scanning
Magnetic resonance imaging
Positron emission tomography
Single photon emission computed tomography
Cerebral angiography
Myelography
Ultrasound imagery
Doppler
EEG
EMG
LP