1. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

2. Gross anatomy
The nervous system is divided into the
central and peripheral nervous system
The CENTRAL NERVOUS SYSTEM consists
of the brain and the spinal cord
The PERIPHERAL NERVOUS SYSTEM
consists of the spinal nerves and the cranial
nerves

3. The Central
Nervous
System

4. The
Peripheral
Nervous
System

5. THE BRAIN
The control
center of the
body.

6. THE BRAIN:
LEFT HEMISPHERE
Left Hemisphere
Communicates by
using words, has
highly developed
verbal abilities, is
logical and
systematic,
concerned with
matters as they
are.

7. THE BRAIN: RIGHT
HEMISPHERE
Right Hemisphere
Communicates
using images
(pictures), has
highly developed
spatial abilities, is
intuitive and
imaginative,
concerned with
emotions and
feelings.

8. THE CEREBRUM
The brain is
composed of lobes-
Frontal lobe-
personality, memory
and motor function
Parietal lobe-
sensory function
Temporal lobe-
hearing and
olfaction and
emotion by the
limbic system
Occipital lobe-
vision

9. THE CEREBELLUM
The cerebellum is
involved in
coordination and
equilibrium
The diencephalon
consists of the :
Thalamus- the
relay center of all
sensory input
Hypothalamus-
center for endocrine
regulation, sleep,
temperature, thirst,
sexual arousal and
emotional response

10. THE BRAINSTEM
MIDBRAIN
Visual and auditory
relay center
PONS
Respiratory center
MEDULLA
OBLANGATA
Respiratory &
cardiovascular
centers
CEREBELLUM
Posture &
equilibrium

11. THE CRANIAL
NERVES
There are 12 pairs of
cranial nerves that
supply structures in
the head, neck,
thorax and
abdomen. A cranial
nerve can be made
up of a mixture of
functions which are
called modalities or
may be made up of a
single modality. A
modality is sensory,
motor, special
sensory, etc.

12. Cranial Nerve: Major Functions:
I Olfactory smell
II Optic vision
III Oculomotor eyelid and eyeball movement
IV Trochlear innervates superior oblique turns eye downward and laterally
V Trigeminal chewing , face & mouth touch & pain
VI Abducens turns eye laterally
VII Facial controls most facial expressions ,secretion of tears & salivataste
VIII Vestibulocochlear
hearing , equillibrium sensation
(auditory)
IX Glossopharyngeal taste , senses carotid blood pressure
senses aortic blood pressure ,slows heart rate
X Vagus
stimulates digestive organs, taste
controls trapezius & sternocleidomastoid controls
XI Spinal Accessory
swallowing movements
XII Hypoglossal controls tongue movements

13. THE SPINAL
NERVES
Sensory and motor
function
Spinal Nerves 31
→ C8, T12, L5, S5, C1
Cerebrospinal Fluid
Covered by
meninges
Protected by
vertebral column

14. THE SKELETAL
SYSTEM
There are 206 bones
in an adult skeletal
system.

15. THE MUSCULAR
SYSTEM
There are 639
muscles in an adult
muscular system
divided into skeletal,
cardiac & smooth
muscles.

16. DEFINITION
Neurological examination is a method of
obtaining specific data in relation to the
function of a patient’s nervous system.

17. INDICATION
Neurological observations are required to
monitor and evaluate changes in the nervous
system by indicating trends, thus aiding
diagnosis and treatment which in turn may
affect prognosis and rehabilitation. The
frequency of neurological observations will
depend on the patient’s condition and the
rapidity with which changes are occurring or
expected to occur.

18. Level of consciousness - Alertness or state of
awareness of the environment
Attention -The ability to focus or concentrate
over time on one task or activity—an inattentive
or distractible person with impaired consciousness
has difficulty giving a history or responding to
questions.

19. Memory - The process of registering or recording
information, tested by asking for immediate
repetition of material, followed by storage or
retention of information. Recent or short-term
memory covers minutes, hours, or days; remote or
long-term memory refers to intervals of years.
Orientation - Awareness of personal identity,
place, and time; requires both memory and
attention

20. Perceptions - Sensory awareness of objects in the
environment and their interrelationships (external
stimuli); also refers to internal stimuli such as
dreams or hallucinations
Thought processes - The logic, coherence, and
relevance of the patient’s thought as it leads to
selected goals, or how people thinks

21. Thought content - What the patient thinks
about, including level of insight and judgment
Insight - Awareness that symptoms or
disturbed behaviors are normal or abnormal;
for example, distinguishing between
daydreams and hallucinations that seem real

22. Judgment - Process of comparing and evaluating
alternatives when deciding on a course of action;
reflects values that may or may not be based on
reality and social conventions or norms
Affect - An observable, usually episodic, feeling tone
expressed through voice, facial expression, and
demeanor
Mood - A more sustained emotion that may color a
person’s view of the world (mood is to affect as
climate is to weather)

23. Language - A complex symbolic system for
expressing, receiving,
and comprehending words; as with consciousness,
attention, and memory, language is essential for
assessing other mental functions
Higher cognitive functions - Assessed by
vocabulary, fund of information,
abstract thinking, calculations, construction of
objects that have two or three dimensions

24. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

25. 1. Cotton applicator 5. Vials containing coffee
Assesses patient’s or vanilla Assesses
response to light touch. olfactory nerve extract,
2. Needle Assesses sugar salt.
patient’s response to pain 6. Tongue blade
3. Test tube containing hot 7. Penlight
& cold water Assesses 8. Snellen chart
temperature sensation. 9. Tuning fork
4. Reflex hammer 10. Thermometer
11. BP apparatus
12. Stethoscope

26. PHYSICAL EXAMINATION
5 categories:
1. Cerebral function- LOC, mental status
2. Cranial nerves
3. Motor function
4. Sensory function
5. Reflexes

27. PREPARED BY: RUSSEL DE LARA, R.N. & JOHN FRANCIS FAUSTORILLA, R.N., R.M.

28. LEVEL OF
CONSCIOUSNESS
• TECHNIQUE
• SPEAK TO THE PATIENT IN A NORMAL TONE OF VOICE. AN
ALERT PATIENT OPENS THE EYES, LOOKS AT YOU, AND
ALERT RESPONDS FULLY AND APPROPRIATELY TO STIMULI (AROUSAL
INTACT).
• SPEAK TO THE PATIENT IN A LOUD VOICE. FOR EXAMPLE, CALL
LETHARGIC THE PATIENT’S NAME OR ASK “HOW ARE YOU?”
OBTUNTED • SHAKE THE PATIENT GENTLY AS IF AWAKENING A SLEEPER.
• APPLY A PAINFUL STIMULUS. FOR EXAMPLE, PINCH A TENDON,
STUPOROUS RUB THE STERNUM, OR ROLL A PENCIL ACROSS A NAIL BED.
(NO STRONGER STIMULI NEEDED!)
COMATOSE • APPLY REPEATED PAINFUL STIMULI.

29. THE GLASGOW COMA
SCALE
ACTION RESPONSE SCORE
BEST EYE OPENING (E)
• SPONTANEOUSLY 4
• TO SPEECH 3
• TO PAIN 2
• NONE 1
BEST VERBAL RESPONSE (V)
• ORIENTED 5
• CONFUSED 4
• INAPPROPRIATE WORDS 3
• INCOMPREHENSIVE SOUNDS 2
• NO VERAL RESPONSE 1
BEST MOTOR RESPONSE (M)
• OBEYS COMMANDS 6
• LOCALIZES PAIN 5
• FLEXION WITH WITHDRAWAL 4
• ABNORMAL FLEXION 3
• ABNORMAL EXTENSION 2
• FLACCID 1
TOTAL SCORE 15

30. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

31. Determine the client’s orientation to time, place
and person.
Ask the client to state his name (general data),
time of the day, date, day of the week correctly

32. 1.Assess and listen for lapses in memory.
2.Assess immediate recall
Ask the client to repeat a series of three digits
spoken slowly.
Gradually increase the number of digits.
Start again to ask a series of three digits but
this time ask the patient to state it backwards

33. 3. Assess recent memory
Ask the client to recall recent events of the
day.
Ask the client to recall information given
early in the interview
Provide the client with three facts to recall
4.Assess remote memory
Ask the client to describe a previous illness or
event

34. Apply the
Glascow Coma
Scale.

35. Test the ability to concentrate or attention span
of the client.
Ask the client to recite the alphabet or count
backwards from 100.

36. Assess any defects in or loss of the power to express
oneself by speech, writing or signs or to comprehend
or written language. If with difficulty speaking:
Point to common objects and ask client to name
them.
Ask client to read some words and to match the
printed and written words with pictures
Ask the client to respond to simple verbal and
written commands.

37. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

38. Nerve Function How to test
I olfaction with an odorous substance
II vision vision chart
III most eye muscles "follow the moving finger"
IV superior oblique look down at the nose
V facial sensation touch the face
muscles of mastication clench the teeth
VI lateral rectus look to the side
VII facial expression smile, raise the eyebrows
taste sugar or salt
VIII hearing a tuning fork
balance look for vertigo
IX pharynx sensation gag reflex
muscles of larynx and check for hoarseness, open
X
pharynx, parasymp. wide and say "AH"
trapezius and test shoulder raise or
XI
sternocleidomastoid turning the head
XII tongue muscles stick out the tongue

39. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

41. FINGER-TO-NOSE TEST: ask the client to abduct
and extend the arms at shoulder height and rapidly
touch the nose alternatively with one index finger
and then the other. The client repeats the test with
the eyes closed if the test is performed easy.
FINGER TO NOSE AND TO THE NURSE’S
FINGERS: Ask the client to touch the nose and then
your index finger held at a distance at about 45 cm at
rapid and increasing rate.

42. FINGERS TO FINGERS: ask the client to spread the
arms broadly at shoulder height and then bring the
fingers together at the midline, first with eyes open
and then closed, first slowly and then rapidly.
FINGERS TO THUMB (SAME HAND): Ask the client
to touch each finger of one hand to the thumb of the
same hand as rapidly as possible.

43. ALTERNATING PRONATION AND SUPINATION
OF HANDS ON KNEES: Ask the client to pat both
knees with the palms of both hands and then with
the back of the hands alternately at ever increasing
rate.

44. HEEL DOWN OPPOSITE SHIN: ask the client to
place the heel of one foot just below the opposite
knee and run the heel down the shin to the foot.
Repeat with the other foot.
TOE OR BALL OF FOOT TO THE NURSE’S
FINGER: Ask the client to touch your finger with the
large toe of each foot.

45. WALKING GAIT: Ask the client to walk across the
room and back and assess the client’s gait.
ROMBERG’S TEST: ask the client to stand with
feet together and arms resting at the sides, first
with eyes open and then closed. Stand close
during this test to prevent the client from falling.

46. STANDING ON ONE FOOT WITH EYES CLOSED:
Ask the client to close the eyes and stands on one
foot and then the other. Stand close to the client
during this test.
HEEL-TOE WALKING: Ask the client to walk a
straight line, placing the heel of one foot directly
in front of the toes of the other foot.
TOE OR HEEL WALKING: Ask the client to walk
several steps on the toes and then on the heels.

47. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

48. 1. Ask the patient to identify the “sharp” or
“dull” or “don’t know” sensation when the
sharp or dull end of the safety pin or
needle is felt on the symmetrical areas of
the body.
2. Points on the spot where the sensation
was felt.

49. 1. Ask the client to tell when vibrations are
first felt by indicating “Yes” and when the
vibrations stop by stating “gone”.
2. Compare the vibratory sensations felt on
symmetrical sides of the body.

50. 1. Ask the client to identify the position of
the big toe while moving it.
2. Use familiar small object to test
stereognosis with client’s are eyes closed.

51. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

53.  Biceps reflex  Cremasteric reflex
 Triceps reflex  Patellar reflex
 Brachioradiallis reflex  Achilles reflex
 Abdominal reflex  Plantar reflex

54. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,

55. ELECTROENCEPH
A-LOGRAPHY
Withhold
medications
that may
interfere with
the results:
anti-
convulsants,
sedatives and
stimulants
Wash hair
thoroughly
before
procedure

56. COMPUTED
TOMOGRAPHY
SCANS
With radiation
risk
If contrast
medium will be
used- ensure
consent, assess
for allergies to
dyes and iodine
or seafood,
flushing and
metallic taste
are expected as
the dye is
injected

57. MAGNETIC
RESONANCE
IMAGING
Uses magnetic
waves
Patients with
pacemakers,
orthopedic
metal
prosthesis and
implanted
metal devices
cannot undergo
this procedure

58. CEREBRAL
ANGIOGRAPHY
Note allergies
to dyes, iodine
and seafood
Ensure
consent
Keep patient
at rest after
procedure
Maintain
pressure
dressing or
sandbag over
punctured site

59. LUMBAR
PUNCTURE
Ensure consent,
determine ability to
lie still
Contraindicated in
patients with
increased ICP
Keep flat on bed
after procedure
Increase fluid
intake after
procedure