Central Mindanao University

University Town, Musuan, Maramag Bukidnon

College of Nursing

PERFORMANCE CHECKLIST

NEUROMUSCULAR SYSTEM – CRANIAL NERVES

NAME: ___________________________________________ RATING: _____________
SEC/GRP: ________________ DATE: ______________

Directions: Every student will be rated according to the rating scale below. Keeping the guidelines in
mind, please complete the Assessment Tool.
Scale Description Interpretation Assistance Needed
5 Outstanding Demonstrates exceptional performance and mastery of the procedure. Proficient, Without Direction
coordinated and confident
Very Able to state and demonstrate the step-by-step procedure but failed to mention the With occasional physical or
4
Satisfactory rationale. Efficient, coordinated, confident. Expedient use of time. verbal direction
Meets the standards or basic requirements of the procedure. Misses some steps
With frequent verbal and/or
3 Satisfactory and rationale with partial demonstration of skills, inefficient, uncoordinated. Delayed
direction
time Expenditure
Barely meets the requirements of the Performance of the procedure. Unskilled and With continuous verbal and/or
2 Fair
inefficient. Considerable and prolonged time expenditure. physical direction
Needs Fails to meet the requirements of the performance of the procedure. Misses most of With continuous verbal and
1
Improvement the steps, without rationale. Lacks confidence, coordination and efficiency. physical direction

COMPONENTS 5 4 3 2 1
Preparatory Phase
1 Reassess client's previous medical records if available.
2 Determine the scope of assessment needed. Prepare necessary equipment.
3 Perform hand washing and donned gloves (if deemed necessary).
4 Assemble equipment & supplies needed
5 Introduce self and verify the client's identity.
6 Explain the procedure to the client.
7 Position patient comfortably and provides privacy.
Assessment Phase
ASSESSING MENTAL STATUS
8 Assess level of consciousness.
9 Observe appearance, behaviour and speech.
10 Observe mood, feelings and expressions.
11 Observe cognitive abilities, thought processes and perceptions.
ASSESSING CRANIAL NERVES
12 Test Cranial Nerve I (Smell).
13 Test Cranial Nerve II (Optic-Visual Acuity & Peripheral Vision- Confrontation Test).
14 Test Cranial Nerve III (Occulomotor- Extraocular Muscle Movement).
15 Test Cranial Nerve IV (Trochlear)
16 Test Cranial Nerve V (Trigeminal )- Facial Movement and Sensation
17 Test Cranial Nerve VI (Abducens)
18 Test Cranial Nerve VII (Facial)Taste Sensation - Anterior Tongue)
19 Test Cranial Nerve VIII (Acoustic-Hearing and Balance)
20 Test Cranial Nerve IX- Glossopharyngeal-Posterior Tongue; Movement of Soft Palate, Gag Reflex
21 Test Cranial Nerve X (Vagus )
22 Test Cranial Nerve XI (Spinal Accessory)- Assess shoulders and neck muscles for strength and
movement.
 COMPONENTS 5 4 3 2 1
23 Test Cranial Nerve XII (Hypoglossal ) Tongue Movement
ASSESSING MOTOR AND CEREBELLAR SYSTEMS
24 Assess condition (tone and strength) and movement of muscles.
A. Evaluate Gait and Balance
25 Perform Tandem Walking
26 Perform Romberg Test
B. Assess Coordination
27 Perform Finger-to-Nose to Test
28 Perform Rapid Alternating Movements
29 Perform Heel-to-Shin Test
ASSESSING SENSORY SYSTEM
30 Test light touch, pain, and temperature sensations.
31 Test vibratory sensations.
32 Test position sensations.
ASSESS TACTILE DISCRIMINATION (fine touch)
33 Test stereognosis
34 Test point localization
35 Test graphesthesia
36 Test extinction
ASSESSING REFLEXES
A. Test for Deep Tendon Reflexes
37 Perform biceps reflex
38 Perfom brachioradialis reflex
39 Perform triceps reflex
40 Perform patellar reflex
41 Perform Achilles reflex
42 Perform ankle clonus
B. Test for Superficial Reflexes
43 Perform plantar reflex
44 Perform abdominal reflex
45 Perform cremasteric reflex in male clients
C. Tests for Meningeal Irritation or Inflammation
46 Perform Brudzinski’s sign.
47 Perform Kernig’s sign.
Termination Phase
Review the information obtained during the assessment phase and discussed findings to the client.
48 Present to the client possible plans to resolve health concern, if present.
Measure client's understanding of the plan and the need for further teaching.
49 Provided the client the opportunity to clarify, ask or raise any concern
50 End the interview politely.
51 Do after care. Fix the equipment used and arrange it properly.
52 Perform hand washing.
53 Document the findings in the client’s record.
TOTAL
References:
Dillon, P. (2006). Nursing Health Assessment: A Critical Thinking, Case Studies Approach, 2nd Ed. Philadelphia: F A Davis.
Weber, Janet R. (2018). Health Assessment in Nursing. Philadelphia: Lippincott Williams & Wilkins.
Potter AP, Perry GA. 2007. Basic nursing essentials for practice. 6th edition. India: Mosby Elsevier