UNIVERSITY OF EASTERN AFRICA BARATON

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF NURSING

AN ASSIGNMENT DONE FOR THE PARTIAL FULFILLMENT OF THE COURSE NRSG 212; HEALTH
ASSSESSMENT .

DONE BY;

OTUCHO JOHN COLLINS

SOTUCO 2111

INSTRUCTOR; MADAM AKURU EDNA

DUE DATE; OCTOBER 26, 2021

SYSTEM ASSESSMENT OF THE NEUROLOGIC

The function of the motor system and reflexes is to control everything from muscle strength and range
of motion to movement, balance, coordination, and certain involuntary responses. That’s show the
importance of thorough examination of parts of the neurologic system. Before examining the motor
system and reflexes, consider the relevant anatomy. The central nervous system has three major motor
pathways or tracks ;

The corticospinal or pyramidal tract

It contains motor nerve fibers that originate in the motor cortex and traveled to the brainstem cross to
the opposite side and pass down the spinal cord. It controls highly skilled voluntary movements such as
writing.

The extra pyramidal tract

It includes all of the motor nerve fibers in the central nervous system that are outside the pyramidal
tract these fibers maintain muscle tone and control automatic body movements such as walking .

The cerebellar system

It coordinates unconscious movements and also maintains equilibrium and maintaining power .The
cerebellum integrates motor information. The cortex or lower motor neurons in the spinal cord reflex
allow rapid reaction via a reflex in the simplest reflex arc. Sensory neurons carry message from the
receptor, dorsal root and into the spinal cord .There they synapse with motor neurons. From the vent
route motor neurons carry the message to the muscle which reduces the reflex.

When the person seems well and has no significant history questions screening Marilla examinations
are done for seizures. Neurologic concern reported show signs of neurologic dysfunction. Perform a
complete neurologic examination, which will be shown in an uncle who had a stroke, he was only 50.
 Incidence of stroke is two and a half times higher in blacks than in whites. And the incidence of Multiple
Sclerosis is higher among whites, yet both disorders affect the motor system. For the motor system
examination, begin by assessing the muscles. Inspect all muscle groups for size comparing one side with
the other muscle groups should have no atrophy be symmetrical bilaterally and be within normal limits
for the person’s age.

The strength of homologous muscles is tested simultaneously. The chest’s strength and shoulders if it is
for the short the person , it should be able to overcome your resistance . Test muscle tone ,the normal
degree of tension involuntarily relaxed muscles. To do this , the person should relax completely then
move each extremity smoothly through a full range of motion, providing support at the elbow or knee.
Normally you will know the mile even resistance to movement. To assess the muscles you should see no
involuntary movements if they are present no their location ,frequency, rate ,amplitude and ability to be
controlled. Begin by assessing the person’s balance. To do this observe his gait as he walks tend to turn
feed turns and comes back. Normally his gait is small rhythmic and effortless. If opposing arm swing is
coordinated did and his step length is about 15 inches now 20 feet. Also, ask the person to work walk a
straight line and a heel- to- toe fashion. This time the walking accentuates any coordination problems
.Normally, he can walk straight and stay bound . In an older adult the gait may be slower and more
deliberate. It may deviate from a midline path.

To further assess balance perform Romberg test while standing close to the person ask him to stand
with his feet together and his arms at his side then have him close to size and hold this for 20 seconds.
Normally he can maintain his posture and bounce but may sway lightly.

Ask the person do a shallow knee bent and place first on one leg and on the other .This demonstrates
normal positions muscle strength and cerebellar function .Evaluate coordination and skilled movements.
Test rapid alternating movements by asking the person to part his knees with both hands lifted up. Turn
his Hands over and part his knees with the backs of his hands .Ask him to do it fast .The movements
should be done with equal turning and a quick rhythmic pace . Ask the person to touch his thumb to
each finger on the same hand starting with the index then reverse direction. Now with the opposite
hand. Normally, this can be done quickly and accurately .Ask the person to perform the fingertip with
his eyes open .Ask him to use his index finger to touch your finger ,then his nose . After a few times
move your finger to different positions. The movements should be smooth and accurate .

Also have the person do the finger to nose test. With his eyes closed and his arms outstretched. Ask him
to touch the tip of his nose with each index finger and you try alternating hands and increasing speed.
Normally this is done with accurate and smooth movements.

The heel to Shin test.

To do this, ask him to place his heel on the opposite knees and move it down the shin from the knee to
the ankle. Do the same thing with your right normally you can move his heel in a straight line down the
shin. Good to do is to set up okay for the reflex examination. Start by testing the deep tendon reflexes
for deters to elicit and grade reflexes proper. Use the hammers pointed end for small targets and the
flat end for large targets. Relax your hold on the hand. Striker short snappy blow to the muscles
insertion tendon Do not let the hammer rests on the tent. Compare the right and left sides which should
have equal responses okay when is relaxed for me. If the reflex does not appear, encourage further
relaxation. Vary the person’s position or increase the strength of the human any free to do is to take
your hands together to kind of also try reinforcement by having the person performing isometric
exercises in a muscle group someone away from the one being tested. After you elicit a refund rate as
for plus very brisk hyperactive response with fondness, three plus for a brisker than average response to
plus average or normal response, one plus four diminished or low normal response or zero for no
response and it tests the reflexes in your legs. So just relax when grading reflexes. Remember that an
older adult normally may have decreased independence and may have no Achilles reflex. I’m going to
check your reflexes to begin reflex testing in the arms with the biceps reflex. Relax the person’s forearm
by supporting it on yours. Then place your thumb on the biceps tendon and strike the normal responses
for on flexion. Next, just the triceps reflex. Okay, I’m going to check your triceps and relax your arm. Let
it dangle. To do this all the persons relaxed up Iran then strike the triceps tendon just above the elbow.
Your normal responses for arm reflexes. Alternatively, while the person’s wrist across his chest to flex
the arm, then tap the tendon move on to test the brachioradialis reflex. While holding the person’s
thumb to suspend relax the fourth strike the arm about two to three centimeters above the radial
styloid process. The normal response is forearm flexion and supination.

Now we’re going to check the reflex perform reflex testing in the legs starting with the quadriceps
reflex, with the person’s lower legs dangling freely strike the tendon just below the patella. This should
elicit lower leg extension and palpable quadriceps contraction. Use your arm to support the weight of
one leg against the other leg and flex the knee. With this position you can’t feel the quadriceps
contraction, but should see lower leg extension .

Next test the Achilles reflex. With the person’s knee flexed and his hip externally rotated all his foot in
dorsiflexion and strike his Achilles tendon. His foot should plantar flex against your hand. If the person is
supine, flex one knee and support that lower leg against the other that it falls out dorsiflex the foot and
tap the tendon now want to check your ankle just one more if the person’s reflexes are hyperactive test
for CONUS. Support his lower leg with one hand, briskly dorsiflex his foot with your other hand and hold
that stretch position.

You should feel no clonus rapid rhythmic contractions in the foot and want to check your stomach
reflexes. Faces color underneath your knees when testing the superficial reflexes. Begin with the
abdominal reflex. With the supine person’s knees slightly bent. Use the handle of the reflex to stroke the
abdomen toward the midline over the upper and lower quadrants. In response, the abdominal muscles
display ipsilateral contraction and the umbilicus points toward the stroke. In a man has the pre-mysteric
reflex, lightly stroking the inner aspect of his thigh.

This should cause elevation of the ipsilateral testing to check the reflexes in your feet finally, test the
plantar refers by stroking up the lateral side of the soul and across the ball of the foot, like an upside
down J You should see plantar flexion of the toes and slight inversion and flexion of the fork In an
infinite laughter recently This normally causes the case You have to know this positive events reflex
should disappear around age two disable is more Great Do you have any questions for Now when you’ve
completed your examination of the motor system and reflexes discuss your fine With the person and
answer any questions you may have So teach him about related health promotion and self care Talk to
us through help him stay healthiest possible .
Cranial nerves, all five senses sight, hearing, smell, taste, and touch, as well as the ability to speak.
Swallow and perceive temperature and other sensations. They should function properly for to a person
have the ability to experience, and communicate. In Practice, you may know the same fine is normal or
abnormal for examining the cranial nerves and sensory system. The nervous system includes the central
nervous system which consists of ;brain and spinal cord and the peripheral nervous system.

Nervous system consists of 31 years of spinal nerves and all their friends, as well as 12 pairs of cranial
nerves. The cranial nerves enter and exit brain, and primarily innervate the head and neck, allowing
sensation and movement and parasympathetic control. The main aspect, the spinal nerves arise from
the spinal cord and supply the rest of the body. These nerves enter and exit the cord through roots.
Sensory afferent fibers through the posterior or dorsal roots and motor efferent fibers, through the
anterior or ventral roots. Pain temperature and crude touch sensations follow the spinal thalamic tract,
they enter the dorsal root synapse. On the opposite side, and travel to the thalamus, where they
synapse again and carry the sensation to the sensory cortex for interpretation. Position vibration and
fine touch sensations, follow the posterior columns. They entered the dorsal root, move up the spinal
cord to the brainstem, where they synapse and cross off. And they travel to the thalamus and it was
synapse again and go to the sensory cortex.

Have you been exposed to during the health history. Keep in mind that the neurologic disorder, you’re
most likely to see is a cerebrovascular accident, stroke, and that strokes are two and a half times more
common in blacks than in whites, and almost twice as likely to be fatal. There’s no problems with
coordination as you take the person’s history also perform a screening examination of the mental status.
Note the level of consciousness, use of language, mood, orientation, memory, and thought processes. If
he seems well and I don’t know significant history fine performance, meaning neurologic examination. If
there are neurologic concerns or signs of neurologic performance, neurologic examination, as shown
here. Any one of the, when examining the sensory system.

Remember to follow these guidelines;

Make sure the person is alert on cooperative, and compare sensations on symmetrical parts of the
body map many increase in sensation by systematic testing in that area. So then the person’s eyes
closed when indicated.

Explain what will happen, and exactly how they should avoid asking leading questions. If the person
has abnormal mental or you suspect an intracranial lesion, fantastic cranial nerve wants olfactory nerve.
By assessing his sense of smell. Again, first check nostril pain, one at a time, and asking him to sniff .
Normally the sense of smell as you can identify an odor, on the other side of the nose.

Let’s use it to test for cranial nerve to beyond visual acuity with a handheld vision screen at the person
on the screener at reading distance, about 35 centimeters from his eyes. Hold an opaque card over one
on ones W 00 x three one cast each die separately. Normally, a person can read without hesitancy or
moving the card closer or farther away, e w m 00 X,.Okay, and if you look straight from an A, take a look
at your eyes and use an ophthalmoscope to examine the ocular fundus, which should display a normal
optic disc, which is innervated by cranial nerve two, as well as retinal vessels background and macula, to
Kroners three four cranial nerves, three, four and six, the ocular motor propria and abducens nerves
mediate eye movement, and the ocular motor nerves mediates pupillary constriction. So test these
cranial nerves together using three techniques, first inspect the palpebral fissures, which usually are
nearly equal in width. You should see no lip drooping strabismus or nystagmus, back and forth I
oscillation. Second, check the pupils, which should appear round regular and equal in size, and should
display brisk direct and consensual light reflexes, and a risk response to a combination test so use your
eyes just to follow my third assess extra ocular movements, leading with a person’s eyes through the six
Cardinal positions of gates, due to denoise, you should not parallel tracking of your finger with both
eyes. You also mean detect a few beats of normal nystagmus during extreme lateral gaze. If you find any
other notions of resolution in one or both eyes pendular or jerk amplitude, frequency in which you may
be in constant or fade after a few minutes, and playing the horizontal or vertical rotary doesn’t get to fill
my folder. When testing extra ocular muscle function in a preschool or school aged child have the parent
hold her head so that she tracks your movement with her eyes only.

When you check cranial nerve five to test the motor function of cranial nerve fibers, the trigeminal
nerve, assess the muscles of mastication the temporalis and masseter muscles as the person in clenches
and relaxes his TT, the muscles feel really strong on both sides of the sensory function of cranial nerve
phenoms with the person’s eyes closed, asked him to say now, whenever he feels in touch if you’re
confident with your face. Tell me, where you can fill me touch your face by seeing now. Bend lightly
touch the whisk to his forehead mean you know, but the cheeks and chin to assess all three divisions of
the nurse. Now, if the person has abnormal facial sensations or mood.

Test the corneal reflex, while he looks forward, bring the cotton Wisp in from the sun and lightly touches
cornea. Normally, he will blink both eyes. To test cranial nerve seven, the facial nerve. To begin with
motor function, facial expressions, note mobility and facial symmetry as the person smiles. Frown
frowns show your teeth shows his teeth. If you don’t raise your eyebrows lifts his eyebrows closes his
eyes tightly against your attempt to open and puffs out his cheeks. Then press his cheeks in the air
should escape equally from both sides.

Next, test cranial nerve, eight, the acoustic nerve. Assess hearing acuity during normal conversation, as
you would during an ear examination, also performed the voice test, which the person should be able to
Repeat each word after you whisper it Friday, Friday armchair arm chair. The favorite test, in which we
should hear a tuning fork tone equally in both ears. You can hear it in both ears are one year, both good
and the Rhine test, which should be returning for longer near the ear, then through the mastoid process
by bone conduction.

Now, test the motor function of cranial nerves nine and 10. First, depress the tongue with a tongue
Blakeman didn’t have the person say, ‘Ah,’ but uvula and soft palate should rise in the midline tonsillar
pillars should move symmetrically, and then touch the posterior pharyngeal wall with a tongue blade to
elicit the gag reflex. Also note that the voice should sound smooth and strange.

Assess cranial nerve 11.Examine the sternomastoid and trapezius muscles. They should be equal in size
also test for muscle strength in two ways. What I need you to do now is just look straight ahead for me
to turn his head against resistance at the side of his chance. Ask him to shrug his shoulders against your
resistance. These movements should feel really strong on both sides.
 Finally, assess cranial nerve 12; the hypoglossal nerve . First inspect the tongue, which should have
no wasting or tremors. Then ask the person to protrude his tongue, which should thrust forward in the
midline . Test sensations mediated by the spinal thalamic. Start with the ability to perceive pain. Using a
fractured tongue blade ,ask the person to close his eyes and say, ‘sharp’ depending on the sensation he
feels, then lightly touch the sharp point or no end of the tongue laid randomly to his body without the
sharp. Let at least two seconds elapsed between each stimulus to avoid summation with the perception
of frequently consecutive stimuli as one strong stimulus to the to the person should be able to identify
each sensation correctly, is a good sharpening. Sharp, sharp, chopping your eyes. If the person’s pain
sensation is abnormal for Susie she has this temperature sensation. Fill one test tube with hot water
and one with cold water, instruct him to say hot or cold, based on which temperature he feels random.
He should be able to identify both sensations Correct. Check light touch sensation when in touch with
different parts of your body. A nice way to tell the chest light touch.

Ask the person to say “now” when you randomly apply a cotton whisk to his arms. Forearms hands. Now
thighs and Lex. Now, he should report feeling light touching all points that you touch. Now test
sensation mediated by the posterior column by testing the ability to feel vibration using a low pitch
tuning. After telling indicates the vibration starts to strike the tuning fork on the heel of your hand and
hold it space on a bony surface of these great toe and fingers. He should feel vibration or a buzzing
sensation on these distal areas. If not, assess proximal areas, such as the ankles patella and iliac crests,
or the wrists and elbows. Remember that some older adults normally lose vibration sensation in the
great tool and dance stops. Please also test position the sentence. To prepare the person, have him
watch a few trials as you move his finger or great toe up and down, and then have him close his eyes
and tell you which way you move the digit. Vary the order of movement up or down. Normally, A person
can detect movement of a few millimeters. Down. Down. If he has normal or near normal sense of touch
in position, perform tactile discrimination tests.

First test and stereo Gnosis, the ability to recognize objects by field with the person’s eyes closed. Place
a familiar object such as a key or paperclip in his hand and ask him to identify it. Normally, he will
explore it with his fingers and name it correctly paperclip test a different object in each hand, pitching
saying your other hand again.

Next, test graph is Stasia, the ability to read a number traced on the skin. With the person’s eyes close,
it’s an A use a blunt instrument to trace a single number or letter on his palm facing him. Ask him to
identify which he should be able to do accurately see the ability to detect two simultaneous pricks on
the skin. Apply the two points of an open paperclip likely to the skin in ever shorter distances to note
the distance in which the person no longer perceives two separate points. Normally, two to eight
millimeters on the fingertips.

Last, the person to state how many sensations he feels, and where he feels as you simultaneously touch
both sides of his body in the same, meaning that normally, he can feel both sensations.

Finally, test point locations. Tell the person to touch the same spot, you touch. Then touch his skin and
withdraw the stimulus promptly. He should be able to point to the touch location accurately. the first
party neurological exam after you complete this part of the neurologic examination.

Decide if the person needs a break before you assess the motor system and reflexes. If so, review your
findings with him so far, answer any questions he may have, and teach him how to maintain and
improve his health, and they can reduce the flow of blood to your feet, and decrease the ability to feel
heat code or pain or how is that a problem.