Name: Honey Bee S.

Platolon Date: May 29, 2022

Course Title: Neurologic Ward Duty Clinical Instructor: Prof. Abolbashar Mangontawar

1. What are Roles and
Responsibilities of
Nurse in the Neuro
ward?
A nurse in neuro ward plays a vital role in the care of patients with
neurological conditions. The roles and responsibilities of a nurse in a
neuro ward is to provide neurology nursing care to patients suffering
from nervous disorders. As a nurse it is also their duty to assist
neurologists in diagnosing patients with brain and nervous system
illnesses. Administer therapeutic interventions to neurology patients.
Initiate neurology nurse programs to provide quality patient care.
Moreover, nurse obtain patient history and communicate to consulting
neurologist. Assist patients in brain scans and other diagnosis
procedures. Monitor and evaluate neurology patients’ health as
ordered by physician or neurologist. Monitor and track vital signs in
neurological in-patients. Monitor and track spinal cord functions in
neurological patients. Integrate patient-comfort issues in neurology
nurse care issues.

2. What are the

Common Equipment
used in the Neuro
ward?

The common equipment used in Neuro ward are the following:

• Intracranial pressure monitors
• external ventricular drains
• mechanical ventilator to assist breathing
• cardiac monitors including telemetry, external pacemakers,
and defibrillators
• equipment for monitoring bodily functions
• numerous intravenous lines, feeding tubes, nasogastric tubes,
suction pumps, drains and catheters
• a wide array of drugs to treat main conditions
 3. What are the Common Nursing
Procedures in Neuro ward (10 pts)

The Glasgow Coma Scale (GCS) is used to

objectively describe the extent of impaired
consciousness in all types of acute medical and
trauma patients. The scale assesses patients
according to three aspects of responsiveness: eye-
opening, motor, and verbal responses.

Apomorphine trials- Apomorphine injection is used to treat

''off'' episodes (times of difficulty moving, walking, and
speaking that may happen as medication wears off or at
random) in people with advanced Parkinson's disease (PD; a
disorder of the nervous system that causes difficulties with
movement, muscle control, and balance) who are taking
other medications for their condition. Apomorphine injection
is in a class of medications called dopamine agonists. It
works by acting in place of dopamine, a natural substance
produced in the brain that is needed to control movement.

Assist in Lumbar Puncture- A lumbar puncture may be

done for various reasons. The most common reason is to
remove a small amount of CSF for testing. This can help in
the diagnosis of various disorders. The fluid is tested for red
and white blood cells, protein, and glucose (sugar). The
clarity and color of the fluid are also checked and it is tested
to see whether bacteria, viruses, or abnormal cells are
present. Excess CSF may also be removed in people who
have an overproduction or decreased absorption of the fluid.
4. Give at least 10
Common Drugs
used in the neuro
ward?
PYRIDOSTIGMINE METHYLPREDNISOLONE

MADOPAR APOMORPHINE

KEPPRA GABAPENTIN

PHENYTOIN HYDROCORTISONE

IMMUNOGLOBULINS LANZOPRAZOLE

Nurses' responsibility for medication

administration includes ensuring that the right
medication is properly drawn up in the correct
dose, and administered at the right time through
the right route to the right patient.
 5. Explain comprehensively the
12 cranial nerves; include how
these cranial nerves are
being tested. (20 pts)

1st Cranial nerve (OLFACTORY)

Smell, a function of the 1st (olfactory) cranial nerve, is usually
evaluated only after head trauma or when lesions of the anterior
fossa (eg, meningioma) are suspected or patients report abnormal
smell or taste.

The patient is asked to identify odors (eg, soap, coffee, cloves)

presented to each nostril while the other nostril is occluded.
Alcohol, ammonia, and other irritants, which test the nociceptive
receptors of the 5th (trigeminal) cranial nerve, are used only when
malingering is suspected.

2nd Cranial nerve (OPTIC)

For the 2nd (optic) cranial nerve, visual acuity is tested using a
Snellen chart for distance vision or a handheld chart for near vision;
each eye is assessed individually, with the other eye covered.

Color perception is tested using standard pseudoisochromatic

Ishihara or Hardy-Rand-Ritter plates that have numbers or figures
embedded in a field of specifically colored dots. Visual fields are
tested by directed confrontation in all 4 visual quadrants. Direct and
consensual pupillary responses are tested. Funduscopic
examination is also done.

3rd (OCOLOMOTOR), 4th (TROCHLEAR), and 6th (ABDUCENS)

Cranial nerves
For the 3rd (ocolomotor), 4th (trochlear), and 6th (abducens)
cranial nerves, eyes are observed for symmetry of movement,
globe position, asymmetry or droop of the eyelids (ptosis), and
twitches or flutters of globes or lids. Extraocular movements
controlled by these nerves are tested by asking the patient to
follow a moving target (eg, examiner’s finger, penlight) to all 4
quadrants (including across the midline) and toward the tip of the
nose; this test can detect nystagmus and palsies of ocular
muscles. Brief fine amplitude nystagmus at end-lateral gaze is
normal.

Anisocoria or differences in pupillary size should be noted in a

dimly lit room. The pupillary light response is tested for symmetry
and briskness.
 5th Cranial nerve (TRIGEMINAL)
For the 5th (trigeminal) nerve, the 3 sensory divisions (ophthalmic, maxillary,
mandibular) are evaluated by using a pinprick to test facial sensation and by
brushing a wisp of cotton against the lower or lateral cornea to evaluate the
corneal reflex. If facial sensation is lost, the angle of the jaw should be
examined; sparing of this area (innervated by spinal root C2) suggests a
trigeminal deficit. A weak blink due to facial weakness (eg, 7th cranial nerve
paralysis) should be distinguished from depressed or absent corneal
sensation, which is common in contact lens wearers. A patient with facial
weakness feels the cotton wisp normally on both sides, even though blink is
decreased.

Trigeminal motor function is tested by palpating the masseter muscles while

the patient clenches the teeth and by asking the patient to open the mouth
against resistance. If a pterygoid muscle is weak, the jaw deviates to that
side when the mouth is opened.

7th Cranial nerve (FACIAL)

The 7th (facial) cranial nerve is evaluated by checking for hemifacial
weakness. Asymmetry of facial movements is often more obvious
during spontaneous conversation, especially when the patient smiles
or, if obtunded, grimaces at a noxious stimulus; on the weakened side,
the nasolabial fold is depressed and the palpebral fissure is widened.
If the patient has only lower facial weakness (ie, furrowing of the
forehead and eye closure are preserved), etiology of 7th nerve
weakness is central rather than peripheral.

8th Cranial nerve (VESTIBULOCOCHLEAR)

The vestibulocochlear nerve (8th cranial nerve) is a sensory
nerve. It is made up of two nerves, the cochlear, which
transmits sound and the vestibular which controls balance.

To examine the 8th cranial nerve the tests to be done are

hearing tests and vestibular function test.

9th Cranial nerve (GLOSSOPHARYNGEAL)

The 9th (glossopharyngeal) and 10th (vagus) cranial nerves are

usually evaluated together. Whether the palate elevates
symmetrically when the patient says "ah" is noted. If one side is
paretic, the uvula is lifted away from the paretic side. A tongue
blade can be used to touch one side of the posterior pharynx, then
the other, and symmetry of the gag reflex is observed; bilateral
absence of the gag reflex is common among healthy people and
may not be significant. In an unresponsive, intubated patient,
suctioning the endotracheal tube normally triggers coughing.
 11th Cranial nerve (SPINAL ACCESSORY)

The 11th (spinal accessory) cranial nerve is evaluated by testing

the muscles it supplies:

• For the sternocleidomastoid, the patient is asked to turn

the head against resistance supplied by the examiner’s
hand while the examiner palpates the active muscle
(opposite the turned head).
• For the upper trapezius, the patient is asked to elevate the
shoulders against resistance supplied by the examiner.

12th Cranial nerve (HYPOGLOSSAL)

The 12th (hypoglossal) cranial nerve is evaluated by

asking the patient to extend the tongue and inspecting it
for atrophy, fasciculations, and weakness (deviation is
toward the side of a lesion).

The Glasgow Coma Scale (GCS) is used to

6. What is Glasglow Coma
Scale? How it is being
interpreted? (20 pts).
objectively describe the extent of impaired
consciousness in all types of acute medical
and trauma patients. The scale assesses
patients according to three aspects of
responsiveness: eye-opening, motor, and
verbal responses.

To calculate a patient’s GCS, first, score the patient on each of the three main areas. Once a
number has been determined, add these to create the sum which is the patient’s Glasgow score.
Once a score has been identified, it’s important to understand the meaning. Every brain injury is
different, but generally, brain injury is classified as:

Severe: GCS 3-8

Moderate: GCS 9-12
Mild: GCS 13-15

Certain scores on the Glasgow Coma Scale have significance. Patients with a Glasgow Coma
Scale score of 7 or less are considered comatose. Patients with a Glasgow Coma Scale score of
8 or less are considered to have suffered a severe head injury.

As previously mentioned, accommodations are made for intubated patients but also those with
gross facial edema, or swelling. These patients are identified with the numerical value of 1 and an
attached modifier.

For example, an intubated patient would have a verbal response of 1t, whereas a patient with
pronounced eye swelling would have an eye response of 1c identifying the eyes as closed and
unable to open due to the swelling.
REFERENCES

https://www.greatsampleresume.com/job-%20responsibilities/nursing/neurology-
%20nurse#:~:text=Assist%20patients%20in%20brain%20scans,cord%20functions%20i%20n%
20neurological%20patients.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lumbar-puncture

https://www.beaumont.org/services/neurology/neuro-intensive-care-unit/inside-the-neuro-ICU

https://healthacademy.lancsteachinghospitals.nhs.uk/app/uploads/2021/09/Bleasdale-Ward.pdf

https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/how-to-
assess-the-cranial-nerves

https://nurse.org/articles/glasgow-coma-scale/