Assessing the Sensory-Neurological System
Cerebrum - superior part of the brain
OUR PATIENT
Mr. Aaron Mann is a 56 year old African
American patient who has a history of Atrial
Fibrillation, hyperlipidemia, hypertension,
smoking orally mild vascular neurocognitive
disorder. He was admitted to an acute care
unit with an acute stroke causing a right sided
weakness. He lives alone, has poor hygiene and
is wearing a multiple layers of mismatched
clothing. Het does not remember the last time
he took his blood pressure medication.
Vital signs are Temperature 36 *C, Pulse 88
beats/min, Respirations 22 cycles/min. and BP
of 168/92 mmHg. He is alert but he appears
somewhat fearful and agitated. He asks for
cigarettes and is oriented to name only.
Speech is comprehensible but slurred.
The Central Nervous System
The Nervous System
The Nervous system is a complex network of
nerves and cells that carry messages to and
from the brain and spinal cord to various parts
of the body.
Divided into 2:
a. Central Nervous System
b. Peripheral Nervous System
I. The Central Nervous System
a. Brain
b. Spinal Cord
Brain
- Center of the Nervous System
- Divided into 6 parts
a.
b. Cerebellum – coordinating voluntary
movements
c. Diencephalon – primary relay and
processing center for sensory information.
Midbrain – associated with vision, hearing,
and others
Pons – bridge between parts of the nervous
system
Medulla Oblungata – containing control
centers of the heart and lungs
Cerebrum
 Frontal Lobe – controls emotional
expression, memory.
 Parietal lobe – sensation and
perception and integration
 Occipital lobe – visual processing
 Temporal Lobe – primary auditory
perception
Spinal Cord
- is a long, thin, tubular structure made
up of nervous tissue, which extends
from the medulla oblongata in the
brainstem to the lumbar region of the
vertebral column
- Functions primarily in the transmission
of nerve signals from the motor cortex
to the body
Peripheral System
- Refers to parts of the nervous
system outside the brain and spinal
cord.
- Includes the cranial nerves,
spinal nerves and their roots and
branches, peripheral nerves, and
neuromuscular junctions.
 NERVOUS SYTEM ASSESSMENT  Dizziness can lead to syncope
 Syncope - temporary loss of
COMMON SYMPTOMS
consciousness
HEADACHE  “blacked out” or “had a spell”

 Most common
 Pain may be mild or severe, acute or
Numbness or Loss of Sensation
chronic, localized or generalized
 90% of HA - benign in nature (muscle  Paresthesia – numbness or tingling
contraction or vascular) sensation
 10% - pathology
 Causes : diabetes, neurologic,
 may be a symptom of a serious
metabolic, CV, renal, inflammatory
medical problem
 Determine area affected & onset &
progression of symptoms
Mental Status Change

 Mental status change = early

Deficits of the Five Senses
indication of a change in neurologic
status…  Smell – CN I (olfactory);
 Begin slowly as forgetfulness, a
 Visual acuity, pupillary constriction,
memory loss or inability to
extraocular movement (EOM) – CN II
concentrate → rapidly proceed to
(optic); III (oculomotor); IV
unconsciousness
(trochlear); VI (abducens)
 Causes : neurologic problems, fluid &
electrolyte imbalance, hypoxia, low  Taste – VII (facial); IX
perfusion state, nutritional (glossopharyngeal)
deficiencies, infections, renal & liver
 Hearing – VIII (acoustic)
disease, hyper or hypothermia,
trauma, medications, & drug &  Touch – V (trigeminal)
alcohol abuse
 mental status (severely impaired) ask
family members to describe the LEVEL OF FUNCTIONING
changes
Terms used to describe Level of
Consciousness (Cerebral Function)*
Dizziness, Vertigo, & Syncope  Alert – follows commands in a timely
fashion
 Dizziness - “fainting” sensation
 Vertigo  Lethargic – appears drowsy, may drift
off to sleep during examination
1. objective vertigo – sensation that the
surroundings are spinning around  Stuporous – requires vigorous
stimulation (shaking, shouting) for a
2. subjective vertigo - the person is
response
spinning around
 Comatose – does not respond
-accompanied by nausea & vomiting,
appropriately to either verbal or
nystagmus & tinnitus
painful stimuli
 Glasgow Coma Scale Abnormal position of the arms with legs
extended & internally rotated & feet plantar
flexed – ominous sign (poor prognosis)

Decorticate (flexion posturing)

Arms are flexed chest & hands are clenched &

internally rotated

Decerebrate (extension posturing)

Arms are extended & the hands are clenched

& hyperpronated

 Provides a more objective way to

assess the patient’s LOC. Decrease
score, impending neuro crisis

 GCS – evaluates best eye response,

best motor response, best eye
response on a scale of 3-15.

 15 (highest score) indicates that

patient is awake, alert, oriented &
able to follow simple commands.

 3 (lowest score) indicates that the

patient does not respond to any
stimulus & has no motor or eye
response, reflecting a very serious
neurologic state with poor prognosis
(forecast of probable outcome of the Assessing Orientation
disease)
TIME*
 9= severe brain injury
Ask date, including the year & the day of the
 Motor: identifies localized pain – week
denotes that the patient is not fully
conscious but is aware enough to PLACE
respond to annoying stimulus Ask to state where he is. (identify
 Flexes & withdraws – is a lower level environmental cues)
motor response & indicates that the PERSON
patient pulls away from painful
stimuli (apply stimuli long enough – Ask patient to state his name
reflex)
Self identity usually remains intact the longest

Orientation to person an ominous sign

Memory  Apraxia – inability to carry out
learned sequencial movements or
IMMEDIATE MEMORY
commands
 repeat a series of numbers
 Circumlocution – inability to name
RECENT MEMORY object verbally, so patient talks
 what the patient had for breakfast around object or uses gesture to
define it
 name 3 objects (pen, tree, ball) &
recall again  Dysarthria – defective speech;
REMOTE MEMORY inability to articulate words;
impairment of tongue & other
 ask dates of major historical events muscles needed for speech
 ask birthdates or anniversary date
 Dysphasia – impaired or difficult
(validate)
speech

 Dysphonia – difficulty with quality of

Common Neurologic Problems
voice; hoarseness
Neurologic problems
 Neologism – made-up, nonsense,
 Agnosia - inability to recognize object meaningless words
a. Sight (visual agnosia)
b. Touch (tactile agnosia)
c. Hearing (auditory agnosia)

 Akinesia – complete or partial loss of

voluntary muscle movement

 Aphasia – absence or impairment of

ability to communicate through
speech, writing, or signs

 Expressive (motor) aphasia – inability

to express language even though
person knows what he wants to say

Also known as Broca’s or motor

aphasia; Frontal lobe affected

 Fluent aphasia – words can be spoken

but are used incorrectly

 Nonfluent aphasia - slow deliberate

speech, few words

 Receptive (sensory) aphasia –

inability to comprehend spoken or
written words ( also known as
Wernicke’s or sensory aphasia)