Mateo, Ella Rose A.
BSN 3 - BLK 4
Assessment of Neurologic Function
Written Assignment:
1. Prepare a chart that depicts the structure and functions of the central nervous
system and the peripheral nervous system; 2. Prepare a chart that outlines the
cranial nerves and specific functions.
Central Nervous System Peripheral Nervous System (PNS)
(CNS)
Composed of the brain and Composed of nerves and ganglia outside of the brain and
spinal cord spinal cord
Receives and processes Transmits information to and from the CNS
information from sensory
organs and initiates motor
responses
Responsible for integrating Divided into the somatic nervous system and the autonomic
and coordinating bodily nervous system
functions
Divided into the cerebrum, Somatic nervous system controls voluntary movements and
cerebellum, and brainstem senses, while the autonomic nervous system controls
involuntary functions such as breathing, heart rate, and
digestion
Cranial Nerve Name Function
I Olfactory Smell
II Optic Vision/Sight
III Oculomotor Eye movement, the elevation
of the upper lid; constriction
of pupils
IV Trochlear Eye movement (control the
superior oblique muscle)
V Trigeminal Sensation for the entire face;
contraction of chewing
muscle
VI Abducens Eye movement (control the
lateral rectus muscle)
VII Facial Sense on taste (anterior 2/3
tongue); contraction of facial
muscle; secretion of saliva
VIII Acoustic (Vestibulocochlear) Cochlear branch: a sense of
hearing; Vestibular branch: a
sense of equilibrium.
IX Glossopharyngeal Sense of taste (Posterior
1/3); controls muscles of the
throat; secretion of saliva
X Vagus Controls muscles of the
throat; PNS stimulation to
thoracic and abdominal
organs
XI Spinal Accessory Controls sternocleidomastoid
and trapezius muscle; motor
to the larynx
XII Hypoglossal Movement of the tongue
Case Study: Assessment of Neurologic Function
Case 1
Maria Dela Cruz, an 88-year-old patient, is at the clinic receiving an annual physical
checkup. The patient is wearing a sweater but complains that the room is cold. The
thermostat reads 70°F. The patient has a slow, wide-based gait, and she is flexed
forward slightly when she walks. She opens her purse and tries to find the bottle of
herbals she bought to make sure it is alright to take the supplement and has
problems locating it by feeling for the bottle. She states that she is all thumbs. She
complains that food does not smell or taste like she remembered it smelling and
tasting 10 years ago. She wonders if it is because she used to grow her food and
that is why it had a better taste and smell. She also stated that her family is
concerned because she does not seem to have enough peripheral vision to drive,
and she wiped out the mailbox yesterday when backing out of the driveway. The
nurse performs a neurologic exam.
Critical Thinking & Discussion Questions
1. Explain the changes in the patient’s neurologic function that are related
to aging and what risks the patient has related to age-related changes.
Aging can lead to several changes in the nervous system, including a decrease in
the number of neurons, changes in the structure and function of neurons, a
decrease in neurotransmitter levels, and changes in the blood flow to the brain.
These changes can increase the risk of cognitive decline, dementia, falls, and other
neurological disorders. The patient's slow, wide-based gait and flexed forward
posture may indicate age-related changes in motor function and balance. Her
difficulty in finding the bottle of herbals and complaints of being "all thumbs" may
be related to age-related changes in fine motor function. The patient's decreased
peripheral vision and recent accident suggest that she may have age-related
changes in visual function, such as cataracts or glaucoma.
2. Because age-related changes have an impact on the neurologic
assessment, for what additional areas should the nurse assess the patient,
and what findings reflect normal aging?
In addition to assessing the patient's motor and visual function, the nurse should
also assess the patient's cognitive function, including memory, attention, and
language. Findings that reflect normal aging include mild forgetfulness, slower
processing speed, and decreased ability to multitask.
3. What neurologic assessment findings do not change with aging?
Neurologic assessment findings that do not change with aging include the presence
of reflexes, the ability to follow simple commands, and the sensation of touch,
pressure, and temperature.
Case 2
Jose Santos, a 71-year-old patient, presents to the emergency department 4 hours
after experiencing an ischemic brain attack confirmed on the CT of the head without
contrast. The patient is a candidate for intra-arterial thrombolytic therapy to
dissolve the blood clot causing significant stroke symptoms. The patient is
scheduled for an emergent cerebral angiogram with possible intra-arterial
thrombolytic therapy. The nurse provided patient and family education and received
the informed written consent from the patient’s spouse. The patient has IV normal
saline at 100 mL/hr infusing into the right forearm with an 18-gauge angiocath,
which is patent.
Critical Thinking & Discussion Questions
1. What labs should the nurse assess before the procedure and why?
Before the procedure, the nurse should assess the patient's coagulation status by
checking their prothrombin time (PT), activated partial thromboplastin time (aPTT),
and international normalized ratio (INR). This is important because thrombolytic
therapy can increase the risk of bleeding, and the procedure should not be
performed if the patient's coagulation status is abnormal.
2. What additional preparation should the nurse provide before the patient
goes to the procedure?
The nurse should ensure that the patient has fasted for at least 6 hours prior to the
procedure to prevent aspiration during the procedure. The nurse should also
remove any dentures, jewelry, or other metal objects from the patient. The
patient's vital signs should be monitored and documented, and a baseline
neurologic assessment should be performed. The nurse should also ensure that the
patient has an adequate IV access in place, and administer any pre-procedural
medications as ordered. The nurse should explain the procedure to the patient and
answer any questions or concerns they may have.
