NEUROLOGICAL EXAMINATION

NEUROLOGICAL EXAMINATION
GILBERT & PROSSY

GROUP 4
NEUROLOGICAL EXAMINATION
This is a type of patient assessment which aims at detecting

the functions of
the cranial nerves in relation to the five senses.
● Sight
● Hearing
● Smell
● Taste
● Touch or feeling
Cont’
It is also an evaluation of a person’s nervous system. The

nervous system consists of the brain, the spinal cord, and the
nerves from these areas. There are many aspects of this
exam, including an assessment of motor and sensory
skills, balance and coordination, mental status (the
patient’s level of awareness and interaction with the
environment), reflexes, and functioning of the nerves.
Indications for a Neurological Exam
A complete neurological exam may be performed in the following

situations:
1. Routine Physical Exam: During a general check-up.
2. Post-Trauma: After any form of injury.
3. Disease Progression Monitoring: To track the development of
neurological disorders.
4. Specific Complaints: If the patient experiences any of the following:
○ Headaches
○ Blurry Vision
○ Behavioral Changes
Cont’
○ Fatigue
○ Balance or Coordination Issues
○ Numbness or Tingling in Limbs
○ Reduced Movement in Limbs
○ Injuries to the Head, Neck, or Back
○ Fever
○ Seizures
○ Slurred Speech
○ Weakness
○ Tremors
Cont’
5. Consciousness Assessment: To determine the level of alertness or

consciousness.
6. Evaluate Paresthesia: To gauge the extent of sensory loss in a body
part.
7. Cranial Nerve Function: To assess the function of the cranial nerves.
Important Points to Note:
When performing the exam, ensure that substances used to assess
taste, smell, touch, or feeling are not visible to the patient. This prevents
the patient from identifying the substance by sight, which could lead to
inaccurate results.
Equipment for the Procedure:
● Ophthalmoscope or Torch: To assess pupil dilation and constriction

(eye reaction).
● Snellen Chart: For visual acuity testing.
Otoscope: For ear examination.
● Tuning Fork: To evaluate hearing.
● Pins or Needles: For testing sense of touch (e.g., pain or sensation
loss).
● Cotton Wool (in a gallipot): For tactile sensation.
● Hot/Cold Water Bottle: To assess the sense of touch and taste.
● Salt and Sugar Bottles: For taste assessment.
Cont’
● Coffee or Lemon Bottle: For smell testing.

● Nasal Speculum: For nasal inspection.
● Tape Measure: To measure areas with sensory loss.
Skin Pencil: To mark areas with no sense of touch.
● Patellar Hammer: For tendon and motor reflex testing.
Note: If assessing a patient’s gait, have them walk to observe their
movements.
Bedside Equipment:
● Hand-washing materials
● Privacy screen
● Safety box
● Adequate bedside lighting
Components of a Neurological Exam
The neurological exam typically includes the following assessments:

Mental Status:
1. Level of Awareness: Assessed through conversation to determine
the patient’s awareness of person, place, and time.
2. Attentiveness: Evaluate whether the patient stays focused or
requires frequent redirection.
3. Orientation: Check orientation to self, place, and time. Disorientation
to time typically occurs before place or person, and disorientation to self
often indicates a psychiatric issue.
4. Speech and Language: Assess fluency, repetition, comprehension,
reading, writing, and naming.
Cont’
5. Memory: Evaluate both registration and retention capabilities.

6. Higher Intellectual Function: Assess general knowledge,
abstraction, judgment, insight, and reasoning abilities.
7. Mood and Affect: Evaluate mood and emotional expression,
primarily to determine if psychiatric conditions are affecting the
neurological assessment.
Evaluation of the cranial nerves:
There are 12 cranial nerves. During a complete neurological exam, most
of these nerves are evaluated to help determine the functioning of the
brain:
1. Cranial nerve I (olfactory nerve): This is the nerve of smell. The
patient may be asked to identify different smells with his or her eyes
closed.
2. Cranial nerve II (optic nerve): This nerve carries vision to the brain.
A Visual test may be given and the patient’s eye may be examined with
aspecial light.
3. Cranial nerve III (oculomotor): This nerve is responsible for pupil
size and certain movements of the eye. The patient’s healthcare
provider may examine the pupil (the black part of the eye) with a light
and have the patient follow the light in various directions.
Cont’
4. Cranial nerve IV (trochlear nerve): This nerve also helps with the
movement of the eyes.
5. Cranial nerve V (trigeminal nerve): This nerve allows for many
functions, including the ability to feel the face, inside the mouth, and
move the muscles involved with chewing. The patient’s healthcare
provider may touch the face at different areas and watch the patient as
he or she bites down.
6. Cranial nerve VI (abducens nerve): This nerve helps with the
movement of the eyes. The patient may be asked to follow a light or
finger to move the eyes.
Cont’
7. Cranial nerve VII (facial nerve): This nerve is responsible for various
functions, including the movement of the face muscle and taste. The
patient may be asked to identify different tastes (sweet, sour, bitter),
asked to smile, move the cheeks, or show the teeth.
8. Cranial nerve VIII (acoustic nerve): This nerve is the nerve of
hearing. A hearing test may be performed on the patient.
9. Cranial nerve IX (glossopharyngeal nerve): This nerve is involved
with taste and swallowing. Once again, the patient may be asked to
identify different tastes on the back of the tongue. The gag reflex may be
tested.
Cont’
10. Cranial nerve X (vagus nerve): This nerve is mainly responsible for
the ability to swallow, the gag reflex, some taste, and part of speech.
The patient may be asked to swallow and a tongue blade may be used
to elicit the gag response.
11. Cranial nerve XI (accessory nerve): This nerve is involved in the
movement of the shoulders and neck. The patient may be asked to turn
his or her head from side to side against mild resistance, or to shrug the
shoulders.
12. Cranial nerve XII (hypoglossal nerve): The final cranial nerve is
mainly responsible for movement of the tongue. The patient may be
instructed to stick out his or her tongue and speak.
Nurses role in neurological examination
1. Provide a clam, suitable environment

2. Collect the personal data with patient &family members
3. Set the equipment needed for neurological examination
4. Assess the current level of consciousness, monitor vital parameters –
temperature, pulse, respiration, blood pressure, pupillary reaction,
whether decelerating or decorticating.
5. Thorough mental status examination should be done & recorded
6. Assessment of cranial nerves should be done correctly & recorded.
7. Assessment of motor, sensory & cerebellar functions should be done
& be recorded accurately.
Cont’
8. During the examination, she should maintain a good
support with patient& family members.
9. She should instruct the procedure correctly & then they
should be asked to do it.
Cont’
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NEUROLOGICAL EXAMINATION

GILBERT & PROSSY

This is a type of patient assessment which aims at detecting

It is also an evaluation of a person’s nervous system. The

A complete neurological exam may be performed in the following

5. Consciousness Assessment: To determine the level of alertness or

● Ophthalmoscope or Torch: To assess pupil dilation and constriction

● Coffee or Lemon Bottle: For smell testing.

The neurological exam typically includes the following assessments:

5. Memory: Evaluate both registration and retention capabilities.

1. Provide a clam, suitable environment

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