Unit # 11 ASSESSMENT OF THE MENTAL STATUS AND SENSORY NEURO SYSTEM Shahzad Bashir RN, BScN, DCHN, MScN (Std. DUHS) Instructor New Life College of Nursing Updated, January 12, 2016 (A PROJECT OF NEW LIFE HEALTH CARE SOCIETY KARACHI) Acknowledge: Myung-Hee Pak, RN, MSN, CNS In The Name of God
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Unit # 11
ASSESSMENT OF THE MENTAL STATUS AND SENSORY
NEURO SYSTEM
Shahzad Bashir
RN, BScN, DCHN, MScN (Std. DUHS)
Instructor
New Life College of Nursing
Updated, January 12, 2016
(A PROJECT OF NEW LIFE HEALTH CARE SOCIETY KARACHI)
Acknowledge:
Myung-Hee Pak, RN, MSN, CNS
In The Name of God
Learning Objectives
• By the end of the unit, learners will be able to
– Review Structure and function of Nervous System.
– Perform mental status examination of a client.
– Assess cranial nerve, sensory, sense of
proprioception and cerebellar functions and deep
tendon reflexes.
– Document findings.
– List the changes in the nervous system that are
characteristics of the aging process.
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• Structure and Function
• Subjective Data—Health History Questions
• Objective Data—The Physical Exam
• Abnormal Findings
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Structure and Function
Central Nervous System (CNS)
• Cerebral cortex
– Frontal lobe
– Parietal lobe
– Occipital lobe
– Werni ke’s area
– Bro a’s area
• Basal ganglia
• Thalamus
• Hypothalamus
• Cerebellum
• Brainstem
– Midbrain
– Pons
– Medulla
• Spinal cord
Neurologic System
Nervous system- divided into 2 structural parts:
•Central Nervous System (CNS)- brain & spinal cord
•Peripheral Nervous System – cranial nerves (carry impulses to and
from brain) & spinal nerve (carry messages to and from spinal cord
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Neurons – The Building Blocks of Our
Mental Computer
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Basic Anatomy
• Impulses transmitted by:
• Neurons- Basic structures for receiving and
sending signals.
• Dendrites – receive signals
• Axons – send signals
• Synapse is space between axon and dendrite.
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Brain
• Cerebrum – Largest part of the brain, composed of 2 hemispheres
and 4 lobes. Frontal, parietal, temporal and occipital.
• Cerebrum
• Frontal - Conceptualization, motor ability and judgment, thought process, emotions.
• Parietal – Interpretation of sensory information, ability to recognize body parts.
• Temporal – memory storage, integration of auditory stimuli.
• Occipital – Visual Center.
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Components of CNS
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Cerebellum
• Cerebellum- Keeps person oriented in space,
alan e. Doesn’t initiate movement but
coordinates it
• Controls skeletal muscles
• Controls voluntary movements
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Diencephalon
• Area between cerebral hemispheres and the
brainstem it contains:
• Thalamus –relay station for the nervous
system, sorts out impulses and directs them to
the cerebral cortex
• Hypothalamus –maintains homeostasis by
controlling vital functions: temperature, heart
rate, BP, pituitary regulator, emotions
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Structure and Function, cont. Pathways of the CNS
• Crossed representation
• Sensory pathways
– Spinothalamic tract
– Posterior (dorsal) column
• Motor pathways
– Corticospinal or pyramidal tract
– Extrapyramidal tracts
– Cerebellar system
• Upper motor neurons
• Lower motor neurons
Neurologic System
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Sensory Pathway
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Motor Pathway
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Brain Stem
• Brain stem – central core of the brain,
• contains midbrain, pons and medulla.
• Midbrain- contains many neurons and tracts
• Pons – Controls rhythmicity of respiration,
contains motor and sensory pathways.
• Medulla – Cardiac, respiratory, vasomotor
control. Swallow, gag and cough reflex.
• Motor and sensory fibers cross here.
• Spinal Cord – continues with the brain stem. 2/26/2016 16 Shahzad Bashir,NLCON, Karachi.
Cerebral Circulation
• Originates from carotid and vertebral arteries.
• Blood Brain Barrier: Prevents diffusion of toxic substances and large molecules.
Neurologic System Abnormal Findings Abnormal Gaits
• Spastic hemiparesis
• Cerebellar ataxia
• Parkinsonian (festinating)
• Scissors
• Steppage or footdrop
• Waddling
• Short leg 2/26/2016 54 Shahzad Bashir,NLCON, Karachi.
Neurologic System Abnormal Findings Common Patterns
of Sensory Loss
• Peripheral neuropathy
• Individual nerves or roots
• Spinal cord hemisection (Brown- Séquard
syndrome)
• Complete transection of spinal cord
• Thalamus
• Cortex
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Neurologic System
Abnormal Findings Abnormal Postures
• Decorticate rigidity
• Decerebrate rigidity
• Flaccid quadriplegia
• Opisthotonos
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References
1. Bickley, L. S., Szilagyi, P. G., & Bates, B. (2007). Bates' guide to physical examination and history taking (11th Edi). Philadelphia: Lippincott Williams & Wilkins. Chapter No.06 & 07 p.n 171-250
2. Weber, Kelley's. (2007). Health Assessment in Nursing, 3rd Ed: North American Edition. Lippincott Williams & Wilkins. Chapter No.14 &15 p.n 239-294