Ch.

41: Assessing the Nervous System

Cerebrum

Diencephalon

Brainstem

Cerebellum

General Functions of the Four Regions of the Brain

Region
Functions
Interprets sensory input
Controls skeletal muscle activity
Processes intellect and emotions
Contains skills memory
Conducts sensory and motor impulses
Regulates autonomic nervous system
Regulates and produces hormones
Mediates emotional responses
Severs as conduction pathway
Serves as site of decussation of tracts
Contains respiratory nuclei
Helps regulate skeletal muscles
Processes information necessary for balance, posture,
and coordinated muscle movement

Functions of Lobes of the Cerebrum and Areas of the Cerebral Cortex

Area
Functions
Parietal lobe (somatic sensory area of cerebral cortex) Promotes recognition of pain, coldness, and light
touch.
Occipital lobe
Receives and interprets visual stimuli
Temporal lobe
Receives and interprets olfactory and auditory stimuli
Frontal lobe
Controls movements of voluntary muscles
Primary motor area
Facilitates voluntary movement of skeletal muscles
Speech area
Promotes understanding of spoken and written words
Motor speech (Brocas area)
Promotes vocalization of words

Appearance
pH
Specific gravity
WBCs
Protein
Glucose
Chloride
Pressure

Normal Laboratory Values for Cerebrospinal Fluid

Component
Normal Value
Clear and colorless
7.35
1.007
0-8
15-45
40-80
118-132
<200
Cranial Nerves
Name

I-Olfactory
II-Optic
III-Oculomotor

IV-Trochlear
V- Trigeminal

Function
Sense of smell
Vision
Eyeball movement
Raising of upper eyelid
Constriction of pupil
Proprioception
Eyeball movement
Sensation of the upper scalp, upper eyelid, nose, nasal

VI-Abducens
VII-Facial

VIII-Acoustic
IX-Glossopharyngeal

X-Vagus

XI- Accessory

cavity, cornea, and lacrimal gland.

Sensation of the palate, upper teeth, cheek, top lip,
lower eyelid, and scalp.
Sensation of the tongue, lower teeth, chin, and
temporal scalp.
Chewing
Lateral movement of the eyeball
Movement of facial muscles
Secretions of lacrimal, nasal, sub-mandibular, and
sublingual glands
Sensation of taste
Sense of equilibrium
Sense of hearing
Swallowing
Gag reflex
Secretions of parotid salivary gland
Sense of taste
Touch, pressure, and pain from pharynx and posterior
tongue
Pressure from carotid arteries
Receptors to regulate BP
Swallowing
Regulation of cardiac rate
Regulation of respirations
Digestion
Sensation from thoracic and abdominal organs
Proprioception
Sense of taste
Movement of head and neck
Proprioception
Movement of tongue for speech and swallowing

XII-Hypoglossal
Diagnostic Tests of the Neurologic System
Computed Tomography (CT) Scanbrain, spine
o Used to identify intracerebral hemorrhage, tumors, cysts, aneurysms, edema, ischemia, atrophy,
tissue necrosis
o Also used to differentiate type of stroke
o NPO 8 hrs before test
o Test lasts 5-10 minutes
Electroencephalogram (EEG)
o Used to measure the electrical activity of the brain
o Electrodes are applied to scalp and a graphic picture is obtained
o Assess medications and inform pt. not to toke meds or liquids that may stimulate or depress brain
wavesanticonvulsants, tranquilizers, depressants, and caffeine-containing food and drinks
o Instruct pt. to wash his/her hair the night before but not to use oil or hair spray on the hair
Lumbar Puncture (LP)
o Used to measure CSF pressure and obtain a sample of CSF for diagnosis of MS, IICP from
meningitis, subarachnoid hemorrhage, brain tumor, brain abscess, encephalitis, and viral
infections
o Needle is inserted in L3-L4 or L4-L5 and fluid is aspirated
o Ask pt. to void prior

o Place pt. on side in the fetal position with back bowed, head flexed on the chest, and knees
drawn up to the abdomen
o Instruct pt. to lie flat in bed in prone or supine prior testing for 4-8 hrs.
o Monitor site for leakage of CSF or hematoma formation
o Encourage increased fluid intake
Abbreviated Neuro Assessment
LOC (response to auditory and/or tactile stimulus)
VS (BP, P, RR)
Pupillary response to light
Assess strength of hand grip and movement of extremities bilaterally
Determine ability to sense touch/pain in extremities
Glasgow Coma Scale
Assessment
Response
Score
Eyes Open
Spontaneously
4
(record C if eyes are closed by
To speech
3
swelling)
To pain
2
No response
1
Best Motor Response
Obeys commands
6
(record best upper arm response)
Localizes pain
5
Flexion-withdrawal
4
Abnormal flexion
3
Abnormal extension
2
No response
1
Best Verbal Response
Oriented
5
(record T if an endotracheal or
Confused
4
tracheostomy tube is in place)
Inappropriate words
3
Incomprehensible sounds
2
No response
1
Total Score= a higher score indicates a higher level of functioning
Abnormal Neuro Findings
Aphasia- defective of absent language function
Dysphonia- change in the tone of the voice; common in strokes
Dysarthia- difficulty speaking
Anosmia- inability to smell
Nystagmus- involuntary eye movements
Ptosis- aka Horner syndrome; drooping eyelids
Fasiculations- twitches
Ataxia- lack of coordination and a clumsiness of movements