Assessment of the Nervous System (CNS & PNS)– 2026 Order Guidelines Notes

🧠1. Health
Assessment of the Nervous System – Study Notes
History
Chief complaint & present illness
Past medical history (falls, trauma, chronic conditions)
Current medications (prescribed & OTC)
Common Neurological Symptoms
 Pain
 Seizures
 Dizziness/vertigo
 Visual disturbances
 Abnormal sensations
 Muscle weakness

2. Neurological Physical Assessment
 Systematic exam: clinical tests, observations, assessments
 Five Components:
1. Consciousness & cognition
2. Cranial nerves
3. Motor system
4. Sensory system
5. Reflexes

3. Consciousness & Cognition
 LOC (Level of Consciousness) = most sensitive indicator of neuro function
 States: alert, responds to verbal, responds to pain, unresponsive
 Assess on first contact & continuously
Mental Status
 Appearance, grooming, hygiene
 Posture, gestures, facial expression
 Awareness & interaction with environment
Intellectual Function
 Digit span (7 forward, 5 backward)
 Abstract reasoning (“A stitch in time saves nine”)
 Similarities (mouse & dog, pen & pencil)
Thought Content – spontaneous, coherent, relevant
Emotional Status – depressed, agitated, euphoric, anxious
Language Ability – understand spoken/written, aphasia?
Impact on Lifestyle – impairments affecting ADLs

4. Cranial Nerves (CN)
CN I – Olfactory
 Smell (coffee, peppermint)
 Abnormal: anosmia
CN II – Optic
 Vision: Snellen chart, visual fields
 Abnormal: visual field defects, blindness
CN III – Oculomotor
 Eye movement (toward nose), pupil size/reactivity, eyelid opening
 Abnormal: diplopia, dilated pupils, ptosis
CN IV – Trochlear
 Upward eye movement
 Abnormal: gaze weakness, diplopia

,CN V – Trigeminal
 Sensory: touch, pain, temp (forehead, cheek, jaw)
 Motor: clench jaw, corneal reflex
 Abnormal: numbness, weak jaw, absent corneal reflex
CN VI – Abducens
 Lateral eye movement
 Abnormal: diplopia, gaze weakness
CN VII – Facial
 Motor: facial expressions, eyelid closure, puff cheeks
 Sensory: anterior 2/3 tongue (taste)
 Abnormal: facial weakness, impaired taste
CN VIII – Acoustic (Vestibulocochlear)
 Hearing (cochlear) & balance (vestibular)
 Abnormal: hearing loss, impaired balance
CN IX – Glossopharyngeal
 Swallowing, posterior tongue taste
 Abnormal: dysphagia, impaired taste
CN X – Vagus
 Swallowing, phonation, gag reflex
 Abnormal: hoarseness, aspiration, dysarthria
CN XI – Spinal Accessory
 Shoulder shrug, head turn (SCM, trapezius)
 Abnormal: weak shrug/rotation
CN XII – Hypoglossal
 Tongue movement, speech (“light, tight, dynamite”)
 Abnormal: tongue atrophy, deviation, slurred speech

5. Motor System
 Inspect: gait, stance, posture, involuntary movements, muscle atrophy
 Muscle tone: spasms, flaccidity, rigidity, spasticity
 Muscle strength scale: 0–5 (5 = normal)
 Coordination: cerebellar/basal ganglia tested with Romberg test
o Positive = loss of balance when eyes closed

6. Sensory System
 Eyes closed during testing
 Tactile – cotton, sharp/dull
 Pain & Temp – lateral spinal cord tracts
 Vibration & Proprioception – tuning fork, joint position (toe/finger up/down)
 Important in diabetes (neuropathy screening)

7. Reflexes
Deep Tendon Reflexes (DTRs)
 Involuntary, graded 0–4+ (2+ = normal)
 Examples: biceps, triceps, patellar, Achilles
Superficial Reflexes
 Corneal, gag, abdominal, plantar, cremasteric
 Graded as present (+) or absent (–)
Pathological Reflexes
 Babinski: abnormal in adults (toes fan out)
 Others: suck, snout, palmar, palmomental

, 8. Gerontologic Considerations
Motor Changes
 ↓ muscle bulk/strength
 Slower, wide-based gait
 ↑ risk of falls
Sensory Changes
 ↓ tactile sensation
 ↓ vision (peripheral, glare sensitivity, night disorientation)
 ↓ hearing → social isolation
Other
 ↓ taste & smell → safety risk (smoke/CO₂ detectors needed)
 ↓ pain/temperature perception
 Mental status usually intact (changes → consider delirium, not “normal aging”)

9. Sample NCLEX-Style Questions
1. CN I dysfunction → loss of smell
2. CN V & VII → cotton wisp to cornea
3. Parasympathetic pupil response → constriction

🧠 4. Severe neuro impairment on GCS → Score of 3
Med-Surg II – Neuro Exam 1 Blueprint Notes
1. Anatomy & Physiology (A&P) – Nervous System
 CNS = brain + spinal cord
 PNS = cranial nerves + spinal nerves
 Autonomic Nervous System (ANS)
o Sympathetic – “fight or flight”
o Parasympathetic – “rest & digest”
Major Functions
 Sensory input → integration → motor output
 Control of movement, sensation, thought, memory, language, homeostasis

2. Glasgow Coma Scale (GCS)
 Purpose: Assess level of consciousness after head injury/trauma
 Scoring (3–15)
o Eye Opening (E)
 4 = Spontaneous
 3 = To speech
 2 = To pain
 1 = None
o Verbal Response (V)
 5 = Oriented
 4 = Confused conversation
 3 = Inappropriate words
 2 = Incomprehensible sounds
 1 = None
o Motor Response (M)
 6 = Obeys commands
 5 = Localizes pain
 4 = Withdraws from pain
 3 = Flexion (decorticate)
 2 = Extension (decerebrate)

👉 Interpretation
 1 = None