Revision of the anatomy and physiology of the nervous system

Revision of ‘Care of the unconscious patient’ (seep. 351).

Neurological examination is a method of obtaining some objective data on the functioning of a patient’s nervous system (Hickey 2003). This may be required:

This procedure is carried out by a medical or skilled nurse practitioner, usually in conjunction with an examination of the motor and sensory function of the patient’s trunk and limbs.

The ophthalmoscope and pen torch are used to assess the function of the optic, oculomotor, trochlear and ophthalmic branch of the trigeminal cranial nerves. The auriscope and tuning fork are used to examine the ears and assess the function of the vestibulocochlear cranial nerve respectively. An assessment of the patient’s sensation to pain, touch and temperature is made using a sterile needle, a cotton-wool ball and test tubes of hot and cold water. The olfactory cranial nerve is assessed when the patient is asked to identify the odours of various strong-smelling substances.

The tendon hammer is used by the medical practitioner when testing a spinal reflex such as the knee jerk. Assessment for an upper motor neurone lesion will also require the use of a tendon hammer for stroking the lateral aspect of the sole of the patient’s foot. The function of the facial cranial nerve is assessed by asking the patient to identify various substances, i.e. salt, sugar, vinegar and lemon juice. To prevent inaccurate results, the patient will be asked to use a mouth rinse after each substance has been tasted.