CHAPTER 10
Neurologic and Sensory Systems
LEARNING OUTCOMES
Upon completion of this chapter, the nurse will:
1. Outline the areas to include when assessing the neurologic and sensory systems
2. Identify appropriate questions to assess the neurologic and sensory systems
3. Analyze approaches to gather more information about the neurologic and sensory systems
THE NEUROLOGIC SYSTEM
For many nurses the neurologic system can be overwhelming because this system interacts and controls all other body systems. As a review, the neurologic system is divided into:
Central nervous system:
Brain
Spinal cord
Peripheral nervous system:
Cranial nerves
Spinal nerves
Central Nervous System
The Brain
The brain contains the frontal, temporal, parietal, and occipital lobes. Each lobe is responsible for specific body functions.
Lobe | Functions |
Frontal |
|
Temporal |
|
Parietal |
|
Occipital |
|
Additional structures within “the brain” include the following:
Structure | Function |
Cerebellum |
|
Diencephalon
|
|
Brain stem
|
|
The Spinal Cord
The spinal cord is an extension of the medulla oblongata and ends around the first or second lumbar vertebra. This structure is the relay station for sensory and motor input, and the function is divided into cervical, thoracic, and lumbar sections.
Peripheral Nervous System
Cranial Nerves
Learning the cranial nerves for nursing school was not always an easy feat. There is no need to memorize them now. There are 12 cranial nerves, each with a specific function.
Nerve | Function |
I Olfactory |
|
II Optic |
|
III Oculomotor |
|
IV Trochlear |
|
V Trigeminal |
|
VI Abducens |
|
VII Facial |
|
VIII Vestibulocochlear |
|
IX Glossopharyngeal |
|
X Vagus |
|
XI Accessory |
|
XII Hypoglossal |
|
Spinal Nerves
There are 31 pairs of spinal nerves that correspond to the vertebral level.
Vertebral Level | Nerves |
Cervical | Nerves C1–C8 |
Thoracic | Nerves T1–T12 |
Lumbar | Nerves L1–L5 |
Sacral | Nerves S1–S5 |
Coccygeal | 1 nerve |
THE SENSORY SYSTEM
The sensory system contains the eyes and ears. Structures of the eye can be divided into three layers:
Cornea
Choroid
Iris
Pupil
Retina
Optic disc
Macula
There are three parts to the ears, which include:
External ear
Ear canal
Middle ear
Tympanic membrane
Eustachian tubes
Inner ear
Cochlea
ASSESSMENT OVERVIEW
As you can see, the neurologic and sensory systems contain a large number of structures and perform many body functions. You will be challenged to complete these assessments and will be limited in your ability to:
Observe body movement and positioning
Assess cranial and spinal nerve functioning
Determine eye function and pupillary response
The one status that you will be able to assess thoroughly is that of hearing because you will be asking carefully structured, succinct questions in order to determine the functioning of these body systems. As with the previous body systems, the best approach might be to introduce this assessment by saying, “Let’s spend some time now talking about the nerves, vision, and hearing. Before we get started, are you having or have you had any problems with your nerves, eyes, or ears?” Plan your assessment according to the response.
QUESTIONS TO ASSESS THE NEUROLOGIC SYSTEM
Body Area | Question |
Brain | Have you ever had an injury to your head? If so,
|
Frontal lobe | Do you have any problems walking or moving your arms and legs? |
| (Observe the patient’s speech pattern. You will not be going into an in-depth assessment of thinking/reasoning/judgment but ask about activities of daily living and instrumental activities of daily living.) Are you able to complete your own care needs such as:
Are you able to perform routine activities such as:
|
Temporal lobe | Have you had or are you experiencing any changes in your ability to smell things? If so, what are the changes?
|
| (This lobe is responsible for the interpretation of hearing. If the patient/client is responding appropriately to your questions, it is unlikely that there are any issues with hearing interpretation.) If the patient/client is not responding appropriately to questions:
(Be advised that these are not appropriate questions for a patient with English as a second language or someone who recently relocated to the United States and has not mastered the English language. These questions are to assess if the spoken word is being appropriately transmitted to the temporal lobe for sensory interpretation and not to measure ability to comprehend a different language.) |
Parietal lobe | Is the temperature of the room where you sitting right now comfortable to you?
|
| Are you having any pain right now? If so,
|
Occipital lobe | Although we will spend more time on vision shortly, can you tell me if you have or have had any problems with your vision?
|
Additional brain structures | Do you have any problems swallowing? |
| Do you ever feel like you aren’t stable on your feet when standing still or walking? |
| Do you have or have you had any issues with a cough or sneezing? |
Cranial nerves | (If no issue with sense of smell, no need to repeat asking questions about CN I) |
| (If no issue with vision, no need to repeat asking questions about CN II, III, IV, and VI) |
| Do you have or have you had any problems with pain on the skin around your eyes, cheeks, or jaw? If so,
|
| When you smile do both sides of your mouth move? If not, which side does not move?
|
| Do you have any problems swallowing food or liquids? If so,
|
| Have you had or are you having any problems with the taste of food? If so,
|
| Have you had or are you having any problems chewing food? If so,
|
| Have you had or are you having any problems with your tongue? If so,
|
Spinal nerves | Are you having or have you had any pain that was caused by nerve irritation? Such as:
If so,
|
| Have you had an injury to your neck or back at any time? If so,
|
| Have you had or currently have numbness or tingling of any body part. If so,
|
| Have you ever had any operations on your neck or back? If so,
|
| Have you had or currently have weakness of any arms or legs? If so,
Has the weakness changed your ability to:
|
Eyes | Do you have any problems seeing/with your vision? If so, what is the problem?
|
| Do you wear eyeglasses? For what reason?
|
| Have you ever been told that you have an eye problem such as:
|
| Have you ever had eye surgery? If so, what was it for?
|
| Are you prescribed any medications for your eyes? If so,
|
| Do you have any problems with:
|
How often do you see your eye doctor?
| |
Ears | Are you having any problems with your ears right now? If so,
|
| How do you remove wax from your ears? |
| Are you having any problems with your hearing? If so,
|
| Have you ever had surgery on your ears? If so,
|
ALGORITHM FOR ASSESSING THE NEUROLOGIC AND SENSORY SYSTEMS
If you are calling a patient/client who is experiencing a new set of symptoms, the following questions might be helpful.
Finding | Action |
Headache | Assess for the location of the headache:
|
| Assess for when the headache started:
|
| Assess for any other symptoms:
|
| Suspect:
|
| Encourage to seek medical attention for any new onset of symptoms |
Pain | Assess for location of pain:
|
| Assess for when the pain started:
|
| Assess for length of time pain has been occurring |
| Assess for what has been done to help the pain |
| Assess for any associated symptoms:
|
| Suspect:
|
| Encourage to seek medical attention for any new onset of symptoms |
Change in vision | Assess for the change:
|
| Assess for length of time vision change has occurred:
|
| Assess for any associated symptoms:
|
| Suspect:
(Conduct additional assessments if indicated) |
| Encourage to seek medical attention for any new onset of symptoms |
Ears Ringing (Tinnitus)/Acute onset of deafness | Assess when the ear ringing/deafness started (Assess medications if noticed after starting/taking a specific medication such as ototoxic antibiotics or over-the-counter aspirin) |
| Assess activities being done when the ear ringing/deafness started:
|
| Assess for any other symptoms:
|
| Suspect:
|
| Encourage to seek medical attention for any new onset of symptoms |
Onset of paralysis | Access if paralysis is on one side (both arm and leg) or just one limb |
| Assess when the paralysis started |
| Suspect acute stroke and refer for immediate medical attention |
See Chapter 17 for additional information about neurologic and sensory system disorders.
TIPS FOR ASSESSING THE NEUROLOGIC AND SENSORY SYSTEMS
Begin the assessment with asking if the client has experienced any new changes or symptoms.
Use terms such as “feeling” or “numbness” to describe a problem with the cranial and/or peripheral nerves. Clients may become confused if the term “nerves” is used and think the assessment will focus on “nervousness” or “anxiety.”
An acute onset of any new symptom should be investigated immediately.
Any onset of slurred speech or confusion could indicate a stroke. Obtain medical assistance for the client.
Emphasize that any acute change in vision or hearing needs immediate attention. Acute loss of vision in one eye could indicate a detached retina, requiring immediate surgery.
Take the time and further assess any symptoms that might be attributed to a problem in another body system.
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