GOVERNMENT COLLEGE OF NURSING,

RAIPUR (C.G.)
Subject: Nursing Education
DEMONSTRATION ON
NEUROLOGICAL EXAMINATION

Submitted To Submitted By
Mrs. Mamta Naik Deepa Mishra
Demonstrator M.Sc. Nsg. 1st Year
 LESSON PLAN

NAME OF THE TEACHER : Mrs. Mamta Naik

NAME OF THE STUDENT TEACHER: Ms. Deepa Mishra

NAME OF THE SUBJECT : Nursing Education

NAME OF THE UNIT : Introduction of Nursing Education (I)

NAME OF THE TOPIC : Neurological Examination

CLASS/GROUP/BATCH : M.Sc. Nsg. 1st Year

SIZE OF THE CLASS : 20

DATE & TIME : 24/10/2013 between 11:00 AM to 01:00 PM

VENUE : M.Sc. Nsg. 1st year Classroom

PREVIOUS KNOWLEDGE : The group will be having some knowledge about Professional Education.

METHODS OF TEACHING : Demonstration

MEDIA OF TEACHING : L.C.D., Blackboard, O.H.P., Flash Cards,

Handouts

GENERAL OBJECTIVE: After the completion of lecture, the group will be able to know about professional education and will be able to
understand the development of professional education.
SPECIFIC OBJECTIVES : After the completion of lecture, the group will be able to :
1. To introduce the Professional Education.
2. To define professional education.
3. To explain responsibilities of professional education.
4. To describe the fundamentals of professional education.
5. To enumerate the historical perspectives of professional education.
6. To explain the development of professional education during first period.
7. To enlist the developments in medicine.
8. To list down developments in law.
9. To explain developments in engineering.
10. To enumerate other forms of vocational education.
11. To describe the development of professional education during second period.
12. To enlist educational means in law.
13. To describe progress of medicine in second period.
14. To list down the progress in engineering.
15. To describe the development in agriculture.
16. To explain the development in commercial education.
17. To explain the miscellaneous progress.
18. To narrate the development of professional education during third period.
19. To describe the development in law during the third period.
20. To explain the progress in the field of medicine.
21. To enumerate the progress in agricultural field.
22. To enlist the commercial development.
23. To describe the miscellaneous development.
24. To narrate the development of the professional education during third period.
25. To explain the development of agricultural and allied personnel during fourth period.
26. To tell about the management strategies.
27. To describe the nursing and nursing education in India.
28. To explain the Dufferin fund.
29. To tell about the educational courses.
30. To describe the auxiliary nursing.
S.NO TIME SPECIFIC CONTENTS TEACHING A.V. EVALUATION
OBJECTIVE LEARNING AIDS
ACTIVITY
NEUROLOGICAL ASSESSMENT

1. 2 min. To introduce INTRODUCTION LCD How will you

the A neurological examination is a physical examination conducted introduce
Professional by a health care provider which is focused on the nervous professional
Education. system. It is a common part of a complete neurological education?
assessment as may be conducted by various physicians, most
commonly a neurologist or neurosurgeon. The goal of the
examination is to detect any signs or symptoms related to the
nervous systems & its functioning.
The neurological examination can be
conducted by anyone, including primary care providers such as
family practitioner & internal medicine, doctors. However, it is
2. 2 min. To define most commonly part of a neurological evaluation by a physician L.C.D What is the
professional specializing in diseases of the nervous system, such as a definition of
education. neurologist or a neurosurgeon. Professional
education?
DEFINITION

3. 2 min. To explain L.C.D What are the

responsibilities responsibilities
of professional of professional
education. education?
 PARTS OF A TYPICAL NEUROLOGICAL
EXAMINATION
4. 2 min. To describe  Behavioral, Cognitive & Mental Status: L.C.D What are the
the This is a part of the neurological evaluation helps to fundamentals of
fundamentals determine the higher functioning of a patient’s brain. It is an professional
of professional assessment of their mental status, or level of alertness & education?
education. consciousness, as well as their higher functions of memory,
reasoning, logic & general behavior. While some of this overlaps
with a psychological assessment. It is at least in part, a part of
the complete neurological examination.

 Head & Neck Examination

Since the brain and the spinal cord are in the head &
neck, a general examination of the head and neck for
malformations, abnormal anatomy, mass & other findings is
5. 1 min. To enumerate often undertaken. O.H.P What are the
the historical historical
perspectives of  Cranial Nerve Examination perspectives of
professional There are 12 cranial nerve which are nerves that professional
education. originate in the head, coming off the brain and brain stem. The education?
examination of these nerves and the functions is complex but
includes areas such as smell, vision & eye movements, facial
sensation, reflexes & movement, hearing taste, tongue & palate
6. 2 min. To explain the movements & even movements of the head, neck & shoulders. Flash How will you
development cards describe the
of professional  Motor Examination development of
education This part of the examination tests the motor function, or professional
during first movement of the major muscle groups most notably in the education during
period. shoulders, arms, hips & legs. The muscles are tested for first period?
mass, muscle tone & strength.

7. 2 min. To enlist the  Reflex Examination O.H.P List down the

developments Various reflexes are tested throughout the body. While development in
in medicine. these can indicate problems with sensation and /or motor medicine?
 function, they can also reveal other aspects of other
aspects of nervous system dysfunctions as well.

 Coordination & Gait

Coordination testing & evaluating a patient’s gait
reveal much about various aspects of their nervous system
8. 1 min. To list down while they involve motor functions they also reveal O.H.P What are the
developments aspects of other more subtle components of brain function . developmental
in law. which control these things. facts in law?

 Sensory Examination
9. 2 min To explain Finally, the sensory examination part of the O.H.P How will you
developments neurological examination evaluates the sensation of the explain the
in engineering. patient this includes not just normal touch but also pain & development in
temperature & sensation of limb position and movement. engineering?

ASSESSING THE NEUROLOGICAL SYSTEM

Begin by asking about the patient’s chief complaint. Then
10. 1 min. To enumerate gather details about his current illness, Past illnesses, O.H.P What is the
other forms of family history & social history. Also perform a system progress in other
vocational review. forms of
education. If possible include the patient’s family education?
members or close friends when taking the history. Don’t
assume that the patient remembers accurately to
11. 2 min. To describe collaborate the details with others to get a better picture. L.C.D What is the
the development in
development  Chief Complaints professional
of professional The most common complaints about the neurologic education during
education system include headache, dizziness, faintness, confusion, second period?
during second impaired mental status disturbances in balance and gait,
period. changes in loss of consciousness. When documenting the
chief complaints, record the information in the patient’s own
12. 1 min To enlist words. L.C.D List down the
educational  Ask about onset and frequency, what precipitates or educational
 means in law. exacerbates it, what alleviates it, and if other means in law?
symptoms accompany it.
 Headache, dizziness or faintness, confusion or
impaired mental status, balance & gait disturbances,
level of consciousness changes.
 Current Health History
 Reveals headache, dizziness, numbness, tingling,
13. 2 min. To describe seizures, tremors, weakness or paralysis. L.C.D What is the
progress of  Detects impairment of memory and concentration. progress in
medicine in  Evaluates speech, comprehension, reading or medicine during
second period. writing skills. second period?
 Identifies interference with ADL’s.

 Special Points
Children and Headache-
 Suspect headache in child who bangs or holds his
head.
 In an infant, a shrill cry or bulging fontanels may
indicate increased intracranial pressure and
headache.
 In children older than 3 years, headache is the most
common symptom of brain tumor.
Neurologic changes with aging-
14. 1 min. To list down  Note that not all neurologic changes in elderly L.C.D What was the
the progress in patients are caused by aging & that certain drugs can progress in
engineering. also cause changes. engineering?

 Past Health History

15. 2 min. To describe Previous major illness, recurrent minor illnesses, L.C.D What was the
the accidents or injuries, surgical procedures and allergies. progress in the
development Health and dietary habits and drug use. field of
in agriculture. agriculture?
  Family History
16. 1 min. To explain the  Diabetes
development  Cardiac or Renal diseases L.C.D What was the
in commercial  High blood pressure or stroke developmental
education.  Cancer steps in
 Bleeding or mental disorders commerce ?
17. 2 min. To explain the  Psychosocial History
miscellaneous  Reveals occupation, home environment religion & L.C.D Explain the
progress. hobbies. miscellaneous
 Assess patient’s self-image progress?
 Check the Vital Signs
18. 3 min. To narrate the  It is controlled by central nervous system
development  Involves body temperature, heart rate and rhythm, L.C.D How will you
of professional blood pressure & respiratory rate. narrate the
education  Normal range- 96.7 F to 100.5 F development
during third  Ability to maintain a constant temperature can be during third
period. impaired due to hypothalamus or upper brain stem period ?
damage.
 Controlled by Autonomic nervous system.
 Slows due to pressure on brain stem & cranial
nerves.
 Abnormal Findings
 Bradycardia
 Tachycardia
 Blood Pressure
19. 2 min. To describe  Continuously monitored by pressure receptors in
the the medulla. Hand What were the
development  Abnormal Findings Outs/ developmental
in law during  Rising systolic blood pressure in a patient with no Black steps in law
the third history of hypertension may signal rising board during third
period. Intracranial pressure. period?
 Respiration
 Respiratory centers in medulla & pons regulate
 rate, depth & pattern of respiration.
 Neurologic dysfunction alters respirations.
20. 3 min. To explain the  Uncovers a central nervous system lesion’s site
progress in the and severity. Hand What was the
field of  Abnormal Findings Outs/ progress in
medicine.  Cheyne-strokes respiration black medicine ?
 Central neurogenic hyperventilations. board
 Apneustic & Biot’s respirations.
 Impaired respiration

ASSESSING MENTAL STATUS & SPEECH

 Begins during health history.
 Gives clue to orientation & memory, guides physical
assessment.
 Assess level of consciousness, appearance, behavior,
communication, cognitive function, constructional ability.
 Level of Consciousness
 Assessment order can be changed, depending on
patient’s state.
21. 1 min. To enumerate  Tactile stimulus can be used if there is no response. LCD How will you
the progress in  Painful stimuli can be used to assess unconscious describe the
agricultural patient or patient with markedly decreased level of progress in
field. consciousness who doesn’t respond to other agricultural
stimuli. field?
 Other Methods to Assess Level of Consciousness
 Squeeze trapezius muscle.
22. 2 min. To enlist the  Apply supraorbital pressure. LCD How will you
commercial  Apply mandibular pressure enlist the
development.  Perform a sternal rub. commercial
 Apply nail bed pressure. development?

CHECKING MENTAL STATUS

To screen patient for disordered thought processes, ask
these questions, an incorrect answer to any question may indicate
 the need for a complete mental status examination.
23. 2 min. To describe Question Function screened LCD What was the
the What is your name? Orientation to person miscellaneous
miscellaneous What is your mother’s name? Orientation to other person development
development. What is today’s date? Orientation to time during third
Where are you now? Orientation to place period ?
How old are you? Memory
Where were you born? Remote Memory
What you have taken in Recent Memory
breakfast?
Who is the president of India? General Knowledge
Can you count backward from Attention and calculation
20 to 1? skill.

 Noting Trends in Level of Consciousness

24. 4 min. To narrate the  Compare findings after assessing patient’s level of LCD, What was the
development arousal, with results of previous assessments. OHP development in
of professional  Describe patient’s responsiveness objectively. professional
education  Use clear terms to describe level of consciousness, education during
during third such as alertness, lethargic, stuporous or comatose. fourth period ?
period.  Alerts !
 If patient with a skull fracture appears lucid & later
has decreased level of consciousness, suspect
arterial epidural bleeding.
 Rapid deterioration of level of consciousness
indicates an acute disorder..
 Generally decreasing level of consciousness
reflects a progressive or degenerative disorder.
 Toxic encephalopathy, hemorrhage, generalized
cortical atrophy (extensive), tumor or intracranial
hemorrhage.
 About Orientation
 Measures ability of cerebral cortex to receive and
accurately interpret sensory stimuli.
  Includes orientation to person, place and time.
Glasgow Coma Scale
 Minimize level of consciousness subjectivity.
 Establishes greater degree of reliability.
 Describes patient’s baseline mental status.
 Detects & interprets changes from baseline findings.
 Evaluate patient’s level of consciousness according to eye
opening, verbal and motor responsiveness.
Using the Glasgow Coma Scale
25. 4 min To explain the The Glasgow coma scale describes a patient’s baseline mental
development status and helps to detect & interpret changes from baseline OHP How will you
of agricultural findings- explain the
and allied  When using the Glasgow coma scale, test the patient’s development in
personnel ability to respond to verbal, motor & sensory stimulation. agricultural and
during fourth  Grade your findings according to the scale. allied
period.  A score of 15 indicates that the patient is alert can follow personnel’s?
simple commands and is oriented to person, place and
time.
 A decreased score in one or more categories may signal
an impending neurologic crisis.
 A score of 7 or less indicates severe neurologic damage.
S.No Test Score Patient Response
1. Eye Opening
Response
Spontaneously 4 Open eye spontaneously
To Speech 3 Opens eyes when told to
To pain 2 Opens eyes only to painful
26. 2 min. To tell about stimulus
the None 1 Doesn’t open eyes in OHP What were the
management response to management
strategies. 2. Motor strategies for
Response development of
Obeys 6 Shows two fingers when professional
asked education ?
 Localizes 5 Reaches toward towards
painful stimulus & tries to
remove it.
Withdraws 4 Moves away from painful
stimulus.
Abnormal 3 Assumes a decorticate
27. 4 min. To describe Flexion posture (Shown below) LCD/ What was
the nursing Abnormal 2 Assumes a decerebrate Flash nursing and
and nursing Extension posture (shown below) cards nursing
education in None 1 No response; just lies flaccid education in
India. (an ominous sign). India in earlier
times ?
Verbal Response (To question, ”What is today’s Date?”)
S.No Test Score Patient Response
1. Oriented 5 Tells correct data.
2. Confused 4 Tells incorrect date
3. Inappropriate 3 Replies randomly with
words incorrect words
4. Incomprehensible 2 Moans or screams
5. No response 1 No response

Detecting Increased Intracranial Pressure

The earlier you can recognize the signs of increased
intracranial pressure (ICP), the more quickly you can intervene
& improve the patient’s chance of recovery. By the time late
signs appear, interventions may be useless.
Test Early Signs Late Signs
Level of Requires increased Unarousable
consciousness stimulation
Subtle Orientation loss
Restlessness & anxiety
Sudden Quietness
 Pupils Pupil changes on side Pupils fixed and
of lesion. dilated ‘or blown’
One pupil constricts
but then dilates.
(unilateral hippus)
Sluggish reaction of
both pupils.
Unequal pupils

Motor Sudden weakness. Profound

response Motor changes on side Weakness
opposite the lesion.
Positive pronator drift
with palms up, one
hand pronates.
28. 2 min. To explain the LCD What is Dufferin
Dufferin fund. Vital Signs Intermittent increases Increased systolic fund ?
in blood pressure. pressure profound
Bradycardia,
abnormal
respirations
(cushing’s
syndrome)
29. 2 min. To tell about LCD Tell about the
the educational Abnormal Findings educational
courses. Orientation to Person: courses in
Inability of patient to remember his name. nursing ?
Self-identity usually remains intact until late in decreasing level
of consciousness.

Abnormal Findings
Orientation to Place:
A hospitalized patient may confuse health care facility with
home.
 A non-hospitalized patient (such as with Alzheimer’s disease)
may fail to recognize familiar home surroundings & wander.

Orientation to Time:
Disorientation to time may be first indicator of decreasing level
30. 1 min. To describe of consciousness. LCD How will you
the auxiliary Facts about Appearance: describe the
nursing. Reveals patient’s behavior, dress & group auxiliary
Evaluates coloring, facial expressions, mobility deformities & nursing?
nutritional state.
Detects impairments in gait, posture & ability to rise.

Abnormal Findings
Subtle changes in patient’s behavior (new onset of chronic
disease or more acute change, involving frontal lobe).
Reccon eyes (Bleeding into peri-orbital tissue)
Otorrhea (Basilar Skull Fracture)

Facts about Behavior

SUMMARY
Historically, Only medicine, law and the ministry were accepted as professions. Today, professional is a term commonly used to identify many
types of people ranging from wrestlers and rock stars, cricketers to college professors and archeologists.

RECAPITUALISATION
How will you introduce professional education?
What is the definition of Professional education?
What are the responsibilities of professional education?
What are the fundamentals of professional education?
What are the historical perspectives of professional education?
How will you describe the development of professional education during first period?
List down the development in medicine?
What are the developmental facts in law?
How will you explain the development in engineering?
What is the progress in other forms of education?
What is the development in professional education during second period?
List down the educational means in law?
What is the progress in medicine during second period?
What was the progress in engineering?
What was the progress in the field of agriculture?
What was the developmental steps in commerce ?
Explain the miscellaneous progress?
How will you narrate the development during third period ?
What were the developmental steps in law during third period?
What was the progress in medicine ?
How will you describe the progress in agricultural field?
How will you enlist the commercial development?
What was the miscellaneous development during third period ?
What was the development in professional education during fourth period ?
How will you explain the development in agricultural and allied personnel’s?
What were the management strategies for development of professional education ?
What was nursing and nursing education in India in earlier times ?
What is Dufferin fund ?
Tell about the educational courses in nursing ?
How will you describe the auxiliary nursing?
 BIBLIOGRAPHY

1. Sudha R. “Nursing Education Principles and Concepts”, Jaypee Brothers Medical Publisher (P) Ltd, 2013, Pg.300
2. Basavanthappa B.T. “Nursing Education”, 1st Edition, Jaypee Brothers Medical Publisher (P) Ltd, 2003, Pg.106-115.
3. Sharma Suresh K. & Reena Sharma “Communication and Education Technology in Nursing”, Chennai, Elsevier Publications,
2012, Pg. 126-146.
4. Neeraja K.P. “Textbook of Nursing Education”, 1st Edition, Jaypee Brothers Medical Publisher (P) Ltd, Pg.211-219.

5. “Professional Education”. By Gauri Doshi, 9 Jan 2012, https://www.preservearticles.com

6. “Professional Education”. https://www.ehow.com

7. Professional Education”. https://www.en.wikipedia.org.

8. “Professional Education”. https://rana03458622422.blogspot.com

9. Professional Education”. https://www.pregi.com

10.“Professional Education”.https://www.sites.google.com