Checklists for Clinical Nursing Skills

30

skill 2-8 Undertaking a neurological examination (continued)

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(h) Evaluate the patient’s ability to understand the spoken and written word. 14. Test cranial nerve (CN) function. (a) Ask the patient to close their eyes, occlude one nostril and then identify the smell of different substances, such as coffee, chocolate and alcohol. Repeat with the other nostril. (b) Test visual acuity and pupillary constriction. (c) Move the patient’s eyes through the six cardinal positions of gaze. (d) Ask the patient to smile, frown, wrinkle their forehead and puff out their cheeks. (e) Test hearing. (f) Before testing the gag reflex, explain to the patient what you are about to do, and that this may be uncomfortable. Test the gag reflex by touching the posterior pharynx with the tongue depressor. (g) Place your hands on the patient’s shoulders while they shrug against resistance. Then place your hand on the patient’s left cheek and have the patient push against it. Repeat for the right cheek. (h) Test the face and neck for pain sensation, light touch and temperature. 15. Assess the patient’s deep tendon reflexes (DTR). (a) Place your fingers above the patient’s wrist and tap with a tendon hammer; repeat on the other arm. (b) Place your fingers at the elbow area with your thumb over the antecubital area and tap with a tendon hammer; repeat on the other side. (c) Place your fingers over the triceps tendon area and tap with a tendon hammer; repeat on the other side. (d) Tap just below the patella with a tendon hammer; repeat on the other side. (e) Tap over the Achilles’ tendon area with a tendon hammer; repeat on the other side. 16. Ask the patient to close their eyes. Using your finger or an applicator, trace a one-digit number on the patient’s palm and ask them to identify the number. Repeat on the patient’s other hand with a different number.

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Copyright © 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Checklists for Clinical Nursing Skills by Louise Sparkes, Jennifer Bassett and Elisabeth Jacob.