NIGHTINGALE INSTITUTE OF

NURSING, NOIDA

NEUROLOGICAL EXAMINATION
(SUBJECT:MENTAL HEALTH NURSING-II)

SUBMITTED TO SUBMITTED BY

Ms. ALKA CHAUHAN Ms. DIVYA THOMAS

LECTURER, M. Sc.(N) 2nd YEAR

NIN, NOIDA NIN, NOIDA

Neurological Examination

Category Normal Findings

Mental Status (as

per Glasgow Coma
Scale)
Alert
Level of
Consciousness

Oriented to person,
time and place.
Orientation
Coherent

Language test Able to remember

Recall

Cranial Nerves

CN I
Olfactory Able to smell and
recognize stimuli

CN II 20x20 vision, able to

Optic read, 3-5 mm [pupil
size]

CN III, IV, VI (+) Extraoccular

Oculomotor Movement (EOM);
Trochlear Lateral Upward and
Abducens downward; pupils
reactive to light.

CN V Able to feel and

Trigeminal clearly identify
stimulus, with
bilateral facial
sensation. With active
corneal reflex.
CN VII
Facial (+) Corneal reflex ,
 Facial symmetry

CN VIII
Vestibulocochlear Able to hear clearly,
can maintain balance

CN IX, X
Glossopharyngeal (+) gag reflex, uvula
Vagus at the center, soft
palate rises
CN XI
Accessory (Spinal) Able to shrug
shoulders against
resistance and able to
turn the head side and
against resistance.
CN XII
Hypoglossal Able to move tongue
from side to side

Muscle Strength MMT Grading

System:
Left Arm
(+5) Full ROM
against gravity,
maximum resistance

Right Arm
(+5) Full ROM
against gravity,
maximum resistance

Left Leg
(+5) Full ROM
against gravity,
maximum resistance

Right Leg
(+5) Full ROM
against gravity,
maximum resistance

Day and Date: Thursday, September 22, 2016

Time: 11:30 AM
Vital Signs
 Temperature :
 PR :
 RR :
 BP

General Survey

Physical Assessment

Assessment Normal Findings Actual Findings Interpretation

Integumentary System

Methods of Assessment
Used:
 Inspection
 Palpation

 Skin Skin is uniform in Skin is fair, warm to Decreased skin

color, warm to touch touch and uniform in turgor and anasarca
with good skin color but slightly indicate dehydration.
turgor. No cyanosis. darker in the exposed Exposed areas are
areas. Decreased skin usually darker
turgor noted. (+) because of exposure
anasarca to the heat of the sun.

 Hair and Scalp Mucous membranes Mucous membranes Within normal range
pink in color, moist pink and moist with
with no lesions or no sores, lesions and
inflammations. inflammations.

Hair is evenly Hair is unevenly Uneven distribution

distributed. Scalp is distributed, thin of hair indicates
intact and free of strand brunette in deterioration given
lesions and color. White hair the age.
pediculosis. noted upon
inspection. Fine body
hair noted over the
body. No scalp
lesions, dandruff, lice
 Nails noted. Within normal range
Nails vary from light
 skinned to light Nails vary from light
brown in darker skinned to light
skinned individuals. brown in darker
Nails are convex in skinned individuals.
shape and firm Nails are convex in
without clubbing. shape and firm
without clubbing.

HEENT

Methods of Assessment
Used:
 Inspection
 Palpation

 Head Round and Round and Within normal range

symmetrical. No symmetrical. No
palpable masses, palpable masses,
swelling and lesions. swelling and lesions.
Facial features and Facial features and
movements movements
symmetrical. symmetrical.

 Eyes In parallel alignment Sclera is white with Pinpointed pupils

with smooth and no lesions. Both eyes indicates disruption
white sclera. Positive are clear and bright of pontine
pupillary reaction to in parallel alignment. sympathetic fibers.
light and blinking Parallel movements
reflex. Smooth, in all directions
conjugate movement noted. Positive
of eyes in all blinking reflex noted.
directions without Cornea is shiny and
eyelid lag and smooth. Pinpointed
nystagmus. pupils are noted at 2
mm in size. Iris is
brown in color upon
inspection. No
corrective lenses or
eyeglasses noted.

Within normal range

Eyebrows and Fair distribution of
eyelashes are evenly eyebrows and
 distributed with no eyelashes without
lesions or swelling. presence of
Eyelids intact. discharges, swelling
or inflammations.
Eyelashes curves
outward without
crusting or
infestations. Eyelids
intact without
lesions. Within normal range
Pinkish – peach color
conjunctiva with no Pinkish – peach color
lesion conjunctiva with no
 Ears lesions. Within normal range
Consistent with skin
color and aligned Aligned with the
with the external external canthus of
canthus of the eyes. the eyes. Consistent
No lesions, with skin color. No
tenderness and lesions, nodules and
swelling. No swelling noted.
palpable nodules or Cerumen noted upon
 Neck exudates. inspection and in Within normal range
small amount.

Skin is intact. No Is in the midline and

palpable masses or movable 180 degrees
bulges, lymph nodes without feeling of
and swelling. discomfort reported.
Thyroid glands not Left and right
enlarge. superficial cervical
nodes not palpable.
No bulges or masses,
lesions and swelling
noted. Thyroid is in
mid lower half of the
anterior neck. No
Enlargement,
 Throat/Mouth tenderness and Within normal range
nodularity noted.

Pink, moist, smooth,

Mucosa pink, no glistening and intact
redness or mucosa. Tongue is
inflammations and pink in color, mobile
lesions. with no lesions or
 swelling and any
discolorations.
Lateral margins
present. Tonsils are Within normal range
pink and indicate no
signs of
inflammation.
Lips pink, moist and
intact. Moist, pink lips Within normal range
noted without any
lesions and swelling.
No cracks noted.
Gums pink with no
lesions, swelling, Gums are consistent
redness and bleeding. in color with other
No discharges or mucosa with no Within normal range
exudates. bleeding. No lesions,
swelling and
exudates noted.
Hard and soft palate
pink and intact, teeth Teeth are white in
are white in color, color. Hard and soft
not loose with good palate is pink and
occlusion and in intact. Dentures
good repair. noted on the upper
Swallowing is easily portion of the buccal
done without mucosa. Reports no
difficulty or feeling difficulty in
of pain. swallowing.

Pulmonary System

Methods of Assessment
Used:
 Inspection Respiratory rate Respiration regulated Presence of
 Palpation ranges from 18 -25 at 18 cpm on respiratory distress.
 Auscultation cycles per minute. mechanical If there is an increase
Equal rise and fall of ventilator, AC mode, in fremitus this
the chest when 40% FiO2, TV: 500. indicates
breathing, full and Nose is symmetrical accumulation of fluid
even. Chest is with no discharges or exudates in the
consistent with skin and nasal flaring. lungs. Even
color. Trachea is in Septum intact and in breathing indicates
the midline. Tactile midline. Trachea is no difficulty in
fremitus equal in the midline. With respiration.
 bilaterally. Nose is ET attached. There is
symmetrical with no equal rise and fall of
discharges. Septum the chest with regular
intact and in midline. rate and rhythm of
respiration without
any masses noted
upon palpation. No
pain reported over
the chest. Breathing
pattern is even, no
dyspnea noted. Vocal
fremitus is
symmetric, equal
bilaterally on the
upper anterior chest.
There are secretions
but no presence of
cough.

Cardiovascular System

Methods of Assessment
Used:
 Inspection Heart rate of 60-100 Pulse rate was During mechanical
 Palpation beats per minute, recorded as 78 bpm ventilation, a breath
 Auscultation regular. Capillary and is in regular for which both the
refill of less than 2 rhythm. Blood timing and the size
seconds. Blood pressure was are controlled by the
pressure of recorded as 120/80 patient (i.e., the
90/60mmHg- mmHg. No murmurs breath is both
140/90mmHg noted. Good capillary initiated [triggered]
refill less than 2 and terminated
seconds. (+) [cycled] by the
spontaneous patient).
breathing.

Gastrointestinal
System

Methods of Assessment
Used: Abdomen is intact No lesions, masses Within normal range
 Inspection with no lesions, and scars noted over
 Palpation masses and the abdomen.
 Percussion consistent with skin Umbilicus noted,
  Auscultation color. Umbilicus inverted and in
inverted and in midline. Bowel
midline. Audible sound audible at four
bowel sounds present abdominal quadrants
5-30 clicks per with 14 clicks per
minute. minute upon
auscultation. Last
bowel movement:
September 18, 2015,
5:30 in the afternoon
with soft yellowish
stool as reported.

Genitourinary System

Methods of Assessment
Used:
 Inspection No burning sensation With intrajugular Within normal range
during urination. insertion. Last
Urine output is 800- voided: September
1,200 ml/day if 22, 2016, 10:30 in
intake is around 2 the evening with dark
L/day yellow colored urine
with total output of
800 cc throughout
the shift.

Musculoskeletal
System

Methods of Assessment
Used: Posture erect, head Immobilization on all Alteration of arousal
 Inspection midline and weight of the extremities. are a spectrum of
 Palpation evenly distributed. Decerebrate posture. abnormalities that
Both feet point range from being
straight ahead. All alert to unresponsive
movements (comatose).
coordinated and arms Decerebrate posture
swings in opposition. indicates upper
Balance intact. pontine damage.

NEUROLOGICAL EXAMINATION
 DEFINITION: A neurological examination is an essential component of a comprehensive physical
examination. It is a systematic examination that surveys the functioning of nerves delivering sensory
information to the brain and carrying motor commands (peripheral nervous system) and impulses
back to the brain for processing and coordinating (central nervous system)

INDICATIONS:

A complete neurological examination may be performed:

 During a routine physical

 Following any type of trauma
 To follow the progression of a disease
 If the person has any of the following complaints:
 Headaches
 Blurry vision
 Change in behavior
 Fatigue
 Change in balance or coordination
 Numbness or tingling in the arms or legs
 Decrease in movement of the arms or legs
 Injury to the head, neck, or back
 Fever
 Seizures
 Slurred speech
 Weakness

The neurological assessment consists of six parts :

1)Mental status 2)Cranial nerves 3)Sensory function 4)Motor function 5) Cerebellar function and
6)Reflexes.

EQUIPMENT NEEDED
1. Penlight
2. Tunning fork
3. Reflex hammer
4. Cotton wisp
5. Paper clip
6. Coin
7. Salt

8. Cotton tipped applicators

9. Glass of water
 10. Tongue blade
11. Ophthalmoscope

1)MENTAL STATUS EXAMINATION

Assessment of mental status is performed by observing the client and asking questions.
Procedure Normal findings Deviations from normal
Observe appearance and
movement
 Posture Relaxed with shoulder back and Tense, rigid, slumped,
both feet stable asymmetrical posture, slumped
posture is seen with depression
or organic brain disease.

 Gait Coordinated and smooth Uncoordinated-staggering,

shuffling, stumbling

 Motor movements Smooth, coordinated movements, Jerky, uncoordinated; tremors,

client alters position occassionally tics, fast or slow movements.
Bizzare movements are seen with
schizophrenia: tense, fidgety and
restless behaviour in anxious
patients.

 Dress Clothes fit and are appropriate for Clothes extra large or small and
occassion and weather . inappropriate for occassion.
Inappropraite dress is seen with
depression, dementia,
Alzheimer's disease and
schizophrenia.

Procedure
Normal findings
Deviations from normal
 Hygiene
  Facial expression

 Speech

Observe mood

 Feelings

 Expressions

Skin clean, nails clean and trimmed

Good eye contact, smiles/frowns appropriately.

Clear with moderate pace

Responds appropriately to topic discussed; expresses feelings

Appropriate to situations.

Expresses good feelings about self, others, and life verbalizes positive coping mechanisms
(talking,support system,exercise etc)
Dirty, unshaven; dirty nails; foul odors. Poor hygiene is seen with depression, dementia,
alzheimer's disease and schizophrenia; obsessive compulsive disorder

poor eye contact is seen in apathy or depression; mask like expression in parkinson's
disease; extreme anger or happiness in anxious clients.

High pitched; monotonal; hoarse very soft or weak . Slow , repetitive speech is present in
depression or parkinson's diasease; loud and rapid in maniac phases. Irregualr
uncoordinated speech in multiple sclerosis; dysphonia in impairement of CN X; aphasia in
lesions of dominant hemisphere.

Expresses feelings inapproriate to situation (eg.anger or euphoria)

Expresses dissatisfaction Alchol, drugs etc);prolonged negative feelings seen with

depression;relation and high energy seen with maniac phases;excessive worry seen in
obsessive compulsive disorders.
Procedure

Normal findings

Deviations from normal

Observe thought,process and perceptions

 Clarity and content

  Perceptions

Observe cognition

Level of consciousness
Expresses full and free flowing thoughts during interview.
Follows directions accurately; perceptions realistic and consistent with yours and others.

Aware of self, others, place, and time; follows instructions.

Expressed thoughts are jumbled,confusing,and not reality oriented. Repetiton and expression of
illogical thoughts are seen with schizophrenia; rapid flight of ideas with maniac phases ;
irritational fears with phobias; delusions seen with psychotic disorders, delirium and dementia;
illusions seen with acute grief, stress reactions,schizophrenia and delirium.

Is unable to follow through with directives; perceptions unrealistic and inconsistent with yours
and others.
Unable to express where he or she is, time, and who others are ;does not follow instructions.
Reduced level of orientation is seen with organic

Procedure

Normal findings

Deviations from normal

Note: if client is not responding verbally, do the following ;

 Ask client to squeeze your hand.

 Ask client to nod head when you touch him her.

 Squeeze clients finger firmly.

 Length of concentration

 Memory

 Abstract reasoning – ask client to explain a proverb, eg ”a stitch in time saves nine.”
Squeezes hand

Nods

Pull finger away

Listens to you and responds with full thoughts .

Correctly answers questions about current days activities; recalls significant past events.

Explains proverb accurately

Is seen with organic brain disorders.

No responses

No responses

No responses(distracrated and unable to follow directions in anxiety, fatigue, attention deficit

disorders and altered states of consciousness)
Fidgets; does not listen attentively to you; expresses incomplete thoughts. Distraction and
inability to focus are noted with anxiety, fatigue,attention deficit disorders and altered states.

Unable to recall any recent events with delirium, dementia depression, and anxiety;unable to
recall past events with cerebral cortex disorders.

Unable to give abstract meaning of proverb with schizophrenia, mental retardation, delirium
,dementia

Procedure

Normal findings

Deviations from normal

 Ability make sound judgements- ask client questions such as “why did you come to the
hospital”?

 Ability to identify similarities ask client questions such as “how are birds and bees
alike?”
  Sensory perception and coordination –ask client to write name and draw circle

Answers to question based on sound rationale

Identifies similarity

Write name and draws circle accurately.

Answers’ to questions are not based on sound rationales in organic brain syndrome, emotional
disturbances, mental retardation, or schizophrenia.
Unable to identify similarity with schizophrenia, mental retardation, delirium or dementia.

Does not write name or draw circle accurately with mental retardation, dementia, and parietal
lobe dysfunction.

2)CRANIAL NERVE ASSESSMENT

Procedure Normal findings Deviations from normal

Assess cranial nerves I to
XII

CN I- olfactory
Identifies scent correctly with Unable to identify correct
Hold scent(eg. cofee, each nostril odor.
orange)under one nostril with
other occluded while client
closes eyes. Repeat with other
nostril
CN II – optic:
Assess vision. Assess visual
fields. Do fundoscopic
examination for direct
visualization of optic neirve.
CN III- oculomotor
CN IV – trochlear
CN VI- abducens
Procedure Normal findings Deviations from normal
 Asses extraocular
movements.
Assess PERRLA(pupils equal,
round and reactive to light
and accommodation)

 CN V- trigeminal
Assess sensory function by:
Touching cornea lightly with Eyelids blink bilaterally. Absent blink of eyelids with
wisp of cotton lesion of CN V (trigeminal) or
lesion of the motor part of CN
VII (facial)

Testing clients ability to feel Identifies light touch, dull, and Unable to identify feel facial
light touch, dull and sharp sharp sensations to forehead, sensations with lesions of CN
facial sensations. cheeks and chin. V, spinothalamic tract
Or posterior columns.

Assess motor function by Muscles contract bilaterally Asymmetrical or no muscles

palpating masseter and contractions; irregular facial
temporal muscles as client movements; pain or bilateral
clenches teeth muscle weakness is seen with
peripheral or central nervous
system dysfunction. unilateral
weakness is seen with lesion
of CN V.

Assess jaw jerk Mouth opens slightly. No response , or mouth opens

widely.

 CN VII- Facial

Assess sensory function by Identifies taste correctly. Unable to taste or to identify

asking client to identify sugar, taste correctly with impaired
lemons, salt on anterior 2 3rd CN VII.
of tongue, with eyes closed
and tongue protruded.

Assess motor function by

asking client to do the
following :

Procedure Normal findings Deviations from normal

Smile Smile Unable to perform facial
Frown Frowns movements as instructed, or
Show teeth Show teeth movements asymmetrical on
Blow out cheeks Blow out cheeks one side of face. Unable to do
Raise eyebrows and tightly Raises eyebrows and closes facial movements along with
closes eyes eyes tightly as instructed; paralysis of the lower part of
facial movements are the face seen in Bell’s palsy;
symmetrical paralysis of lower part of face
 on opposite side is seen with
central lesion affecting upper
motor neurons from
cerebrovascular accident.

 CN VIII- acoustic
Assess hearing

 CN IX –
glossopharyngeal

 CN X – Vagus

Ask client to open mouth and Bilateral, symmetrical rise of Unequal or absent rise of soft
say “ah.” soft palate and uvula. palate and uvula with lesions
of CN X

Touch back of tongue or soft Gag reflex present Gag reflex absent with lesions
palate with tongue blade . of CN

Ask client to identify sugar, Identifies correct taste. Unable to identify correct taste
lemon juice, and salt tastes on with lesion of CN IX.
posterior one third of
protruded tongue with eyes
closed.

 CN XI- spinal
accessory
Symmetrical, strong Asymmetrical, weak or absent
Palpate strength of trapezius contraction of trapezius contraction of trapezius
muscles by asking client to muscles. muscles seen with paralysis or
shrug shoulders against your muscle weakness
hands.
Procedure Normal findings Deviations from normal
Weak or absent contraction of
Palpate strength of Strong contraction of sternocleidomastoid muscle on
sternocleidomastoid muscles sternocleidomastoid muscle on opposite side that head is
by asking client to turn head opposite side that head is turned seen with peripheral
against your hand. turned. nerve disease.

 CN XII- hypoglossal

Ask client to protrude tongue Symmetrical tongue with Asymmetrical tongue;

and move it to each side smooth outward movement deviation to one side seen with
against tongue blade. and bilateral strength. unilateral lesion;
fasciculations and atrophy of
tongue seen with peripheral
nerve disease; unequal or no
strength.

3)SENSORY NERVE ASSESSMENT

Procedure Normal findings Deviations from normal

Test for primary sensations
with clients eyes closed by
touching client with the
following :

 Piece of cotton Identifies area of light touch Unable to identify location or

light touch sensation

 Alternately with sharp Identifies area touched and Unable to identify location or
tip and dull tip of differentiates between sharp differentiate touch sensations
paper clip and dull sensation.

 Vibrating tunning fork Identifies vibratory sensation Unable to identify vibratory

on major distal bony sensation.
prominences of wrist,
sternum.

Procedure Normal findings Deviations from normal

Test for cortical and
discriminatory sensation
with client’s eyes closed by
asking client to identify the
following:

 The number of points Identifies two points on : Unable to identify two points
 touching him or her forearm at 40 mm apart; back at normal ranges with lesions
while you touch client at 40-70 mm apart; dorsal of the sensory cortex.
with two points hands at 20 -30 mm apart;
simultaneously(two fingertips at 2-5 mm apart.
points discrimination)

 The object (eg a coin) Identifies correct object. Unable to identify object with
you palce in client’s lesions of the sensory cortex.
hand(sterogenesis)

 A number you write on

client’s palm with a Identifies correct number Unable to identify number
tongue blade with lesions of the sensory
(graphesthesia) cortex.

 The direction you Identifies correct direction Unable to identify direction in

move a part of client’s body part is moved. which body part is moved
body(eg, move great with lesions of the sensory
toe up or down; cortex.
kinesthesia)

4)CEREBELLAR ASSESSMENT

Procedure Normal findings Deviations from normal

Close eyes, and hold arms Holds arms over head and Downward drift; a flexion of
over head and straight out in straight for 20 seconds one or both arms
front with arms extended to
the sides, touch each Smooth accurate movements Uncoordinated jerky
forefinger alternately to while touching finger to nose. movements; inability to touch
nose, first with eyes open nose seen with cerebellar
and then with eyes closed. disease.

 Tap forefinger to Rapidly taps forefinger to Jerky, unccordinated

thumb rapidly thumb movements offorefinger and
thumb.

 Touch each finger to Rapidly touches each finger to Spastic, awkward movements
thumb. thumb with cerebellar disease, upper
motor neuron weakness, or
extrapyramidal disease.

 Button and unbutton Buttons and unbuttons clothes Clumsy attempts to button and
coat /shirt smoothly unbutton clothes

 Run each heel down Runs each heel smoothly

opposite shin one at a down each shin. Unable to place heel on shin
time. and move it down shin with

Procedure Normal findings Deviations from normal

 Stand erect with feet Stands straight with minimal Sways,moves feet out to
together and arms at swaying. prevent fall with disease of
sides, first with eyes posterior columns, vestibular
open and then with dysfunction, or cerebellar
eyes closed .(Romberg disorders.
test)
  Walk naturally Steady gait with opposite arm Unsteady gait, uncoordinated
swing arm swing, uses wide foot
stance; shuffles or drags feet;
lifts feet high off ground ;
crosses feet when walking.
Gait is affected by disorders
of the motor , sensory ,
vestibular and cerebellar
systems.

 Walk in a heel to toe Maintains balance with Unsteady tandem walk.

fashion(tandem walk) tandem walk.

 Stand on each foot Stands on one foot at a time. Uanable to stand on one foot.
(one at a time )

 Hop on each foot (one Hops on each foot without Unable to walk on heels or
at a time ) losing balance toes.

5)REFLEX ASSESSMENT

Deep tendon reflex are rated as follows

4+ hyperactive

3+ brisk

2+ normal

1+ sluggish

0 no response

Procedure Normal findings Deviations from normal

Elicit deep tendon reflexes as
follows:

Biceps reflex Biceps contract Absent or hyperactive

: with reflex hammer, tap your (1+, 2+,3+ biceps reflex) contraction of biceps (0, 4+
thumb placed over biceps biceps reflex)
tendon with client’s arm
flexed (tests nerve roots C5,
C6)
Brachioradialis reflex: Elbow flexes with pronation Absent or hyperactive flexion
Tap brachioradialis tendon of forearm.(1+,2+, 3+ of elbow and forearm
just above wrist on radial side brachioradialis reflex) pronation (0+,4+
with client’s arm resting brachioradialis)
midway between supination
and pronation(tests nerve roots
C5, C6)

Triceps reflex:
Tap triceps tendon(just above Absent or hyperactive elbow
elbow) with client’s arm Elbow extends (1+,2+,3+ extension (0, 4+ triceps reflex)
abducted and forearm hanging tricep reflex)
freely (tests nerve roots C6,
C7, C8)

Patellar reflex:
Tap patellar tendon with Extension of knee Absent or hyperactive
client’s knee flexed and thigh (1+, 2+, 3+ patellar reflex) extension of knee ( 0, 4+
stabilized (tests nerve roots patellar reflex)
L2, L3)

Procedure Normal findings Deviations from normal

 Achilles reflex : tap Palantar flexion of foot Absent or hyperactive plantar
Achilles tendon with (1+,2+,3+ Achilles reflex) flexion of foot ( 0, 4+ plantar
client’s foot slightly flexion)
dorsiflexed and
stabilized (tests nerve
roots S1,S2)

 Elicit superficial
reflexes as follows
Lightly stroke each side of Bilateral upward and Absent or unilateral
abdomen above and below downward movements of movement of umbilicus ; no
umbilicus (umbilicus reflexes) umbilicus toward stroke; abdominal contraction
abdomen contracts

Stroke gluteal area Anal sphincter contracts Absent contraction of gluteal

reflex.

Stroke inner upper thigh of Scrotum elevates on side No elevation of scrotum

males. stimulated

Assess for pathological

reflexes as follows:
 Babinski reflex:
Use tongue blade to stroke Flexion of all toes (plantar Great toe extends and other
lateral aspect of sole from heel responses negative babinski toes fan out (positive babinski
to ball of foot . reflex in adults) reflex in adults)

 Ankle clonus: sharply

dorsiflex foot with Foot stays dorsiflexed with no Foot oscillates between
knee supported and movements. dorsiflexion and plantar
partially flexed and flexion.
hold this way

 Brudzinski sign : No pain, resistance , or hip Pain, resistance and hip knee
have client lie flat and knee flexion accompanies flexion occur in response to
flex neck forward maneuver. maneuver.

 Kernig sign : have

client lie flat and flex No pain or resistance to Pain and resistgance to
one knee and hip on maneuver. maneuver.
same side.

AFTER CARE:

 Provide the comfortable position to the patient.

 Replace all the articles and perform hand hygiene.
 Document the findings in the client record using forms or checklist or in the patients file
 Relate the findings to the previous assessment data if available
 Report significant deviations from normal to the primary care provider

BIBLIOGRAPHY:

 Black Joyce M. Medical Surgical Nursing. 7th ed. Vol-1. Elsevier Publication; 2004. p.
958-61.

 Suzzane C. Smeltzer. Brunner and Suddarth’s Textbook Of Medical Surgical Nursing.

11th ed. Wolters Kluwer Pvt. Ltd, New Delhi;2008. p. 2144-50.

 Malasansons, barkauskas. Health assessment. 3rd ed. C.V Mosby Publications ,st. Louis,
Missouri 63146. P. 532-575
 Phillps, Long, Wood. Medical Surgical Nursing. 7th ed. BI Publication Pvt. Ltd.,New
Delhi;2002. p. 649-52.