You are on page 1of 7

Priority areas of the Neurological assessment

To: Karen Goodwin


From: Karimah Lewis
Student # 804441954

Neurological assessment is a form of examination used to determine if a patients nervous


system is functioning properly. The assessment is divided into numerous components, each
focusing on specific parts of the nervous system. They are mental status, cranial nerves, motor
functions, sensory system, vital signs, tone, and cerebral function
(http://www.healthcommunities.com/brain-nerve-tests/what-is-a-neuro-exam.shtml#mental). In
case study that I received, the two primary areas that I selected were cranial nerve VIII: acoustic
(vestibulocochlear) nerve and metal status.
The first priority problem I am going to discuss is Hearing. I selected hearing as a priority
area for this client, because it was mentioned in the scenario that his name would have to be
called out loudly before he can hear you. This indicates that he is having some issues with his
hearing. Due to Mr. Chestnuts age he is at greater risk for a type of hearing loss called
presbycusis. This is a gradual loss of sensorineural caused by declined nerve in the inside of the
ear. Aging adults hearing loss happens when the lining of the ear, which is called cilia becomes
stiff and coarse. This delays the travelling of sound waves towards the tympanic membrane
which decreases hearing. It also causes cerumen to accumulate and oxidize, which decreases
hearing greatly (Jarvis 2009, pg.345). Three different kinds of hearing loss are conductive,
sensorineural and mixed loss. Hearing is a priority area because it is one of the most important
senses of our body. It allows us communicate with others and socialize with friends, and it
enables us to be aware of our surroundings and when necessary it alerts us of potential danger.
According to Bellmon and Symfon 2013, out of all of the five senses, our hearing is the most
precious (http://bellman.com/en/your-hearing/facts-about-hearing/). Communication has two
categories, non-verbal and verbal. When someones hearing is impaired it makes it very difficult
for he/she to verbally communicate to other, because of their inability to hear what the person is

saying. It restricts a person from effectively communicating with another person. As noted by
Bellmon and Symfon 2013, hearing empowers individuals by assisting them with leading
everyday lives without limitation. It also plays a great role in helping people socialize, work and
communicate. Hearing impairment increases individuals chances of getting injured. Being able
to hear your environment, alarms you of any danger headed towards you. For example, if a
person was walking home alone and someone was following them, they would be able to hear
the persons footsteps approaching them. This would then enable them to react in a manner to
protect themselves; whereas a person who is hearing impaired wouldnt be able to hear anything.
The Hear-IT website mentions how hearing impairment increases the risks of injury because
individuals who are hearing impaired might miss danger signals due to hearing (http://www.hearit.org/hearing-loss-and-noise-workplace-can-be-dangerous-cocktail). When a person loses their
hearing it affects them drastically. It does not only affect individuals physically but it can impact
them socially and emotionally as well. This can lead to other issues which will need to be taken
into consideration such as: stress, fatigue, anger, irritability, depression, isolation, trouble
remembering thing or following direction, and safety (http://www.sonici.com/Sonic/Abouthearing-and-hearing-loss/About-hearing/Why-hearing-is-important.aspx). Hearing loss is
common in elderly people over the age of 65 as Javis 2009 states, 50% of Canadians experience
hearing loss over 65 years old.
The Neurological assessment that is important to assess Mr. Chestnuts hearing issue, is
the cranial nerve VIII: acoustic (vestibulocochlear) nerve. This test focuses on hearing acuity by
the ability to hear normal conversations (Jarvis 2009, pg. 667). I will address my hearing
concerns by completing the whispered voice test, Weber test and Rinne tuning fork test. I would
then compare the result of all three test. These test would confirm if Mr. Chestnut is hearing

impaired. The whispered voice test is conducted by standing 30 to 60cm away from the patient,
my patient would then place his fingertip in his auditory canal. This ensures the ear being tested
is not receiving help from the other ear, I will then begin to whisper directly into the ear that is
being tested. I will begin with three low-whispers then two-syllable. If my patient does hear
clearly, I will increase the whisper gradually. The second test is the Weber test. To begin the test I
would select a tuning fork, then I would use my finger to activate it. Following I would place the
base of the tuning fork on the midline of his skul,l while asking him to inform me where he hears
the sound. This test allows me to assess for lateralization of sound. To complete the Rinne test, I
would also have to use a tuning fork. I would then activate it using my finger and place the base
at the end of the mastoid surface, making sure it is on the same level of the ear canal. Next I
would ask for my patient to inform me when they can no longer hear the sound. Following I
would place the tuning fork 2.54cm from the auditory meatus of the same ear, making sure that
the U of the fork is facing forward. By doing this I would be assessing bone conduction. Lastly
I would ask my patient if he could hear the sound, taking note whether air conduction is longer
than bone conduction (Potter and Perry 2009, pg574). Depending on the results I would suggest
that Mr. Chestnut get a hearing aid.
The second priority problem Im going to address is metal status. Metal status is
the mental process of knowing, including aspects such as awareness, perception, reasoning,
and judgment (http://www.thefreedictionary.com/Cognitive+ability). The reason why I chose
metal status as a primary area pertaining to the scenario, is because when Mr. Chestnuts family
members came to visit for his birthday he didnt react in a normal manner, instead he just stared
out of the window like they werent even there. Normally when someone is celebrating their
birthday they are happy unless something upset him/her. People would normally be socializing

with their loved ones. This concerns me because it seems like his mental state is abnormal. A
persons mental status is one of the most important functions of their body. As proven by The
World Health Organization which mentions in their key facts that emotional well-being and
mental state is very important in older age
(http://www.who.int/mediacentre/factsheets/fs381/en/). A persons mental state is very important
because it determines their ability to take care of themselves and make rational decisions. As a
person ages they become at risk for physical and mental challenges, but due to the negative
stigma attached they are more reluctant to seeking help. Some individuals silently stress over
becoming older that they become depressed, which later on may lead to substance abuse issues
which will also affect their ability to care for themselves. This can lead to physical neglect and
maltreatment. Factors that contribute to psychological distress in which a person whos assessing
and elderly patients mental status should keep in mind, are bereavement, a decrease in
socioeconomic status due to retirement, or a disability. Change is not always easy to accept.
When a person ages, their body changes and certain task sometimes become more difficult.
Being limited to do certain things is very hard for an individual to accept. According to The
World Health Organization, dementia and depression are the two most common health issues that
affect the elderly population (http://www.who.int/mediacentre/factsheets/fs381/en/). Elderly
people are more willing to commit suicide than any other population due to mental health issues.
As noted by CTV News states, studies show that Canada's elderly are at a much higher risk of
suicide than adolescents. Elders experiencing mental health issues isolate themselves, thinking
that there is something wrong with them and no one would understand. This causes them to feel
alone. (http://www.ctvnews.ca/health/health-headlines/canada-s-elderly-at-high-risk-of-suicideexperts-warn-1.1388778). This demonstrates the severity of how a person mental health state can

affect their desire to live. As a nurse three of my interventions would be to educate family
members on my patients mental status. This allows the family member to understand his
situation, causing them to interact accordingly. It also helps them know what to expect from the
individual. The second intervention would be to identify challenging behaviours surrounding my
patients mental health issues by completing the mental state examination, and finding ways to
resolve it. Lastly I would give my patient and his family resources like support groups,
information sessions and a list of long term care facilities. This will to support them during
theyre experience with dealing with a life changing situation.
Having drastic changes occur in your life, resulting in permanent changes is very hard for
anyone to deal with. It is very important for a nurse to aware of a persons culture and the role it
plays before interaction. Nurses need to educate themselves on this, because it can positively or
negatively affect the help professional relationship. Completing this assignment has allowed me
to be more empathetic to anyone going through difficulties. It also makes me feel more confident
when dealing with an elderly patient who is experiencing hearing and mental impairment. It also
allows me to reflect on the importance of culture and how my approach would vary because of it.

References

1. Bellmon, & Symfon. (2013). Design for Ears. Retrieved from


http://bellman.com/en/your-hearing/facts-about-hearing/
2. CTV News. (2014). Canadas elderly at risk of suicide, experts warn. Retrieved
from http://www.ctvnews.ca/health/health-headlines/canada-s-elderly-at-highrisk-of-suicide-experts-warn-1.1388778
3. Farlex. The Free Dictionary Online. Retrieved
from(http://www.thefreedictionary.com/Cognitive+ability
4. Hear-it. Hearing loss and noise in the workplace can be dangerous cocktails.
(2014). Retrieved from http://www.hear-it.org/hearing-loss-and-noise-workplacecan-be-dangerous-cocktail
5. Jarvis, C. (2009). I. Browne, A., MacDonald-Jenkins, J., & Lucktkar-Flude, M.
(Eds.), Physical Examination and Health Assessment: Canadian Edition (1st ed).
Toronto: Elsevier.
6. Remedys Health .com Communities (2000). What is a neurological exam?
Retrieved from http://www.healthcommunities.com/brain-nerve-tests/what-is-aneuro-exam.shtml#mental
7. Sonic. Why is hearing important. Retrieved from
http://www.sonici.com/Sonic/About-hearing-and-hearing-loss/Abouthearing/Why-hearing-is-important.aspx
8. Potter, P., Perry, A. G. (2009). Ross-Kerr, J., Wood, M. (Eds.), Canadian
fundamentals for nursing (4th ed). Toronto: Mosby.
9. World Health Organization. (2014). Mental Health and Older Adults. Retrieved
from(http://www.thefreedictionary.com/Cognitive+ability

You might also like