✅ I will be checking the power point and the book to add other stuff in this and the previous note.

🔄 Recap of Previous Classes

• Age considerations:
• Loss of taste (may be age-related)
• Dry tongue (medication-related).
• Presentation matters → food should look good & colorful to encourage eating.
• Normal face changes: Loss of facial fat, dentures affect appearance, skin loses elasticity, skin tags, wrinkles

Skin Tags

Ears 👂

• Cranial Nerve VIII → Acoustic Or Vestibulocochlear (hearing, balance). (Either name both are correct, Both refers to the same thing)
• Tests:
• Whisper test
• Weber (bone conduction)
• Rinne (air conduction) Air conduction should be Higher than bone conduction, usually is 2 times higher.
• Normal finding:
• Tympanic membrane grayish
• could have scars (witch is normal, it means previous ear infection, or small damages that cicatrized)
• moves when coughing.
• Tinnitus (ringing, buzzing sound), sometimes with blurring. Not normal in most situations.
• Cerumen impaction → (cerumen) builds up in the ear canal and blocks it.  Affects hearing.

Nose 👃

• Septum perforation → could mean cocaine use or piercings.

Mouth 👄

• Frenulum (Tissue that holds the tongue) → assists with speech.
• Some people have their tongue to attach to the floor of the mouth so they required the frenulum to be cut in surgery.

• Tonsillitis → inflammation of tonsils/uvula → it could mean infection.
• Cranial nerves IX, X, XII → swallowing, taste, tongue movement.
• Dentures → must always check them.

🧾 Chapter 24 – Neurological System

Anatomy & Physiology

• Nervous system → CNS + PNS.
• Cerebral cortex → thought, memory, sensation, voluntary movement.
• Lobes: frontal, parietal, occipital, temporal.
• The stroke in different areas will have different consequences. If u see a blacked area u can give something to help remove the cloth, if active bleeding u can't do anything to help.
• Crossover →
• left brain damage → right body symptoms.
• right brain damage → left body symptoms.
• Cerebellum → coordination, balance, posture.
• Reflexes:
• Nurses usually only test plantar reflex.
• Babinski response should be absent in adults.


• The Babinski sign is a neurological reflex that causes the big toe to extend upward and the other toes to fan out when the sole of the foot is stroked. It is a normal reflex in infants but indicates damage to the brain or spinal cord in children over two years old and adults. A positive Babinski sign suggests a problem with the corticospinal tract, a pathway of nerves from the brain to the spinal cord
• Aging → decreased cerebral blood flow → slower responses.

Neurological Assessment

• Subjective questions:
• History of stroke?
• Difficulty swallowing?
• Problems with coordination?
• Environmental hazards at home?
• Objective assessment:
• Mental status (sensory checked before mental in elderly).
• Cranial nerves (know number, name, function).
• Motor function.
• Sensory function.
• Reflexes.

Cranial Nerve Testing

• CN II (Optic) → vision at 20 ft, accommodation (finger).
• CN III, IV, VI → extraocular movements, pupils (PERRLA).
• CN V (Trigeminal) → sensory (cotton), motor (jaw/teeth clench).
• CN VII (Facial) → smile, frown, eyebrows, eye closure.
• CN VIII (Acoustic) → whisper test.
• CN IX, X (Glossopharyngeal, Vagus) → “Ahhhh,” uvula and palate rise.
• CN XI (Accessory) → shoulder shrug, head resistance.
• CN XII (Hypoglossal) → tongue midline (“Light, tight, dynamite”).

Motor & Coordination

• Upper extremities:
• Arms forward x5 sec, finger squeeze.
• Lower extremities:
• Leg raise x5 sec, foot resistance.
• Coordination tests:
• Finger-to-finger
• Finger-to-nose
• Heel-to-shin
• RAM (Rapid Alternating Movements) (Tested together with Finger to Finger)

Balance & Gait

• Nursing consideration: When pt. sit or stand ask if they are feeling dizzy before make them walk, and while walking ask if they are ok.
• Stand feet together, arms at side, eyes closed.
• Walk normally, turn, walk back.
• Tandem walking → heel-to-toe (“drunk test”).
• Could be normal or abnormal
• Romberg sign → stand still w/ eyes closed for 20 sec.
• Positive Romberg Test: The patient loses balance or sways significantly when their eyes are closed.
• Negative Romberg Test: The patient maintains balance well with their eyes closed.

This indicates that proprioception and vestibular function are likely normal. 

Sensory System

• Light touch (cotton), sharp/dull, temperature, pain.
• Stereognosis → identify object in hand.
• Graphesthesia → identify number/letter drawn on palm.
• the ability to recognize letters, numbers, or symbols written on the skin by touch
• Two-point discrimination → identify where touched if right or left hand or leg.
• Types of paralysis: hemiplegia, paraplegia, etc.

⚡ Key Takeaways / Important for Exam

• 🔹 Know ALL cranial nerves by name, number, and function.
• 🔹 ABCT mental assessment – Appearance, Behavior, Cognition, Thought process.
• 🔹 Always screen for suicide → put on watch until psych clears.
• 🔹 Glasgow Coma Scale → Normal 15, <7 severe, 3 = no response.
• 🔹 Cerebellum = coordination & balance (important).
• 🔹 Only plantar reflex tested by nurses.
• 🔹 Stroke patients → must assess swallowing before giving food/drink. Don’t assume that if they can talk they can swallow.
• 🔹 Recap tests to memorize: Whisper, Weber, Rinne, Romberg, Four Word Test, Graphesthesia, Stereognosis.

Read Level of consciousness

Read chapter 5 abnormalities.

• Glasgow Coma Scale (GCS)
• Normal = 15
• <7 = severe impairment → requires referral.
• 3 = no motor response.

Think "EVM" for the three parts:

• Eye response: scored from 1 to 4.
• Verbal response: scored from 1 to 5.
• Motor response: scored from 1 to 6.