This page carries one complete NUR 325 Module 4 focused neurological assessment of acute facial weakness, organized as subjective data, objective data, interpretation, SBAR and patient teaching, with references and margin notes. Searches like "nur 325 module 4 assignment", "nur325 module 4 focused assessment" and "nur 325 module 4 example" land here.
The NUR 325 Module 4 example, in full
Focused Neurological Assessment: Acute Right-Sided Facial Weakness in a 44-Year-Old Woman
[Student Name]
Southern New Hampshire University
NUR 325: Patient Assessment and Health Literacy
Module Four Focused Assessment
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Focused Neurological Assessment: Acute Right-Sided Facial Weakness in a 44-Year-Old Woman
Subjective Data
Chief complaint: "The right side of my face won't move, and I'm scared it's a stroke."
History of present illness: A 44-year-old dental hygienist noticed on waking at 6:30 a.m. that the right side of her mouth drooped and that water dribbled from that side when she rinsed. She was last known normal at 10:45 p.m. the night before, when she went to bed. Over the next two hours she noticed that her right eye felt dry and would not close fully, that sounds seemed uncomfortably loud in her right ear, and that food tasted odd on the right side of her tongue. She had mild aching behind the right ear the day before. Denies weakness or numbness in her arms or legs, difficulty finding words, vision loss, double vision, dizziness, headache, trouble walking or a rash.
Relevant history: A cold with a sore throat one week ago. No hypertension, diabetes, heart disease or previous stroke. Takes no medications. Nonsmoker. Not pregnant. No recent tick bites or travel to wooded areas.
Objective Data
Vital signs: temperature 36.8 degrees Celsius, regular pulse of 84, respirations 16, blood pressure 132/84 mmHg, oxygen saturation 99 percent. Point-of-care glucose 102 mg/dL.
Stroke screen: Balance steady, no visual field loss or double vision, right facial droop present, no arm drift, speech clear with mild slurring of lip sounds, no word-finding difficulty.
Cranial nerves: Pupils equal and reactive; extraocular movements full. Facial nerve: at rest, the right nasolabial fold is flattened and the right corner of the mouth droops. The patient cannot wrinkle the right forehead or raise the right eyebrow. Right eye closure is incomplete, with the eyeball rolling upward on attempted closure. She cannot puff the right cheek or smile symmetrically. Left face moves normally. Facial sensation intact to light touch on both sides. Hearing grossly intact; sounds reported as loud on the right. Palate rises symmetrically; tongue midline.
Motor, sensory and coordination: Strength 5 out of 5 in all extremities, no pronator drift. Light touch intact in all extremities. Finger-to-nose and heel-to-shin accurate. Gait normal. Ears: no vesicles or rash in the right ear canal or on the pinna. Neck supple.
Interpretation
The central finding is that the entire right side of the face is weak, including the forehead. The facial nerve controls the muscles of facial expression. The part of the brain that controls the lower face sends signals mainly to the opposite side, while the upper face receives signals from both sides of the brain. A stroke affecting the motor cortex or its pathways therefore tends to weaken the lower face and spare the forehead, whereas damage to the facial nerve itself weakens the whole side of the face, forehead included (Bickley et al., 2021).
Her other findings fit a lesion of the facial nerve as it travels through the temporal bone. Dry eye reflects the nerve's role in tear production, sound sensitivity reflects the branch to a small muscle that dampens sound in the middle ear, and altered taste reflects the branch that carries taste from the front of the tongue. The recent cold and the ear pain before onset are typical of Bell's palsy, an acute facial nerve palsy without an identified cause (Baugh et al., 2013). The absence of vesicles makes shingles of the facial nerve less likely, normal limbs and speech make a stroke less likely, and the lack of a tick exposure and bilateral findings make Lyme disease less likely.
Even so, the nurse cannot rule out stroke. Stroke-recognition tools that include balance and eye symptoms were developed because screening only the face, arm and speech misses some strokes (Aroor et al., 2017), and a patient with sudden facial weakness needs prompt provider evaluation. Her onset time also matters for Bell's palsy: evidence shows that starting a corticosteroid within 72 hours of onset improves the chance of full recovery (Sullivan et al., 2007).
Communication: SBAR Handoff to the Provider
Situation: 44-year-old woman with acute right facial weakness, noticed on waking at 6:30 a.m.; last known normal 10:45 p.m. last night.
Background: No vascular risk factors, no medications. Viral upper respiratory infection one week ago; right ear ache yesterday.
Assessment: Weakness of the entire right face including the forehead, incomplete right eye closure, sound sensitivity on the right and altered taste. No limb weakness or drift, no sensory loss, no ataxia, normal gait and language. No ear vesicles. Glucose 102, blood pressure 132/84. Pattern suggests a peripheral facial nerve palsy, but I have not excluded stroke.
Recommendation: Request immediate provider evaluation to confirm or exclude stroke. If Bell's palsy is confirmed, she is within the window for corticosteroid treatment. Her right eye needs protection now; I have applied lubricating drops per protocol and will monitor for any new neurological signs.
Explaining the Findings and Teaching the Patient
The patient's first fear was stroke, so the nurse addressed it directly but carefully: "The way your whole face is affected, including your forehead, is more typical of a problem with the nerve that moves your face than with the brain. The doctor still needs to examine you to be sure, and that is happening now." After the provider diagnosed Bell's palsy and prescribed a short course of prednisone, the nurse focused teaching on the two things that mattered most.
The first was eye protection. Because her right eye cannot close fully, the surface of the eye can dry out and become scratched. The nurse showed her how to use lubricating drops during the day and ointment at night, and how to tape the eyelid gently closed or wear a moisture shield while sleeping. The second was the medication plan: taking the prednisone with breakfast, finishing the course as prescribed and not stopping early because her face was not yet moving. Using teach-back, she explained both steps in her own words and named the warning signs that would need urgent care: new weakness in an arm or leg, trouble speaking, severe headache or eye pain and redness. The nurse also told her that most people recover fully over weeks to months, which eased her anxiety without promising a specific timeline.
Summary
This focused neurological assessment documented acute weakness of the entire right face, including the forehead, with dry eye, sound sensitivity and altered taste and no other neurological deficits. Those findings point to a peripheral facial nerve lesion consistent with Bell's palsy, but the nurse escalated the case as a possible stroke with a precise onset time, allowing the provider to exclude stroke and begin time-sensitive treatment. Plain-language teaching on eye protection, medication use and warning signs completed the assessment.
References
Aroor, S., Singh, R., & Goldstein, L. B. (2017). BE-FAST (balance, eyes, face, arm, speech, time): Reducing the proportion of strokes missed using the FAST mnemonic. Stroke, 48(2), 479-481. https://doi.org/10.1161/STROKEAHA.116.015169
Baugh, R. F., Basura, G. J., Ishii, L. E., Schwartz, S. R., Drumheller, C. M., Burkholder, R., Deckard, N. A., Dawson, C., Driscoll, C., Gillespie, M. B., Gurgel, R. K., Halperin, J., Khalid, A. N., Kumar, K. A., Micco, A., Munsell, D., Rosenbaum, S., & Vaughan, W. (2013). Clinical practice guideline: Bell's palsy. Otolaryngology-Head and Neck Surgery, 149(3 Suppl.), S1-S27. https://doi.org/10.1177/0194599813505967
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Sullivan, F. M., Swan, I. R. C., Donnan, P. T., Morrison, J. M., Smith, B. H., McKinstry, B., Davenport, R. J., Vale, L. D., Clarkson, J. E., Hammersley, V., Hayavi, S., McAteer, A., Stewart, K., & Daly, F. (2007). Early treatment with prednisolone or acyclovir in Bell's palsy. New England Journal of Medicine, 357(16), 1598-1607. https://doi.org/10.1056/NEJMoa072006
How this NUR 325 Module 4 example is structured
The write-up follows the order a nurse works in an urgent neurological complaint. Subjective data establish the time the symptom was first noticed, because every stroke decision depends on it, and they collect the clues that point toward the facial nerve. Objective data move from a stroke screen to cranial nerves, motor, sensory, coordination and gait, with the facial examination described in detail. The interpretation explains why forehead involvement matters, what other causes were considered and why stroke still cannot be dismissed by the nurse alone. The SBAR handoff and plain-language teaching on eye protection and medication timing complete the assessment.
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NUR 325 Module 4 questions, answered
What does NUR 325 Module 4 usually cover?
Around the middle of the course, sections commonly continue system-focused assessments, which may include neurological, cardiovascular or abdominal systems, often through a digital clinical experience. Students document findings and interpret them, sometimes with a focus on how to communicate results to the patient. Your classroom specifies the system and format.
Why does forehead involvement matter in facial weakness?
The muscles of the upper face receive signals from both sides of the brain, while the lower face receives signals mainly from the opposite side. A stroke usually weakens the lower face and spares the forehead. Weakness that includes the forehead suggests a problem in the facial nerve itself, as in Bell's palsy.
Should a nurse rule out stroke based on the examination?
No. The examination can make one cause much more likely, but any new facial weakness is treated as a possible stroke until a provider evaluates it, especially when onset is recent. The nurse's job is to gather precise findings, including time of onset, and escalate them quickly.