Module 2- Health Assessment of the Nervous System Flashcards Preview

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Flashcards in Module 2- Health Assessment of the Nervous System Deck (141):
1

What are the main components of the nervous system?

- Central Nervous System
- Peripheral Nervous System
> Autonomic Nervous System
* Sympathetic Nervous System
* Parasympathetic Nervous System
> Somatic/Visceral Nervous System

2

What are the four objectives of neurological assessment?

1. Gather data about the functioning of the nervous system
2. Correlate and trend the data over time
3. Analyse the data to develop a list of potential/actual issues/problems in order to establish goals
4. Determine the effect of dysfunction on the patient's activities of daily living

3

List some cues to collect during a neurological assessment and explain why they are relevant

1. Coordination/balance
2. Autonomic responses/reflexes
3. Movement
4. Mental status
5. Sensation

- Damage to/disease of nervous system can lead to changes in function of ^
- A Neuro assessment allows you to determine where the damage has occurred
- The tests you perform indicate how well the nervous system is doing its job in controlling the body

4

What are the two main control systems of the body?

- Nervous
- Endocrine

5

Contrast the nervous system and endocrine system regarding:
> Response time
> Duration of actions/changes
> Mechanisms they use to control the body
> Target area where commands are affected
> Requirements of cells to respond to commands

Response time:
> N: quick (1-10 ms)
> E: slow (seconds to days)

Duration of actions/changes:
> N: Short-term
> E: Long-term

Mechanisms to control the body:
> N: Electrical impulses and neurotransmitters
> E: hormones

Target area where commands are affected:
> N: signals act where delivered
> E: Hormones reach the whole body

Requirements of cells to respond to commands:
> N: Must be connected to respond
> E: Must have receptors to respond

6

List the main components of the CNS and PNS

- Central Nervous System:
> Brain
> Spinal Cord

- Peripheral Nervous System:
> Peripheral nerves
* Cranial nerves- 12 pairs
* Spinal nerves- 31 pairs

7

How many cranial nerves does the human body have?

12 pairs

8

How many spinal nerves does the human body have?

31 pairs

9

List and describe the main functions of the nervous system

1. Sensing our internal and external environment
- Internal environment is monitored by visceral receptors
- External environment is monitored by special receptors and somatic receptors

2. Responding to our internal and external environment
- Skeletal muscle generates consciously controlled responses
- Smooth and cardiac muscle, as well as glands generate unconsciously controlled responses

10

Draw a diagram indicating the stimulus--> response pathway and the divisions of the PNS and CNS

1. Sensory receptors detect internal/external stimuli
> Visceral: monitor internal organs/conditions
> Special: smell, taste, vision, balance, hearing
> Somatic: position, touch, pressure, pain, temperature

2. Sensory division of PNS receives sensory information and transmits this to the CNS (to the brain via the spinal cord)

3. Information processing at the CNS - information is integrated and processed and motor commands are then distributed to the PNS (from the brain to the spinal cord)

4. Motor division of the PNS- receives commands from the CNS and transmits these to effectors
> Somatic (SNS) - controls voluntary movement- via skeletal muscle
> Autonomic (ANS) - controls involuntary movement- via smooth and cardiac muscle, glands, and adipose

5. Effectors- receive and carry out commands to generate a response to the initial stimulus

11

In what direction do sensory neurons carry signals?

Towards the spinal cord and brain (CNS) from the receptors and peripheral nerves (PNS)

12

In what direction do motor neurons carry signals?

Towards the peripheral nerves and effectors (PNS) from the brain and spinal cord (CNS)

13

List and describe the two divisons of the peripheral nervous system

1. Sensory (afferent)
> Somatic sensory: carries general and special sensory signals
> Visceral sensory: carries signals from organs

2. Motor (efferent)
> Somatic motor: carries signals to skeletal muscles
> Autonomic: carries signals to smooth and cardiac muscle, glands and adipose

14

What is another name for the sensory division of the peripheral nervous system?

(Afferent)

15

What is another name for the motor division of the peripheral nervous system?

(Efferent)

16

What are the two classifications of nervous tissue found in the central nervous system?

- Neurons
- Neuroglia (aka. Glial cells) - supporting cells

17

How many neurons are found in the brain and spinal cord

~ 100 billion

18

Draw a diagram of a neuron, identifying its major components, and explain the function of each component

* Dendrites- highly branched with many processes extending off called dendritic spines
--> Information is received mostly at dendritic spines but also at dendrites.

* Cell body- contains the perikaryon (cytoplasm of the neuron) of the neuron.
--> Provides neuron with energy and synthesises neurotransmitters

* Axon- carries information along neuron to the next cell
> Axon hillock- where summation occurs
> Initial segment- where the AP is generated

* Axolemma - cell membrane of the axon

* Axoplasm- cytoplasm of the axon

* Telodendria- extensions which branch off of the end of the axon
--> End in axon/synaptic terminals- where neurons communicate with other cells

19

What is the function of the dendrites of the neuron?

* Dendrites- highly branched with many processes extending off called dendritic spines
--> Information is received mostly at dendritic spines but also at dendrites.

20

What is the function of the cell body of the neuron?

* Cell body- contains the perikaryon (cytoplasm of the neuron) of the neuron.
--> Provides neuron with energy and synthesises neurotransmitters

21

What are the components of the axon and what are their functions?

* Axon- carries information along neuron to the next cell
> Axon hillock- where summation occurs
> Initial segment- where the AP is generated

* Axolemma - cell membrane of the axon

* Axoplasm- cytoplasm of the axon

22

What are the components of the telodendria of the neuron and what are their functions?

* Telodendria- extensions which branch off of the end of the axon
--> End in axon/synaptic terminals- where neurons communicate with other cells

23

Describe how neurons communicate with each other

- Information enters the neuron at the dendrites and travels along the neuron in one direction to the axon terminals.
- Neurons communicate via synapses.
- At the synapse, an electrical impulse travels along the presynaptic cell towards the axon terminals where it triggers the release of vesicles containing neurotransmitters.
- The neurotransmitters are released into the synaptic cleft and crosses to the postsynaptic cell via diffusion.
- At the postsynaptic cell, the neurotransmitters bind to receptors, causing excitatory or inhibitory graded action potentials to be generated.
- These potentials travel to the axon hillock of the neuron, if their sum is large enough to reach the neuron's threshold, an action potential is then generated.

24

What impacts the speed of tranmission of action potentials along neurons?

The presence of myelin

25

Describe myelin

- Myelin sheaths are concentric layers of plasma membrane (lipids) which wrap along axon terminals.
- They are produced by oligodendrocytes in the CNS and Schwann cells in the PNS.
- Myelin sheaths act as fatty insulation, increasing the speed of impulses along axons.

26

What is an example of a degenerative neurological condition which affects myelin?

- MS (multiple sclerosis)
- Myelin degenerates causing slower conducting of stimulus and abnormal changes in neural pathways

27

Describe the arrangement of neurons in the central nervous system

- Neural tissue in the central nervous system can be divided into:
> Grey matter- cell bodies and dendrites (unmyelinated)
> White matter- axons (myelinated)
- White matter on the inside, grey matter on the outside

- Some neurons are fully contained within the CNS.
- Some neurons extend outside the CNS and make up the PNS (cranial and spinal nerves)

28

Account for the colouration of grey and white matter

- The presence of myelin
- Myelin present- white matter
- Myelin absent- grey matter

29

Draw a diagram indicating the major parts of the brain

- Cerebrum
- Corpus callosum
- Diencephalon:
> Thalamus
> Hypothalamus
- Cerebellum
- Brain stem
> Midbrain
> Pons
> Medulla oblongata

30

Describe the cerebrum and list its functions

- Large part of the brain composed of paired cerebral hemispheres connected structurally by the corpus callosum.
- Externally the two hemispheres are connected by the medial longitudinal fissure.
- Covered by the cerebral cortex

Functions:
> higher mental functions
> conscious thought
> memory storage and processing
> sensory processing
> regulating skeletal muscle contractions
> planning and initiating movement

- Origin of CNI - II

31

Describe the cerebral cortex and list its functions

- Covers the cerebrum
- Superficial, thin (1.5 to 4.5 mm), wrinkled layer of grey matter densely packed with unmyelinated neurons.
- Consists of folded bulges (gyri) that create deep fissures (sulci)

Functions:
> Highly folded to increase the surface area.

32

Describe the diencephalon and list its components

- Structural and functional link between the cerebral hemispheres and the rest of the CNS.
- Composed of the thalamus and hypothalamus

33

Describe the thalamus and list its functions

- Processes, integrates and relays sensory information
(relay station for all sensory inputs)

34

Describe the hypothalamus and list its functions

- Inferior to the thalamus
- Superior to the brainstem

Functions:
> Maintains homeostasis
> Regulates biological rhythms - body temperature, hunger, water balance and thirst, sleep-wake cycles
> Controls autonomic nervous system and endocrine system (via pituitary gland)

35

Describe the cerebellum and list its functions

- Posterior to the brainstem
- Accounts for 10% of the brain's volume
- Contains over 50% of the brain's neurons

Functions:
> Centre for coordination, posture, and balance
> Stores learned sequences of movements (muscle memory)
> Refines movements to make them fast and accurate.

36

Describe the brainstem and list its components

- Posterior to the hypothalamus
- Origin of cranial nerves

Contains:
- Midbrain
- Pons
- Medulla Oblongata

37

List the functions of the midbrain

- Coordinates visual and auditory inputs
- Coordinates pupillary light reflex

- Origin of CNIII- CNIV

38

List the functions of the pons

- Contributes to respiration
- Origin of several cranial nerves (CN V- CNVIII)

39

List the functions of the medulla oblongata

- Control centre of vital involuntary reflexes
- Origin of many cranial nerves (CNIX - XII)

40

Where does CN I originate from? What is it called?

cerebrum
olfactory

41

Where does CN III originate from? What is it called?

midbrain
oculomotor

42

Where does CN V originate from? What is it called?

pons
trigeminal

43

Where does CN VII originate from? What is it called?

pons
facial

44

Where does CN IX originate from? What is it called?

medulla oblongata
glossopharangyeal

45

Where does CN XI originate from? What is it called?

medulla oblongata
accessory

46

Where does CN II originate from? What is it called?

cerebrum
optic

47

Where does CN IV originate from? What is it called?

midbrain
trochlear

48

Where does CN VI originate from? What is it called?

pons
abducens

49

Where does CN VIII originate from? What is it called?

pons
vestibulochlear

50

Where does CN X originate from? What is it called?

medulla oblongata
vagus

51

Where does CN XII originate from? What is it called?

medulla oblongata
hypoglossal

52

List the cranial nerves

Cerebrum
1. olfactory nerve (CN I)
2. optic nerve (CN II)

Midbrain
3. oculomotor nerve (CN III)
4. trochlear nerve (CN IV)

Pons
5. trigeminal nerve (CN V)
6. abducens nerve (CN VI)
7. facial nerve (CN VII)
8. vestibulocochlear nerve (CN VIII)

Medulla oblongata
9. glossopharyngeal nerve (CN IX)
10. vagus nerve (CN X)
11. accessory nerve (CN XI)
12. hypoglossal nerve (CN XII)

53

Draw a diagram of the 4 visible regions of the brain

Frontal lobe (x2)
Parietal lobe
Temporal lobe (x2)
Occipital lobe

54

List the functions of the frontal lobe

- Planning and executing movement
- Higher intellectual functions
- Thinking
- Decision-making

- Speech
- Smell

55

List the functions of the parietal lobe

- Processing and integrating somatic sensory information

- Taste

56

List the functions of the temporal lobe

- Hearing
- Understanding language
- Memory

57

List the functions of the occipital lobe

- Vision

58

Where do cranial nerves exit?

- Mostly at brainstem
- Some exit through holes in the skull to innervate muscles of the face

59

How many spinal nerves do you have? How can these be further divided?

31 pairs
- 8 Cervical nerves
- 12 Thoracic nerves
- 5 Lumbar nerves
- 5 sacral nerves
- 1 Coccygeal spinal nerve

Exit each level of the vertebral column in pairs (one to supply each side of the body)

60

How are spinal nerves named?

- C1-C7 nerves - named by the vertebrae below them
- C8 nerve- sits above T1, named C8
- T1-T12- named by the vertebrae above them
- L1 - L5 - named " "
- S1- S5- named " "
- Coccygeal spinal nerve- " "

61

Describe the anatomy of the spinal cord

- Part of CNS
- Connected to the medulla oblongata, ends at Cauda Equina (L1-L2)
- Nerves continue past spinal cord.
- Composed of outer layer of white matter and inner layer of grey matter surrounding a small central canal.
- The amount of grey matter is greatest in segments dedicated to sensory and motor control of limbs
--> Results in cervical and thoracic enlargements

62

Describe cognition

- Mental processes involved in acquiring knowledge and understanding (higher level thinking)
- Performed by Association areas of cerebral cortex (frontal, parietal, temporal)

E.g. behaviour, intelligence, language, personality, thinking, judging, problem solving etc

63

Describe consciousness

- State of being aware and responsive to one's surroundings
- Includes:
> Ability to experience/feel
> Wakefulness
> Sense of selfhood

64

Briefly summarise the difference between cognition and consciousness

- Cognition: mental processes involved in acquiring knowledge and understanding
- Consciousness: state of awareness and responsiveness

65

Describe how cognition can be altered and how you can assess cognitive changes

- Disease or injury
- Changes can be progressive e.g. dementia or acute e.g. delirium

- Assessed using mental status assessment

66

Describe how consciousness can be altered and how you can assess consciousness level

- Alert: awake or easily aroused
- Confused: disorientated, impaired thinking
- Delirious: disoriented, restless, hallucinations, attention deficit
- Lethargic: not fully alert, drifts off when not stimulated
- Obtunded: sleeps most times, difficult to arouse (requires loud noise, vigorous shaking, or pain)
- Stupor: requires persistent noise or pain for arousal; responds to stimuli
- Coma- no response

- Assessed using AVPU or glasgow coma scale

67

Describe how you can test a patient's balance. What part of the brain does this test assess?

- Cerebellum

- Romberg Test
--> Ask patient to stand with feet together and close eyes
--> See if they can keep their balance (be prepared to catch)

- Fail to keep balance= positive = abnormal

68

What other tests can you use to test cerebellar functioning?

Accuracy- Fingers to nose test
- Ask pt to touch your finger then touch their own nose (or close eyes and touch own nose)
- Alternate with each arm
- You should move your finger after both hands have been tested
- Abnormal: misses target

Coordination- Rapid alternating movements
- Ask pt to repeatedly tap anterior and posterior surface of hand against leg or arm
-Abnormal: slow movements and/or inaccurate

69

How many peripheral nerves do you have?

43

70

Describe the basic structure and function of a peripheral nerve

- Nerves: means by which CNS communicates with structures in peripheral
- Nerve is a bundle of axons
> Cell bodies are clustered inside/close to the CNS
> Axons extend into the PNS

- Peripheral nerves consist of:
> Bundles of axons that carry sensory information (toward the CNS) and / or bundles of axons that carry motor information (away from the CNS)

71

List the cranial nerves and identify whether they are sensory, motor, or both

Olfactory- Sensory
Optic - Sensory
Oculomotor- Motor
Trochlear- Motor
Trigeminal - Both
Abducens - Motor
Facial- Both
Vestibulocochlear- Sensory
Glossopharyngeal- Both
Vagus- Both
Accessory- Motor
Hypoglossal- Motor

72

How many sets of each spinal nerve do you have?

8 cervical (C1-C8)
12 thoracic (T1-T12)
5 lumbar (L1-L5)
5 sacral (S1-S6)
1 coccygeal

73

Describe the location and function of cranial nerves

- Attach to the brain directly at the brainstem
- Primarily innervate structures in the head and neck
- Exception: Vagus Nerve (CNX)
- Have motor, sensory, or mixed function

74

Describe the location and function of spinal nerves

- Found in the spinal cord, project from between each vertebrae notch
- Each side consists of a posterior and anterior root:
> Posterior: sensory (afferent)
> Anterior: motor (effert)
- Posterior and anterior roots combine to form mixed spinal nerve right ouside the vertebrae

75

Draw and describe a somatic sensory pathway

- Stimulus travels from receptor to the first-order sensory neuron.
- The first-order sensory neuron transmits the sensory stimulus to the second-order sensory neuron found in the spinal cord.
- The second-order sensory neuron transmits the stimulus up the spinal cord to the thalamus of the brain.
- The thalamus relays the stimulus via the third-order sensory neuron to the specialised region of the primary sensory cortex (on the opposite side of the brain) of the parietal lobe.

- Sensory pathways end at specialised regions of the primary sensory cortex.
- The third-order neuron must stimulate the corresponding specialised region for sensation to be felt.

76

Draw and describe a somatic motor pathway

- Motor command originates in the primary motor cortex of the frontal lobe where the cell body originates.
- The left motor cortex controls muscles on the right side of the body etc).
- The stimulus travels along the upper motor neuron (brain spinal cord) towards the lower motor neuron (extends along peripheral nerves).
- The stimulus ends at the correct muscle group which then contracts, enabling movement.

77

Draw and describe a reflex pathway arc

- Sensory receptor transmits stimulus to spinal cord via first-order sensory neuron
- Interneuron relays stimulus from the posterior root to the anterior root
- Motor command is carried by lower motor neuron to the effector

78

Describe reflexes

- 99% of what we do occurs via reflexes.
- Does not require thinking brain (cerebral cortex)
- Also allows for quick reaction to potentially painful or damaging situations.

79

Describe the aim of reflex assessment and list the four main types

- Assessment aims to determine integrity of spinal nerves
- Four types of reflexes
– Deep Tendon (i.e. Muscle stretch)
– Superficial (e.g. Abdominal, Pupillary)
– Visceral (e.g. Baroreceptor reflex)
– Pathologic (e.g. Babinski reflex)

80

List protective layers of the brain

- Scalp
- Skull
- Meninges

81

Draw a diagram of the meninges

-

82

List the three layers of the meninges and the spaces

- Dura mater
--> Subdural space
- Arachnoid mater
--> Subarachnoid space
- Pia mater

83

Describe the layers of the meninges

1. Dura mater
> Adheres to brain and arachnoid mater
> Provides protection –
* attaches brain to the skull and spinal cord to the vertebral column to prevent jostling
* Provides system for venous drainage.

Subdural space- serous space

2. Arachnoid mater
> Consistency and appearance of spider web – much less substantial than dura mater
> Consists of strands of connective tissue (arachnoid trabeculae) which stretch between arachnoid and pia mater
* Helps suspend brain in place

Subarachnoid space - Filled with CSF

3. Pia mater
> Thin layer that closely follows contours of brain.
> Forms a tight membrane around brain and spinal cord.
* Acts as barrier
* Aids in secretion and containment of CSF.
* Blood vessels are held against pia mater by connective tissue before penetrating brain.
> Helps form choroid plexuses

84

Describe the dura mater

1. Dura mater
> Adheres to brain and arachnoid mater
> Provides protection –
* attaches brain to the skull and spinal cord to the vertebral column to prevent jostling
* Provides system for venous drainage.

Subdural space- serous space

85

Describe the arachnoid mater

2. Arachnoid mater
> Consistency and appearance of spider web – much less substantial than dura mater
> Consists of strands of connective tissue (arachnoid trabeculae) which stretch between arachnoid and pia mater
* Helps suspend brain in place

Subarachnoid space - Filled with CSF

86

Describe the pia mater

3. Pia mater
> Thin layer that closely follows contours of brain.
> Forms a tight membrane around brain and spinal cord.
* Acts as barrier
* Aids in secretion and containment of CSF.
* Blood vessels are held against pia mater by connective tissue before penetrating brain.
> Helps form choroid plexuses

87

Describe the ventricular system of the brain and flow of CSF

- The pia mater is a thin vascular layer which helps form the choroid plexuses.
- These are vascular structures contained within the ventricles which consists of a combination of specialised cells with tight junctions.
- The brain consist of 4 ventricles, which are involved in producing and maintaining the CSF.
- The CSF is sterile fluid which surrounds and bathes exposed surfaces of the CNS
- The CSF circulates from the choroid plexuses through the ventricles and fills the central canal of the spinal cord.
- As the CSF circulates, materials diffuse between the CSF and the interstitial fluid of the CNS across the cells of the choroid plexuses.

88

How much CSF is produced each day / circulated?

> The choroid plexuses produce CSF at a rate of ~ 500 mL/day.
> At any given moment the total volume of CSF is ~ 150 mL
> The entire volume of CSF is replaced every ~ 8 hours.

89

Draw a diagram indicating where the ventricles are located

-

90

How can CSF be safely obstructed?

- Central canal of spinal column using lumbar puncture/ spinal tap below L1/L2
- Needle passes through the dura mater and arachnoid mater before withdrawing fluid from subarachnoid space

91

List two conditions involving the meninges and/or CSF

- Meningitis
- Hydropcephalus

92

Describe meningitis

- Potentially life-threatening infection of meninges (inflammation)
- Signs: headache, lethargy, stiff neck, fever, vomiting
- Diagnosis – examination of CSF for infectious agents and white blood cells
- Bacteria and viruses are most common causative agents
- Two strains:
* Viral- generally mild; resolves in 1-2 weeks
* Bacterial – can rapidly progress to brain involvement and death; requires aggressive antibiotic treatment

93

Describe hydrocephalus

- Hydrocephalus- enlargement of ventricles due to build up of CSF.
- In adults- causes increased inter-cranial pressure and can compromise blood supply.
- In children below 18 months- causes enlargement of cranium due to skull bones not yet fusing.

94

Describe the blood supply to the brain

- Collateral blood supply from multiple vessels.
- The brain has 4 arteries responsible for supplying it with blood.
> L + R Internal Carotids
> L + R Vertebral

95

Why is the brain so incredibly vascularised?

- Neurons have high demand for oxygen and glucose
- Brain accounts for 2% of body's mass yet consumes 20% of glucose

- Reduces likelihood of serious interruption to cerebrum

96

Draw a diagram indicating the:
> Vertebral arteries
> Basilar artery
> Posterior cerebral artery
> Internal carotid arteries
> Middle cerebral artery
> Anterior cerebral artery
. Circle of willis

-

97

What do the anterior middle and posterior cerebral arteries supply?

- Anterior: frontal lobe
- Middle: temporal and parietal
- Posterior- occipital

98

Draw the circle of willis

-

99

Describe the circle of willis

- Consists of a circular network of arteries.
- Reduces the likelihood of serious interruption to cerebral blood flow, as the blood is able to be redirected through the circle.

100

How could you distinguish between a stroke in the circle of willis vs elsewhere?

- Circle of Willis is asymptomatic because blood can be redirected to reach areas of the brain

101

What happens if the brain goes without oxygen for?
10 seconds
1-2 minutes
4 minutes

10 seconds= loss of consciousness
1-2 mins= impaired function
4= irreversible damage/ brain death

102

Describe venous drainage in the brain

- The superficial cerebral brains and small veins of the brainstem empty into network of Dural sinuses.
- The vertebral vein on each side receives blood from the transverse and occipital sinuses as well as superficial veins of the skull.


- Dural sinuses drain into internal jugulars

103

List FAST

Face – middle cerebral arterial
Arms – frontal lobe
Speech – hypoglossal nerve
Time – important because brain needs oxygen and glucose.

104

What is the blood brain barrier?

- Blood vessels in brain have tight junctions
- Allows the entry of essential substances whilst blocking other substances.
- Capillary membrane is selectively permeable and can exclude harmful substances.
- Whilst useful at preventing can also prevent certain beneficial medications from reaching the brain.

105

Describe a neurological examination

- Assessment of sensory and motor responses to determine if the nervous system is impaired
--> Concerned with ascertaining if there is an impairment of the central or peripheral nervous systems

106

List the three main types of neurological assessments

1. Ongoing
2. Screening
3. Complete neurological assessment

107

When would you perform an ongoing neurological observaiton?

- Recent head trauma
- Surgery
- Stroke
- Systemic disease/illness
- Sensory blocks

108

When would you perform a screening neurological assessment?

- Seemingly well people who have had no significant subjective findings as part of a complete examination

109

When would you perform a complete neurological assessment?

- Neurological symptoms detected during health interview

110

Outline the significance of neurological conditions on a person's life

Impairments may arise of:
1. Physical functioning
2. Cognition
3. Behavioural issues
4. Communication
5. Basic ADL
6. Psychosocial aspects of life
7. Economics

111

List some common neurological presentations

1. Dementia
2. Epilepsy
3. Headache disorders (migraines)
4. Stroke
5. Traumatic brain injuries
6. Neuro disorders

112

List some assessments that could be conducted to asses the nervous system

1. Mental status assessment
2. Emergency assessment
3. Focused neurological health history
4. Ongoing neurological observations
5. Screening assessment
6. Comprehensive assessment

113

When conducting a mental status assessment what would you be assessing?

1. Physical appearance and behaviour
- Posture and movements
- Dress, grooming, and personal hygiene
- Facial expression
- Affect
2. Communication
3. LOC (GCS)
4. Cognitive abilities and mentation
- Thought process and content
- Attention
- Spatial perception
- Judgement
- Abstract reasoning
- Memory
- Insight
- Suicidal ideation

114

When conducting an emergency assessment what would you be assessing?

ABCDE

115

When conducting an ongoing neurological observations assessment what would you be assessing?

AVPU
Neuro obs chart
Dermatome assessment

116

When conducting a screening assessment what would you be assessing?

- Inspection of head, face, and neck
- Test cranial nerves
- Inspect and palpate the motor system
- Assess sensory system
- Test reflexes

117

When conducting a comprehensive neurological assessment what would you be assessing?

1. Mental status
2. Cranial nerve exam
3. Motor exam
4. Reflexes
5. Sensory exam
6. Evaluation of coordination and balance

118

When conducting a health history what information would you be gathering?

- Patient profile - age/dob, gender, race
- Chief complaint
- Focused set of questions
- Past health history
- Family health history
- Social health history

119

List some common neurological chief complaints

- Headaches/migraines
- Seizures
- Syncope
- Tremor
- Pain
- Parasthesia
- Changes to: gait, vision, swallowing/speech, memory
- Vertigo

120

What is a dermatome?

- Area of skin- supplied by single nerve

121

Describe the assessment of a dermatome

- Used to assess:
> Spinal cord injury
> Effectiveness of spinal + epidural blocks
(important to ensure pain is covered but anaesthetic isn't so strong that the patient experiences other complications)

- Assessed using ice

122

Define pain

- Unpleasant sensory and emotional experience associated with actual / potential tissue damage

123

Is pain a subjective or objective cue?

Subjective symptom

124

What roles does pain serve?

1. Motivates people to seek help
2. Encourages the adoption of behaviours to enhance healing
3. Acts as a conditioning stimulus to avoid further damage

125

List the three types of pain

1. Nociceptive
2. Neuropathic
3. Psychogenic

126

Describe nocicpetive pain

- Directly caused by stimulation of pain nerve endings (nociceptors) due to somatic or visceral damage

127

Describe neuropathic pain

- Damage to nerves themselves rather than stimulation of nerve receptors

128

Describe psychogenic pain

- Pain disorder associated with psychological factors. Some types of mental/emotional problems can cause, increase, or prolong pain

129

Define actue pain

- Pain that lasts less than 3 months

130

Define allodynia

- Pain due to a stimulus that does not normally provoke pain

131

Define analgesia

- Absence of pain in response to a stimulus that would normallly be painful

132

Define chronic pain

- Pain that lasts more than 3 months

133

Define hyperalgesia

Increased response to a stimulus that is normally painful

134

Referred pain

- Pain perceived as occuring in a region of the body distinct from the region in which the actual source of pain is

135

List variables which affect pain

1. Gender- females have lower pain threshold than men
2. Age- general pain tolerance increases with age
3. Previous experience with pain
4. Cultural expectations - e.g. men are expected to be stoic in terms of pain

136

What effects does pain have on the body

- Emotional and subjective responses
- Can affect every system of the body
- Unrelieved pain degrades health over time

137

Define pain tolerance

- Amt of time / intensity of pain endured before initiation of pain responses

138

Define pain threshold

- Point at which a stimulus is perceived as pain

139

If someone is experiencing pain, what clinical signs would you expect them to exhibit

- Tachycardia
- Tachypnoea
- Increased BP
- Sweating
- Nausea
- Vomiting

140

When assessing pain, what are the 10 characteristics you assess?

- Location- where is the pain?
- Radiation- does the pain spread elsewhere?
- Quality- how does the pain feel? (sharp/dull etc)
- Quantity- how severe is the pain (pain scale)
- Associated manifestations- accompanying signs/symptoms
- Aggravating factors- what makes the pain worse
- Alleviating factors- what makes the pain better
- Setting- where were you and what were you doing when the pain started? How were you (physically, mentally) feeling?
- Timing- when did the pain start? How long does it last (time approx)? How frequently does it occur (ongoing/recurrent / frequency)

141

List pain assessment tools and identify which one would be appropriate for what pt

- Visual analogue scale- 12+
- Wong-Baker Faces Pain rating scale- 3-12
- Oucher pain assessment tool- <3
- abbey pain scale- non-verbal people (e.g. dementia)