Neuro Assessment.

Question 1

initial changes

Answer 1

will be subtle

Question 2

brain is the most metabolically active organ

Answer 2

consumes 20% oxygen and 25% glucose; if it doesn’t get this, there will be changes

Question 3

patient history

Answer 3

sudden? progressive?

trauma, meds, bleeding; metabolic, recent fall - subdural hematoma

Question 4

level of consciousness

Answer 4

single most important sign of neuro dysfunction

Question 5

full consciousness

Answer 5

aao x3, comprehend, express ideas

Question 6

confusion

Answer 6

disoriented to either time, place, or person

worse at night, brain fatigue, sundowning

Question 7

lethargy

Answer 7

oriented x3, slow and sluggish

Question 8

obtundation

Answer 8

readily a rousable with stimulation, respond verbally, follow command, very drowsy

Question 9

stupor

Answer 9

appropriate response to pain; lie quietly with minimum spontaneous movement; unresponsive except to vigorous/repeated stimuli; incomprehensible sounds or eye opening

Question 10

coma

Answer 10

sleep-like state; do not resound appropriately, no verbal sounds.

Question 11

light coma

Answer 11

unarousable, no spontaneous movement; withdraw purposefully to painful stimuli; may have brain stem reflexes

Question 12

coma coma

Answer 12

unarousable, withdraw non purposefully to painful stimuli; bran stem reflexes may or may not be intact; posturing

Question 13

deep coma

Answer 13

unarousable, no pain response, no brain stem reflex, decerebrate

Question 14

persistent vegetative state

Answer 14

chronic

eyes open, permanent stage of unconsciousness; have sleep cycle but no sense of anything

Question 15

locked-in syndrome

Answer 15

paralysis of voluntary muscles, despite full consciousness - MG

Question 16

brain death

Answer 16

state of irreversible loss of both cortical and brain stem activity

Question 17

glasgow coma scale

Answer 17

eye opening: 4 spontaneous, 3 to verbal command, 2 to pain, 1 none
verbal response: 5 oriented, 4 disoriented, 3 inappropriate word, 2 incomprehensible sound, 1 none
motor response: 6 obeys verbal, 5 localizes pain, 4 withdraws from pain - decorticate, 3 flexion - decerebrate, 2 - extension, 1 none

Question 18

cranial nerves

Answer 18

olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal

Question 19

olfactory

Answer 19

smell

Question 20

optic

Answer 20

vision

Question 21

oculomotor

Answer 21

eye movement, pupils, lens shape

Question 22

trochlear

Answer 22

eye movement

Question 23

trigeminal

Answer 23

corneal reflex, sensory - face

Question 24

abducens

Answer 24

eye movement

Question 25

facial

Answer 25

motor - face, salivation, tears

Question 26

acoustic

Answer 26

hearing

Question 27

glossopharyngeal

Answer 27

gag/swallow

Question 28

vagus

Answer 28

talk, swallow

Question 29

accessory

Answer 29

head/shoulder movement

Question 30

hypoglossal

Answer 30

tongue, speech, swallow

Question 31

pupils can..

Answer 31

help localize the problem

Question 32

normal pupil

Answer 32

3.5mm, can range from 1.5-8mm

Question 33

anisocaria

Answer 33

pupil asymmetry >1mm; forewarning that it will dilate

Question 34

oval pupil

Answer 34

CN 3 compressoin

Question 35

key hole pupil

Answer 35

irredectomy, trauma

Question 36

oculocephalic reflex - doll's eyes

Answer 36

normal - eyes turn together to opposite side from turn of head abnormal - eyes don't turn in conjugate manner absent - don't turn

Question 37

oculovestibular reflex - caloric ice water

Answer 37

20-50cc in ear normal - eyes toward irrigated ear abnormal - dysconjugate or asymmetric eye movements absent - no response - no brain stem function

Question 38

motor function assessment

Answer 38

muscle size, tone, strength; involuntary movement? compare side to side commands - simple and direct, reduce distractions, no visual or tactile stimuli, no reflex activity

Question 39

noxious stimuli

Answer 39

acceptable: nail bed pressure, trapezius pinch, pinch arm/leg unacceptable: sternal rub - skin breakdown, supraorbital pressure - facial trauma, nipple/testicular pinch

Question 40

if one side is different than other..

Answer 40

SUDDEN LATERALIZATION IS AN EMERGENCY

Question 41

decorticate

Answer 41

flexion of arms, wrist, and fingers with adduction in upper extremities; extension, internal rotation, and plantar flexion in lower extremities

Question 42

decerebrate

Answer 42

all four extremities in rigid extension, with hyper-pronation of forearms and plantar extension of feet

Question 43

vital signs are..

Answer 43

the last thing to change | body will maintain them in order to perfuse brain

Question 44

cushings reflex (response)

Answer 44

increased systolic BP causes widened PP and bradycardia | worry about increased ICP

Question 45

cushings triad

Answer 45

hypertension with increased PP, bradycardiea, abn resp pattern - won't do good on a vent indicates impending brainstem herniation through the foramen magnum and death

Question 46

increased temp

Answer 46

due to infection, sepsis

Question 47

decreased temp

Answer 47

r/t therapeutic interventions or really severe brain damage