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From Flashcardlet > Neuro Assessment Part 2 > Flashcards

Neuro Assessment Part 2 Flashcards

1
Q

What is key to assess because it may be the only neurological sign that can be assessed?

A

pupils

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2
Q

What are the 3 things we assess for with pupils?

A

size, shape, and reactivity

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3
Q

What part of pupil assessment is somewhat subjective and has to do with ambient lighting in the room?

A

size

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4
Q

What is the pupil size range?

A

1.5-8mm

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5
Q

What is average pupil size?

A

3.5mm

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6
Q

What do you ALWAYS have to consider with pupil size?

A

lighting

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7
Q

What is anisorcoria?

A

pupil asymmetry

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8
Q

What percentage a people naturally have size differences in their pupil?

A

10-15%

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9
Q

Do we worry if the size difference in the pupils is less than 1 mm?

A

no

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10
Q

What size difference in pupils us an early sign that the pupil is progressively dilating?

A

more than 1 mm

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11
Q

What shape pupil indicates early CN 3 compression?

A

oval

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12
Q

If you can get intracranial pressure down, what happens to oval pupils?

A

they return to normal

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13
Q

If we don’t treat an oval pupil, what happens?

A

they dilate and become unresponsive

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14
Q

How much intracranial pressure do oval pupils indicate?

A

18-35mmHg

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15
Q

What are irregular pupils normally due to?

A

trauma of some sort

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16
Q

What may result in “keyhole” pupils?

A

cataract surgery

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17
Q

Are “keyhole” pupils reactive to light?

A

yes, but may be harder to detect

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18
Q

How should pupils respond?

A

briskly, especially in the young

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19
Q

What color eyes react most briskly?

A

blue eyes

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20
Q

When does reactivity of pupils get slower?

A

after age 60

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21
Q

Is sluggish response normal?

A

no, always abnormal

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22
Q

What can abnormal pupils tell us?

A

Where the problem is located in the brain

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23
Q

What test is an examination of the function of the eye muscles?

A

Extra Ocular Movement

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24
Q

How is Extra Ocular movement test done?

A

A doctor observes the movement of the eyes in six specific directions and watches for nystagmus

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25
Q

What does extra ocular movement test evaluate?

A

any weakness or other problem in the extraocular muscles

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26
Q

What may weakness or problems in extra ocular movement result in?

A

double vision or rapid, uncontrolled eye movements (nystagmus)

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27
Q

What test is also called doll’s eye reflex?

A

Oculocephalic Reflex Response

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28
Q

Who can Oculocephalic Reflex Response be tested on?

A

a. Can only be done on an unconscious patient and NOT ON ANY ONE who might have a cervical spinal cord injury

29
Q

What is a normal oculocephalic reflex?

A

When the head is rotated, the eyes turn together to the side opposite the head movement

30
Q

What does an absent oculocephalic reflex mean in a person with a brain injury?

A

very poor prognosis

31
Q

What do physicians use the oculocephalic reflex to assess for?

A

brain death

32
Q

What does an absent oculocephalic response look like?

A

when the head is rotated, the eyes do not turn in a conjugate manner or eyes do not move in socket

33
Q

When testing oculocephalic reflex and the head is rotated, the eyes do not turn in a conjugate manner, what is this a sign of?

A

brainstem injury

34
Q

When testing oculocephalic reflex and as the head position is changed, eyes do not move in the sockets, what is this a sign of?

A

brain death

35
Q

What test is done when you inject 20-50 cc of cold saline into auditory canal, provided there is no obstruction and the tympanic membrane is intact?

A

Oculovestibular Reflex Response (ice water test)

36
Q

What is performed by a physician as one of their final brain stem tests?

A

Oculovestibular Reflex Response (ice water test)

37
Q

What is a normal Oculovestibular Reflex Response?

A

ice water produces eye movements toward irrigated ear

38
Q

What is an abnormal Oculovestibular Reflex Response?

A

infusion produces no eye movements

39
Q

With the Oculovestibular Reflex Response, what do dysconjugate or asymmetrical eye movements indicate?

A

brain stem lesion

little or no brain stem function

40
Q

What do you look at for general motor function assessment?

A

Muscle size, tone, strength
Presence or absence of any involuntary movement
Side vs Side
Need to know what is normal for that person

41
Q

Next to orientation and awareness, what is one of the highest levels of functioning that we can evaluate?

A

the ability to follow commands

42
Q

How should we give commands?

A 
Simple and direct statements
Do not coach them
Reduce surrounding distractions
No visual or tactile stimuli
No reflex activity
43
Q

If a person seems unable to follow commands, what must you do to determine motor response?

A

noxious stimuli

44
Q

What are acceptable noxious stimuli?

A

nail bed pressure
trapezius pinch
pinching (arm/leg)

45
Q

What are unacceptable noxious stimuli?

A

sternal rub (unless only once or twice)
supraorbital pressure
nipple/testicular pinch

46
Q

If sternal rub is done repeatedly, what may this cause?

A

necrosis and damage to the tissue

47
Q

What is an involuntary, reflex activity?

A

posturing

48
Q

What is flexion of arms, wrist, and fingers with adduction in upper extremities, extension, internal rotation, and plantar flexion in lower extremities, bring arms into the core?

A

decorticate posturing

49
Q

What posturing is all four extremities in rigid extension, with hyperpronation of forearms and plantar extension of feet, posturing out?

A

decerebrate response

50
Q

Is decerebrate or decorticate worse?

A

decerebrate

51
Q

Can you have decerebrate on one side and decorticate on another?

A

yes

52
Q

What is the last thing to change with brain injury/neuro patients?

A

vital signs

53
Q

What is Cushing’s Reflex (Response)

A

Increased systolic blood pressure
Widened pulse pressure
Bradycardia

54
Q

If someone develops Cushings reflex, what do you need to be concerned they may have?

A

increased intracranial pressure

55
Q

What is a hypothalmic response to ischaemia, usually due to poor perfusion (delivery of blood) in the brain?

A

Cushings reflex

56
Q

What is normally seen in the terminal stages of acute head injury?

A

Cushing reflex

57
Q

What are the parts of Cushing’s Triad?

A

Hypertension (with increased pulse pressure)
Bradycardia
Abnormal respiratory pattern

58
Q

Why may it be harder to determine Cushing’s Triad?

A

many patients are on ventilators so you will not see abnormal respirations

59
Q

What is many times a sign of brain herniation?

A

Cushing’s Triad

60
Q

What treatment will those with Cushing’s Triad need?

A

require urgent life-saving surgery which may include drilling a burr hole into the head to release intracranial pressure

61
Q

What are later vital sign changes with Cushing’s Triad?

A

hypotension and rapid, thready pulse

62
Q

What can abnormal respiratory patterns tells us?

A

where brain injury has occured

63
Q

What labs should we look at when assessing deteriorating neuro function, especially since hypoxemia and hypercapnea can increase ICP?

A

blood gases

64
Q

With neuro patients, what happens to their body temperature?

A

wide fluctuations

65
Q

What are the wide fluctuations of temperature driven by?

A

the immune response to an organism or by damage to the regulating center in the hypothalamus

66
Q

What temperature is most common with neuro patients?

A

hyperthermia - use cooling blankets

67
Q

What do we need to determine if neuro patient is hyperthermic?

A

if they’re febrile due to infection of brain damage

68
Q

What is hypothermia normally due to in neuro patients?

A

overcooling by us or very, very severe brain injury

From Flashcardlet (107 decks)

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