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NSG 316 TOPIC 1-5 > TOPIC 5-6 > Flashcards

TOPIC 5-6 Flashcards

1
Q

CN 1- olfactory test

A

o With person’s eyes closed, occlude one nostril and present familiar aromatic substance
-e.g., coffee, orange, vanilla, soap, or peppermint

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2
Q

CN II- optic test

A

o Test visual acuity (eye exam chart) and visual fields by confrontation (peripheral vision)

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3
Q

CN III, IV, and VI- oculomotor, trochlear, and abducens nerves

A

eye lid blink
pupils (size, regularity, equality, direct and consensual light reaction, and accommodation)
eye up, down, side to side movement, cross eyed

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4
Q

nystagmus

A

involuntary rapid eye movements - back-and-forth oscillation of eyes

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5
Q

pendular movement

A

oscillations move equally left to right

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6
Q

jerk movement

A

a quick phase in one direction, then a slow phase in other

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7
Q

assessment of nystagmus: amplitude

A

degree of movement: fine, medium, or coarse

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8
Q

assessment of nystagmus: frequency

A

constant, or fades after a few beats

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9
Q

assessment of nystagmus: plane of movement

A

horizontal, vertical, rotary, or combination

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10
Q

CN V- Trigeminal

A

-palpating temporal and masseter muscles as person clenches teeth
-with person’s eyes closed, test light touch sensation by touching a cotton wisp to designated areas on person’s face: forehead, cheeks, and chin

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11
Q

corneal reflex

A

blinking in response to corneal stimulation by a cotton wisp, Þ Tests sensory afferent in cranial nerve V and motor efferent in cranial nerve VII (muscles that close eye)

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12
Q

CN VII- facial test

A

-request to smile, frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth
-puff cheeks, then press puffed cheeks in, to see that air escapes equally from both sides
(taste on anterior 2/3 is not routinely tested)

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13
Q

CN VIII- Vestibulocochlear test

A

o Test hearing acuity by ability to hear normal conversation and by whispered voice test

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14
Q

CN IX and X- glossopharyngeal and vagus test

A

-Depress tongue with tongue blade, and note pharyngeal movement as person says “ahhh” or yawns;
-Gag reflex-Touching posterior pharyngeal will induce; voice should sound smooth, not strained

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15
Q

CN XI- accessory test

A

o Ask person to shrug shoulders against resistance

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16
Q

CN XII- hypoglossal test

A

o Inspect tongue; no wasting or tremors should be present
o Note forward thrust in midline as person protrudes tongue
o Ask person to say “light, tight, dynamite,” and note that lingual speech (sounds of letters l, t, d, n) is clear and distinct

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17
Q

anosmia

A

decrease or loss of smell bilaterally

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18
Q

hemianopia

A

Visual defect that affects half of visual field

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19
Q

what are the developmental changes in the neuro system of the agin adult

A

Atrophy with steady loss of neuron structure in brain and spinal cord
o loss of weight /volume with thinning of cerebral cortex,
o reduced subcortical brain structures, and
o expansion of the ventricles

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20
Q

Decreased Velocity of nerve conduction in older adults leads to

A

reaction time slower

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21
Q

Delay at synapse in older adult leads to

A

diminished sensation of touch, pain, taste, and smell

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22
Q

Motor system is older adults

A

general slowing down of movement; muscle strength and agility decrease

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23
Q

Progressive decrease in cerebral blood flow and oxygen consumption in older adults

A

may cause dizziness and loss of balance (increasing fall risk)

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24
Q

if an older adult has any problems with diziness what are they more at risk for

A

orthostatic hypotension

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25
Q

micturition syncope

A

feeling like fainting while urinating at night

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26
Q

Screening neurologic examination is used for

A

o well persons with no significant findings from history

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27
Q

Complete neurologic examination is used for

A

o persons with neurologic concerns, e.g., headache, weakness, loss of coordination
o shown signs of neurologic dysfunction

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28
Q

Neurologic recheck examination is used for

A

persons with demonstrated neurologic deficits who require periodic assessments

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29
Q

what is the sequence for a complete neurologic exam

A

-Mental status
-Cranial nerves
-Motor system
-Sensory system
-Reflexes

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30
Q

nero assessment equiptment

A

Penlight, Tongue blade, Cotton swab, Cotton ball, Tuning fork: 128 Hz or 256 Hz, Percussion hammer

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31
Q

what do you assess for in the muscles?

A

size
strength
tone
involuntary movement

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32
Q

balance test

A

-Gait: observe as person walks 10 to 20 feet, turns, and returns to starting point;
o walk straight line in heel-to-toe fashion;
o Also, walk on toes, then on heels for a few steps

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33
Q

Romberg test

A

o stand up with feet together and arms at sides; when in stable position, ask person to close eyes and to hold position for about 20 seconds
o shallow knee bend or hop in place, first on one leg, then other

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34
Q

Rapid Alternating Movements (RAM)

A

ask the person to pat the knees with both hands, life tup, turn hands over, and pat knees with the backs of the hands, then faster, usually with equal turning and quick rhythmic pace

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35
Q

Finger-to-finger test

A

with eyes open, ask person to use index finger to touch your finger, then their own nose; then move your finger to continue test

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36
Q

Finger-to-nose test

A

with eyes closed and stretch out arms and touch tip of their nose with each index finger, alternating hands and increasing speed

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37
Q

Heel-to-shin test

A

ask person in supine position to place heel on opposite knee and run it down shin to ankle

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38
Q

faccidity

A

Decreased muscle tone or hypotonia;muscle feels limp, soft, and flabby; muscle is weak and easily fatigued

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39
Q

Spasiticity

A

Increased tone or hypertonia;increased resistance to passive lengthening

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40
Q

Rigidity

A

Constant state of resistance; resists passive movement in any direction; dystonia

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41
Q

Cogwheel rigidity

A

Type of rigidity in which the increased tone is released by degrees during passive range of motion so it feels like small, regular jerks

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42
Q

Paralysis

A

Decreased or loss of motor power caused by problem with motor nerve or muscle fibers

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43
Q

hemiplegia

A

spastic or flaccid paralysis of one side (right or left) of body and extremities

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44
Q

paraplegia

A

symmetric paralysis of both lower extremities

45
Q

quadriplegia

A

paralysis in all four extremities

46
Q

Paresis

A

weakness of muscles rather than paralysis

47
Q

Tic

A

Involuntary, compulsive, repetitive twitching of a muscle group

48
Q

Myoclonus

A

Rapid, sudden jerk or a short series of jerks at fairly regular intervals.
ex: A hiccup is a myoclonus of diaphragm. Single myoclonic arm or leg jerk is normal when the person is falling asleep

49
Q

Fasciculation

A

Rapid, continuous twitching of resting muscle or part of muscle without movement of limb, which can be seen by clinicians or felt by patients

50
Q

chorea

A

Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face. Occurs at irregular intervals, not rhythmic or repetitive, more convulsive than a tic. Some are spontaneous, and some are initiated; all are accentuated by voluntary acts. Disappears with sleep.

51
Q

Athetosis

A

Slow, twisting, writhing, continuous movement, resembling a snake or worm. Involves the distal more than the proximal part of the limb.

52
Q

tremor

A

Involuntary contraction of opposing muscle groups. Results in rhythmic, back-and-forth movement of one or more joints. May occur at rest or with voluntary movement. All tremors disappear while sleeping.

53
Q

rest tremor

A

It occurs when muscles are quiet and supported against gravity (hand in lap); partly or completely disappears with voluntary movement (e.g., “pill rolling” )

54
Q

intention tremor

A

Rate varies; worse with voluntary movement as in reaching toward a visually guided target.

55
Q

seizure disorder

A

a time-limited event caused by excessive, hypersynchronous discharge of neurons in the brain

56
Q

spastic hemiparesis

A

Arm is immobile against the body, with flexion of the shoulder, elbow, wrist, and fingers and adduction of shoulder; does not swing freely. Leg is stiff and extended and circumducts with each step (drags toe in a semicircle).

57
Q

cerebellar ataxia

A

staggering, wide-based gait; difficulty with turns; uncoordinated movement with positive Romberg sign

58
Q

parkinsonian (festinating)

A

Posture is stooped; trunk is pitched forward; elbows, hips, and knees are flexed. Steps are short and shuffling. Hesitation to begin walking, and difficult to stop suddenly. The person holds the body rigid. Walks and turns body as one fixed unit. Difficulty with any change in direction.

59
Q

scissors

A

Knees cross or are in contact, like holding an orange between the thighs. The person uses short steps, and walking requires effort.

60
Q

steppage or footdrop

A

slapping quality-looks as if walking up stairs and finds no stair there. lifts knee and foot high and slaps it down hard and flat to compensate for footdrop.

61
Q

waddling

A

weak hip muscles- when the person takes a step, the opposite hip drops, which allows compensatory lateral movement of pelvis. often the person also has marked lumbar lordosis and a protruding abdomen

62
Q

short leg

A

Leg length discrepancy >2.5 cm (1 inch). Vertical telescoping of affected side, which dips as person walks. Appearance of gait varies, depending on amount of accompanying muscle dysfunction.

63
Q

cerebral palsy

A

paralysis due to damage to cerebral cortex from a developmental defect

64
Q

muscular dystrophy

A

Chronic, progressive wasting of skeletal musculature, which produces weakness, contractures, and in severe cases respiratory dysfunction and death.

65
Q

parkinsonism

A

Loss of dopamine-producing neurons in the substantia nigra and through the basal ganglia, causing motor tract disorder. Cardinal symptoms are resting tremor, bradykinesia, cogwheel rigidity, loss of balance; also anxiety, depression, and urinary incontinence. Cognitive impairment is widespread, including loss of executive function, visual-spatial impairment, and memory loss.7Body tends to stay immobile; facial expression is flat, staring, expressionless; excessive salivation occurs; eye blinking is reduced. Posture is stooped; equilibrium is impaired; balance is easily lost;

66
Q

cerebellar

A

lesion in one hemisphere produces motor abnormalities on the ipsilateral side. Characterized by ataxia, lurching forward of affected side while walking; rapid alternating movements are slow and arrhythmic

67
Q

multiple sclerosis

A

Chronic, progressive, immune-mediated disease in which axons experience inflammation, demyelination, degeneration and, finally, sclerosis. Structures most frequently involved are the optic nerve, oculomotor nerve, corticospinal tract, posterior column tract, and cerebellum. Thus symptoms include nystagmus, diplopia, extreme fatigue, weakness, spasticity, loss of balance, hyperreflexia, Babinski sign (upgoing toes). MS affects young adults in their productive years, with onset between 20 and 40 years

68
Q

decorticate rigidity upper extremities

A

-Flexion of arm, wrist, and fingers
-Adduction of arm: tight against thorax

69
Q

decorticate rigidity lower extremities

A

-Extension, internal rotation, plantar flexion; indicates hemispheric lesion of cerebral cortex

70
Q

Decerebrate rigidity upper extremities

A

stiffly extended, adducted, internal rotation, palms pronated

71
Q

Decerebrate rigidity lower extremities

A

stiffly extended, plantar flexion; teeth clenched; hyperextended back

72
Q

flaccid quadriplegia

A

complete loss of muscle tone and paralysis of all four extremities, indicating completely nonfunctional brainstem

73
Q

Opisthotonos

A

prolonged arching of back, with head and heels bent backward, and meningeal irritation

74
Q

what are the routine screening procedures for the sensory system

A

o testing superficial pain, light touch, and vibration in few distal locations, and testing stereognosis

75
Q

pain is tested by

A

person’s ability to perceive a pinprick.

76
Q

temperature is tested

A

only when pain sensation is abnormal; otherwise, you may omit it because the fiber tracts are much the same.

77
Q

light touch is tested by

A

apply wisp of cotton to skin in random order of sites and at irregular intervals; include arms, forearms, hands, chest, thighs, and legs; ask person to say “now” or “yes” when touch is felt

78
Q

vibration is tested by

A

tuning fork over bony prominences

79
Q

position (kinesthesia)

A

test person’s ability to perceive passive movements of extremities

80
Q

Tactile discrimination (fine touch):

A

tests also measure discrimination ability of sensory cortex

81
Q

Stereognosis:

A

test person’s ability to recognize objects by feeling their forms, sizes, and weights

82
Q

Graphesthesia:

A

ability to “read” a number by having it traced on skin

83
Q

Two-point discrimination:

A

test ability to distinguish separation of two simultaneous pin points on skin

84
Q

Extinction:

A

simultaneously touch both sides of body at same point; normally both sensations are felt

85
Q

Point location

A

touch skin and withdraw stimulus promptly; ask person to put finger where you touched

86
Q

Peripheral neuropathy (abnormal)

A

Loss of sensation involves all modalities; loss most severe distally at feet and hands

87
Q

Individual nerves or roots (abnormal)

A

o Decrease or loss of all sensory modalities; corresponds to distribution of involved nerve

88
Q

Spinal cord hemisection (Brown-Séquard syndrome) (abnormal)

A

o Loss of pain and temperature, contralateral side, loss of vibration and position discrimination on ipsilateral side

89
Q

Complete transection of spinal cord (abnormal)

A

o Complete loss of all sensory modalities below level of lesion; associated with motor paralysis and loss of sphincter control

90
Q

thalamus (abnormal)

A

o Loss of all sensory modalities on face, arm, and leg; contralateral to lesion

91
Q

cortex (abnormal)

A

o Loss of discrimination on contralateral side; loss of graphesthesia, stereognosis, recognition of shapes and weights, finger finding

92
Q

deep tendon reflexes (DTR)

A

muscle contraction; Measurement of stretch reflexes reveals intactness of reflex arc at specific spinal levels and normal override on reflex of higher cortical levels

93
Q

Reflex response graded on 4-point scale

A

4 = very brisk, hyperactive with clonus, indicative of disease
3 = brisker than average, may indicate disease
2 = Average, normal
1 = diminished, low normal, or occurs with reinforcement
0 = no response

94
Q

Biceps reflex, C5 to C6

A

Support the person’s forearm on yours; place your thumb on biceps tendon and strike a blow on your thumb
-Normal response is contraction of biceps muscle and flexion of forearm

95
Q

Triceps reflex, C7 to C8

A

o Tell person to let arm “just go dead” as you strike triceps tendon directly just above the elbow
-Normal response is extension of forearm

96
Q

Brachioradialis reflex, C5 to C6

A

o Hold person’s thumbs to suspend forearms in relaxation and strike forearm directly, about 2 to 3 cm above radial styloid process
-Normal response is flexion and supination of forearm

97
Q

Quadriceps reflex, L2 to L4 (“knee jerk”)

A

o Let lower legs dangle freely to flex knee and stretch tendons; strike tendon directly just below patella
-Normal response is extension of lower leg

98
Q

Achilles reflex, L5 to S2 (“ankle jerk”)

A

o Position person with knee flexed; hold foot in dorsiflexion and strike Achilles tendon directly
-Normal response is foot plantar flexes against your hand

99
Q

Þ Abdominal reflexes: upper: T8 to T10; lower: T10 to T12

A

o Person in supine position, knees slightly bent; use handle end of reflex hammer to stroke skin
o Move from each corner toward midline at both upper and lower abdominal levels
o Normal response is ipsilateral contraction of abdominal muscle with observed deviation of umbilicus toward stroke

100
Q

Cremasteric reflex, L1 to L2 (not routinely done)

A

o On male, lightly stroke inner aspect of thigh with reflex hammer or tongue blade
-Note elevation of ipsilateral testicle

101
Q

Plantar reflex, L4 to S2

A

o Position thigh with slight external rotation
o With reflex hammer, draw a light stroke up lateral side of sole of foot and inward across ball of foot, like an upside-down “J”
-Normal response is plantar flexion of toes and inversion and flexion of forefoot

102
Q

use the ____ examin ation fro older adults as younger adults

A

same

103
Q

senile tremors

A

benign and include head nodding and tongue protrusion

104
Q

dyskinesias

A

repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present

105
Q

gait in a an older adult

A

may be slower and more deliberate than in younger person; may deviate from midline path

106
Q

in older adults, senstion of vibration, tactile sensation, light touch, and DTR

A

tend to lose sensation, may need stonger stimuli

107
Q

clonus

A

test when reflexes hyperactive

108
Q

clonus test

A

o Support lower leg in one hand and with other hand, move foot up and down to relax muscle; then stretch muscle by briskly dorsiflexing foot; hold the stretch
-Normal response: you feel no further movement
-When clonus present, you will note rapid rhythmic contractions of calf muscle and movement of foot

NSG 316 TOPIC 1-5 (13 decks)

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