Week 5 - Neuro

Question 1

CNS

Answer 1

brain and spinal cord

Question 2

PNS

Answer 2

12 pairs of cranial nerves
31 pairs of spinal nerves

Question 3

cranial nerves

Answer 3

enter and exit the brain rather than spinal cord
(so when we are testing these it is a direct assessment of the brain). most supply the head and neck, except vagus nerve which travel to the:
- heart
- respiratory system
- stomach
- gallbladder

Question 4

spinal nerves

Answer 4

arise from the spinal cord and supply the rest of the body; contain both sensory and motor fibers

Question 5

neurological injuries and symptoms

Answer 5

Partial or complete paralysis.
Muscle weakness.
Partial or complete loss of sensation
Seizures
Difficulty reading and writing
Poor cognitive abilities
Unexplained pain
Decreased alertness
Head injuries (falls)
Headaches
Dizziness/vertigo/fainting
Tremors
Weakness (usually one-sided)/paralysis
Incoordination
Numbness/tingling sensation
Dysphagia
Aphasia (difficulty w/ speaking)
Falling
Confusion
Visual disturbances

Question 6

developmental considerations - older adults

Answer 6

General atrophy & loss of neurons in brain and spinal cord.
Decrease in weight and volume of brain.
Decreased muscle strength and impaired fine coordination.
Decreased muscle bulk.
Slowed reaction time.
Dizziness and loss of balance.
Senile tremors: benign tremors of hands, head nodding, tongue protrusion.
Slowed gait.

Question 7

subjective data - neuro

Answer 7

headache
head injury dizziness or vertigo
- vertigo = sensation of rotation spinning
seizures = involuntary movements with altered consciousness
tremors = involuntary movements
- shaking, vibrating, trembling while conscious
incoordination
numbness or tingling sensation
difficulty swallowing or speaking
significant past history
environmental or occupational hazards
Syncope

Question 8

1. screening neuro exam

Answer 8

health history in otherwise healthy patients

Question 9

2. complete neuro exam

Answer 9

neuro concerns, most detailed and through exam

Question 10

3. neuro re-check

Answer 10

those with deficits and require frequent rechecks p. 738-43

Question 11

critical findings that require immediate attention

Answer 11

-sudden decline in alertness or loss of consciousness
-sudden change in speech or a new onset of speech difficulties
-signs of stroke or TIA
-sudden onset of severe headache
-signs of raise intracranial pressure
-sudden onset weakness, numbness, eye movement problems, double vision
-seizures
-lethargy that persists beyond appropriate times and circumstances
-sudden loss of vision

Question 12

LOC

Answer 12

APVU
Alert, responds to Verbal or Painful stimuli or Unresponsive

Question 13

alert and oriented

Answer 13

person (first, last name, DOB, occupation, names of others)
place (building, city, province, country)
time (date, month, year, day of week, season)

Question 14

impaired LOC terms

Answer 14

Alert – opens eyes spontaneously, appears to be aware of person and surroundings

Lethargic – more than sleepy, may take a few tries to wake them, or require loud verbal stimuli

Obtunded – severe drowsiness, may rouse for brief periods with repeated painful stimuli

Stupor – mostly unresponsive, will only rouse with vigorous repeated painful stimuli and will immediately lapse back into unresponsiveness

Coma – unresponsive, cannot be roused with any stimuli, eyes remain closed

Acute delirium – a fast-developing type of confusion, often caused by an illness or environmental factors that disrupt brain function

Question 15

CN I

Answer 15

olfactory
smell not usually assessed

Question 16

CN II

Answer 16

optic
“how many fingers am I holding up?”
Cover one eye and wiggle your finger peripherally while look straight ahead of you

Question 17

CN III, CN IV, CN VI

Answer 17

oculomotor
trochlear
abducens
III: PERRL, PERRLA, ptosis (eyelid droop)
IV: “can eyes track downward? have pt follow your finger from top to bottom”
VI: “can eyes track side to side? asses cardinal fields of gaze with letter H”

Question 18

CN V

Answer 18

trigeminal:
- motor function
- sensory function
- corneal reflex
“sensation of forehead, cheek and jaw, assess jaw opening strength by having pt attempt to open jaw while you hold it closed”

Question 19

VII

Answer 19

facial
- motor function
- sensory function
“assess facial symmetry, ask pt to show teeth, smile”

Question 20

VIII

Answer 20

acoustic (vestibulocochlear)
“is patient able to hear you?”

Question 21

IX, X

Answer 21

glossopharyngeal
vagus
- motor function
- sensory function
taste usually not assessed
“can pt swallow? does uvula lift symmetrically when pt says, Ahhh?”

Question 22

XI

Answer 22

spinal accessory
“raise your shoulders and turn head side to side with resistance applied”

Question 23

XII

Answer 23

hypoglossal
“stick our tongue”

Question 24

motor function

Answer 24

Gait/balance – cerebellar test as the cerebellum controls balance (ataxia = uncoordinated, unsteady)

Romberg test for loss of balance when standing on one foot with eyes closed (MS, alcoholism)

Finger-to-finger test (cerebellar disorders)
Finger to nose test (cerebellar disorders)
Heel to shin test for lower extremity coordination (cerebellar disorders)

Question 25

voluntary movement

Answer 25

Check facial symmetry - Lift eyebrows, frown, bare teeth (presence of facial droop)
Test hand grips “Squeeze my fingers”, lift hands/finger
Test for pronator (palmer) drift
Test straight leg raise strength to 90 degrees
Test dorsiflexion “Lift your toes to your nose”, and plantarflexion “Push on the gas”

Question 26

facial droop

Answer 26

Check facial symmetry - Lift eyebrows, frown, bare teeth (presence of facial droop)
FAST
risk for a stroke:
CAD, cardiac failure, PAD, hypertension, smoker, diabetes, irregular cardiac rhythms, diet and nutrition, obesity, physical inactivity, history of TIA

Question 27

pronator drift

Answer 27

Ask patient to close eyes, hold both arms out, at shoulder height with palms extended and supinated
Watch for downward drift and pronation of a weak limb
Suggests mild hemiparesis and lesion on opposite side
“don’t let me push your arm down”

Question 28

bilateral strength

Answer 28

grip strength
follows commands (LOC)

Question 29

grading muscle strength

Answer 29

0 = no muscle contraction is seen
1 trace = flicker or trace of contraction is seen
2 poor = active movement only with gravity eliminated
3 fair = active movement against gravity but not resistance
4 good = active movement against gravity with some resistance
5 normal = active movement against gravity with full resistance

Question 30

sensory assessment

Answer 30

Pain
Temperature
Touch
Vibration
Kinanesthesia
Tactile discrimination
Stereognosis - shape identification
Graphesthesia - tracing numbers/letters
Two point discrimination

Question 31

basic neuro check in acute care

Answer 31

every 4 hours
- LOC
- motor function
- pupillary response
- vital signs

Question 32

Glasgow Coma Scale

Answer 32

evaluating LOC, assess 3 aspects
1. eye opening - PERRL
2. verbal response
3. motor response

Score 3-15
13-15 = mild impairment
9-12 = moderate impairment
3-8 = severe impairment or coma

Question 33

eyes and GCS

Answer 33

4 eyes are open spontaneously
3 eyes open when you call your patients name or say hello
2 eyes open when painful stimuli is given
1 eyes don’t open at all to verbal or painful stimuli

Question 34

verbal response

Answer 34

5 oriented x3
4 confused
3 inappropriate speech
2 incomprehensible sounds
1 no response

Question 35

motor response

Answer 35

6 patient does as requested
5 patient has a localized response to painful stimuli
4 patient has a withdrawal, or flexion response to painful stimuli
3 patient has an abnormal flexion response to painful stimuli
2 patient has an abnormal extension response to painful stimuli
1 no response

Question 36

seizures

Answer 36

focal onset
generalized onset
unknown onset

Tonic - muscle stiffing
Myocronic - full body jerking

Question 37

aphasia types

Answer 37

expressive (Broca’s) aphasia
- ability to form language and express thoughts is impaired: patent may become frustrated as they’re aware of deficit
receptive (Wernicke’s) aphasia
- ability to comprehend written or verbal language is impaired, speech is clear but words so not express clear sentence.
global aphasia
- all language functions are impaired

Question 38

Objective data - neuro

Answer 38

Mental health/status
LOC
Cranial nerves
Motor system
Sensory system
Reflexes
GCS
Vital signs
Dysphasia
Aphasia