WEEK 9- NEUROLOGICAL Flashcards
Conduct an independent review of neurological system anatomy & physiology including central, peripheral nervous systems
Central nervous system
- brain, spinal cord
Peripheral nervous system
- 12 CN’s, 31 spinal nerves
afferent towards brain
efferent from brain
When you ask your 68-year-old patient to stand with feet together and arms at his side with his eyes closed, he starts to sway and moves his feet further apart. You would document this as a(n):
POSITIVE ROMBERG SIGN
A 21-year-old female has a head injury secondary to trauma and is unconscious. There are no other injuries. In your assessment what would you expect to find when you test her deep tendon reflexes?
Reflexes will be normal
You are doing an assessment on a 29-year-old woman here for “always dropping things and falling down.” While testing rapid alternating movements you notice she is unable to pat both her knees. Her response is very slow and she misses frequently. What might you suspect?
Dysfunction of the cerebellum
While you take the history of a 68-year-old patient who sustained a head injury 3 days earlier, he tells you he is on a cruise ship and is 30 years old. What would this be indicative of?
decreased level of consciousness
The client’s partner tells the nurse that the client has had loss of coordination and weakness for three days. The nurse notes that the client is lethargic prior to starting a neurological examination of the client. What should the nurse do first?
assess clients level of orientation
The nurse is conducting a neurological assessment of a hospitalized client. The client has a GCS of 5. What should the nurse do?
take the clients vital signs
Testing of the Trigeminal nerve needs to cover assessment of:
both, sensory and motor assessments.
Identify developmental considerations across the lifespan- older adults
- general atrophy and loss of neurons in brain and spinal cord - decrease in weight and volume of brain - decrease in muscle strength - impaired fine coordination - slowed reaction time - dizziness and loss of balance
- risk of falls (when are they occurring)
- cognitive function - tremor
- vision
Outline health history questions relevant to multiple reasons for seeking care.
- headaches (how often, when did they occur, how severe)
- head injury ( any previous head injury, describe head injury, any loss of consciousness)
- dizziness or vertigo
- seizures (when do they start, how often did they occur, trauma during seizure- ask witnesses)
- tremors (where in the body) - weakness (where in the body)
- incoordination (history of falling) - numbness or tingling (what does it feel like, when does it occur)
- difficulty swallowing (dysphagia)
- difficulty speaking
- significant neurological history - environmental and occupational hazards
For each of the 12 cranial nerves: Identify function & purpose of testing.
I- olfactory: test the patients sense of smell
II- Optic: test visual acuity: Snellen eye chart
III- Oculomotor: extraocular eye muscles (3,4,6)
IV- Trochlear: extraocular eye muscles, cross eye into nose
V- Trigeminal: open and close mouth, dull vs light sensation in forehead, check, jaw
VI- Abducens: left and right, extraocular, tested w 3, 4
VII- Facial: facial symmetry, 2/3 tongue
VIII- Acoustic: whisper test, hearing
IX- Glossopharyngeal: gag reflex, 1/3 tongue
X- Vagus: say ahh, talk
XI- Accessory: shoulder shrug, spine
XII- Hypoglossal: movement of tongue
Describe techniques to inspect & palpate the motor system.
muscles
- size (symmetrical, atrophy, hypertrophy)
- strength (paresis, paralysis)
- tone (passive ROM) (mild resistance, flaccidity (loose) and spasticity( stiff/rigid)
- involuntary movements
Describe techniques of assessing cerebellar function.
balance tests
- gait (walk 3-6 metres)
- ataxia (bad coordination)
- Romberg’s test (‘eyes closed’, stay still, no sway)
- positive- if you sway
- negative- stay still
- shallow knee bend/hop
coordination
- rapid alternating movements
- finger to finger test “eyes open”
- finger to nose test “eyes open”
- heel to shin test (lay supine)
Describe techniques of assessing the sensory system.
spinothalamic tract
- pain (hypoalgesia, analgesia, hyperalgesia) dull vs sharp
- temperature (only if pain is abnormal)
- light touch (“now” when you feel the cotton ball) -hypoesthesia, anesthesia, hyperesthesia
posterior column tract
- vibration (distal locations, big toe, fingers)
- position- kinesthesia,
- tactile discrimination- stereognosis, astereognosis, graphesthesia.
Describe techniques of testing reflexes (deep tendon & superficial) & grading of reflexes.
- limbs relaxed
- patient hug themselves
- short, snappy blow of hammer onto muscles tendon.
grading:
0- no response
1+ - diminished
2+ - normal
3+ - brisker than average
4+ - very brisk
Describe abnormal motor system findings: describe atrophy, hypertrophy, paresis, limited range of motion, flaccidity, hypotonicity, spasticity, & rigidity.
atrophy: when you don’t use a muscle, it gets weak, and smaller.
Hypertrophy; enlargement of muscle
Limited ROM- something is wrong w the muscle, unable to do full coordination
flaccidity- loose muscles
hypotonicity- reduced tone/tension of muscle
spasticity- stiff muscles
rigidity- rigid muscles
Describe abnormal cerebellar function findings: describe atrophy, hypertrophy, paresis, limited range of motion, flaccidity, hypotonicity, spasticity, & rigidity.
atrophy- lack of coordination, smaller muscles
hypertrophy: enlargement
limited ROM- cant move body parts a certain way
flaccidity- loose muscles
hypotonicity- reduced tone or tension in muscle
spasticity- rigid/stiff muscles
rigidity- walking very rigid/stiff
Explain how to use the Glasgow coma scale & the Canadian Neurological Scale.
Glasgow coma scale: test for consciousness and response: max score 15:
- eye opening (4)
- verbal response (5)
- motor response (6)
the higher the score the better, the lower, the more cognitively impaired.
Canadian neurological scale:
patients with strokes mental function:
- LOC
- orientation
- speech
- facial
lower score: more severe cognitive impairment, stroke severity
Identify equipment needed for physical examination & safe infection prevention & control practices.
penlight (cranial nerves, pupils)
tongue depresser
cotton swab
percussion hammer
familiar scents/objects
& social determinants of health considerations.
south Asian: high blood pressure, and diabetes
stroke:
FACE—Is it drooping?
* ARMS—Can you raise both?
* SPEECH—Is it slurred or jumbled?
* TIME—To call 9-1-1 right away
developmental considerations- infants
cranial nerves cant be tested directly
- neurons are not yet myelinated
- social smile after 6 weeks
- head control
- reflexes (moro, rooting, stepping, plantar, babinski, tonic, grasping,)
developmental considerations- children
observations
- test balance, coordination
- lack of reliability testing sensation
developmental considerations- adults
decrease in muscle bulk
loss of ankle jerk
difference in gait
deep tendon reflexes less brisk
senile tremors
cranial nerves (12)
I- Olfactory
II- Optic
III- Oculomotor
IV- trochlear
V- Trigeminal
VI- Abducens
VII- Facial
VIII- Acoustic
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
( Oh, oh, oh, to touch and feel a girls v, ah heaven)
(some say big money , but my brother says big brains matter more)
pathway of CNS
sensory pathway
- spinothalamic tract
- posterior columns
motor pathway
- corticospinal/pyramidal tract
-cerebella system
- extrapyramidal tract
upper and lower motor neurons
reflex arc
- defense mechanisms
- automatic reaction
4 types - deep tendon, superficial, visceral, and pathological.
