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The Neurological System 2 Neurological Exam 5 Components
 

The Neurological System 2 Neurological Exam 5 Components

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  • Check both sides
  • Light touch – assessing the trigeminal nerve CN V
  • vibration
  • dermatomes
  • Ex: traffic school – show videos of sobriety test – walk in straight line, finger to nose
  • Note smoothness of motion Perform bilaterally
  • Ex sobriety test

The Neurological System 2 Neurological Exam 5 Components The Neurological System 2 Neurological Exam 5 Components Presentation Transcript

  • The Neurological System
  • Neurological Exam 5 Components
    • Mental status
    • Cranial nerves
    • Reflexes
    • Motor- includes Cerebellar function
    • Sensory
  • Mental Status Examination
    • Examination - ABCT
      • Appearance
      • Behavior
      • Cognition
      • Thought processes (thought content & perceptions)
    • Mini Mental State Exam
    • Glasgow Coma Scale
  • Assessing LOC: Glasgow Coma Scale
    • Eye opening
    • Verbal responsiveness
    • Motor responsiveness
  • Glasgow Coma Scale
  • Physical Examination
    • Levels of Consciousness
    • Alert- awake or easily aroused
    • Lethargic- not fully alert, drifts off when not stimulated
    • Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain)
    • Stupor- need persistent loud noise or pain for arousal; responds to stimuli
    • Coma- no response
    • (Jarvis CH 2)
  • Cranial Nerves
    • “ O n o ld O lympus’ T owering T ops a F inn a nd G erman V iewed s ome h ops .”
    • I – Olfactory VII - Facial
    • II – Optic VIII – Auditory (V-C)
    • III – Occulomotor IX - Glossopharyngeal
    • IV – Trochlear X - Vagus
    • V – Trigeminal XI – Spinal Accessory
    • VI – Abducens XII - Hypoglossal
  • Neurological : Physical Examination Sensory System Function
    • With eyes closed
          • Interpret sensations
          • Discriminate side to side
    • Examine in detail if:
          • Reduced sensation
          • Numbness or pain
          • Motor or reflex abnormal
          • Skin changes
      • Be specific: “tell me where I touch”
  • Physical Examination
    • Sensory Function Tests :
    • Touch
      • Light touch 1 st then Pain & Temperature
    • Vibration
    • Proprioception: Position sense
    • Stereognosis
    • Graphesthesia
    • 2-point discrimination
  • Sensory Function Tests : Sensory Exam: Light Touch
  • Sensory Function Tests : Sensory Exam: Vibration
  • Sensory Function Tests : Proprioception: Position sense
  • Sensory Function Tests : Stereognosis
  • Sensory Function Tests : Graphesthesia
  • Sensory Function Tests : Two-point discrimination
  • Sensory Function Tests : Dermatomes
  • Motor Examination
    • Symmetry, size, and presence f involuntary movements
    • Full ROM of joints
    • Check strength against resistance
    • Neuro patients: Assess hand grips and foot pushes if bedridden
  • Cerebellar Function
    • 1. Gait and posture
      • Heel to toe in straight line
      • Walking on toes and heels
      • Hop on one foot
      • Note width of gait
    • Cerebellar Function, con’t
    • 2. Coordination of hands and legs
      • RAM
      • nose to examiner’s finger
      • heel to shin coordination
  • Cerebellar Function, con’t RAM
  • Cerebellar Function, con’t Nose –to - Finger Test
  • Cerebellar Function, con’t Heel to Shin
  • Cerebellar con’t
    • Romberg:
    • Stand upright, place feet together, then close eyes
    • loss of balance means + Romberg test
    • Be prepared to protect client from falling!
  • 4 types of Reflexes
    • Superficial (abdominal reflex, Cremasteric reflex)
    • Visceral (pupillary response to light) PERRL
    • Pathologic
      • + Babinski in adults
    • DTRs (e.g. knee)
    Abdominal Reflex Cremastic Reflex
  • Reflexes-Cont: PERRL/PERRLA
  • Reflexes-Cont: Babinski’s Reflex (Adult)
  • Reflexes-Cont: Reflex Arc – Deep Tendon Reflex
  • Reflexes-Cont: Deep Tendon Reflexes
    • Technique
    • Position limb so muscle is slightly stretched
    • Reflex hammer should strike tendon briskly to stretch tendon
    • Get patient to relax
  • BRACHIORADIALIS BICEPS TRICEPS PATELLAR ACHILLES/PLANTAR DEEP TENDON REFLEXES
  • Grading of DTRs
    • 4+ very brisk
    • 3+ brisker than average
    • 2+ average, normal
    • 1+ diminished, low normal
    • 0 no response
  • Assessment Guide: Neurological
    • LOC : alert, comatose, lethargic, obtunded
    • GCS
      • Eye opening: spontaneously, to speech, to pain
      • Verbal Response: oriented, confused, inappropriate, incomprehensible
      • Motor Response: obeys, command, localizes pain, withdraws, flexion, extension
  • Assessment Guide : cont..
    • Seizure
      • Describe: tonic clonic, absence, status epilepticus
      • Timing: once at 10 am; 2 pm and 2:45 pm
    • Altered mental status : yes, no
    • Aphasia : present, none
    • Intelllectual functioning : intact; short attention span, dementia, memory loss
    • Itnerventions in use :
      • Seizure precautions : side rails padded, oral airway at bedside
      • Med List : Klonopin, Aricept, Neurontin, Dilantin, etc.