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

    • 1. The Neurological System
    • 2. Neurological Exam 5 Components
      • Mental status
      • Cranial nerves
      • Reflexes
      • Motor- includes Cerebellar function
      • Sensory
    • 3. Mental Status Examination
      • Examination - ABCT
        • Appearance
        • Behavior
        • Cognition
        • Thought processes (thought content & perceptions)
      • Mini Mental State Exam
      • Glasgow Coma Scale
    • 4. Assessing LOC: Glasgow Coma Scale
      • Eye opening
      • Verbal responsiveness
      • Motor responsiveness
    • 5. Glasgow Coma Scale
    • 6. 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)
    • 7. 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
    • 8. 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”
    • 9. Physical Examination
      • Sensory Function Tests :
      • Touch
        • Light touch 1 st then Pain & Temperature
      • Vibration
      • Proprioception: Position sense
      • Stereognosis
      • Graphesthesia
      • 2-point discrimination
    • 10. Sensory Function Tests : Sensory Exam: Light Touch
    • 11. Sensory Function Tests : Sensory Exam: Vibration
    • 12. Sensory Function Tests : Proprioception: Position sense
    • 13. Sensory Function Tests : Stereognosis
    • 14. Sensory Function Tests : Graphesthesia
    • 15. Sensory Function Tests : Two-point discrimination
    • 16. Sensory Function Tests : Dermatomes
    • 17. 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
    • 18. 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
    • 19.
      • Cerebellar Function, con’t
      • 2. Coordination of hands and legs
        • RAM
        • nose to examiner’s finger
        • heel to shin coordination
    • 20. Cerebellar Function, con’t RAM
    • 21. Cerebellar Function, con’t Nose –to - Finger Test
    • 22. Cerebellar Function, con’t Heel to Shin
    • 23. 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!
    • 24. 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
    • 25. Reflexes-Cont: PERRL/PERRLA
    • 26. Reflexes-Cont: Babinski’s Reflex (Adult)
    • 27. Reflexes-Cont: Reflex Arc – Deep Tendon Reflex
    • 28. 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
    • 29. BRACHIORADIALIS BICEPS TRICEPS PATELLAR ACHILLES/PLANTAR DEEP TENDON REFLEXES
    • 30. Grading of DTRs
      • 4+ very brisk
      • 3+ brisker than average
      • 2+ average, normal
      • 1+ diminished, low normal
      • 0 no response
    • 31. 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
    • 32. Assessment Guide : cont..
      • Seizure
        • Describe: tonic clonic, absence, status epilepticus
        • Timing: once at 10 am; 2 pm and 2:45 pm
    • 33.
      • 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.

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