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Neuromuskuloskeletal

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  • 1. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 2. Gross anatomy The nervous system is divided into the central and peripheral nervous system The CENTRAL NERVOUS SYSTEM consists of the brain and the spinal cord The PERIPHERAL NERVOUS SYSTEM consists of the spinal nerves and the cranial nerves
  • 3. The CentralNervousSystem
  • 4. ThePeripheralNervousSystem
  • 5. THE BRAINThe controlcenter of thebody.
  • 6. THE BRAIN:LEFT HEMISPHERELeft HemisphereCommunicates byusing words, hashighly developedverbal abilities, islogical andsystematic,concerned withmatters as theyare.
  • 7. THE BRAIN: RIGHTHEMISPHERERight HemisphereCommunicatesusing images(pictures), hashighly developedspatial abilities, isintuitive andimaginative,concerned withemotions andfeelings.
  • 8. THE CEREBRUMThe brain iscomposed of lobes-Frontal lobe-personality, memoryand motor functionParietal lobe-sensory functionTemporal lobe-hearing andolfaction andemotion by thelimbic systemOccipital lobe-vision
  • 9. THE CEREBELLUMThe cerebellum isinvolved incoordination andequilibriumThe diencephalonconsists of the :Thalamus- therelay center of allsensory inputHypothalamus-center for endocrineregulation, sleep,temperature, thirst,sexual arousal andemotional response
  • 10. THE BRAINSTEMMIDBRAINVisual and auditoryrelay centerPONSRespiratory centerMEDULLAOBLANGATARespiratory &cardiovascularcentersCEREBELLUMPosture &equilibrium
  • 11. THE CRANIALNERVESThere are 12 pairs ofcranial nerves thatsupply structures inthe head, neck,thorax andabdomen. A cranialnerve can be madeup of a mixture offunctions which arecalled modalities ormay be made up of asingle modality. Amodality is sensory,motor, specialsensory, etc.
  • 12. Cranial Nerve: Major Functions:I Olfactory smellII Optic visionIII Oculomotor eyelid and eyeball movementIV Trochlear innervates superior oblique turns eye downward and laterallyV Trigeminal chewing , face & mouth touch & painVI Abducens turns eye laterallyVII Facial controls most facial expressions ,secretion of tears & salivatasteVIII Vestibulocochlear hearing , equillibrium sensation(auditory)IX Glossopharyngeal taste , senses carotid blood pressure senses aortic blood pressure ,slows heart rateX Vagus stimulates digestive organs, taste controls trapezius & sternocleidomastoid controlsXI Spinal Accessory swallowing movementsXII Hypoglossal controls tongue movements
  • 13. THE SPINALNERVESSensory and motorfunctionSpinal Nerves 31→ C8, T12, L5, S5, C1Cerebrospinal FluidCovered bymeningesProtected byvertebral column
  • 14. THE SKELETALSYSTEMThere are 206 bonesin an adult skeletalsystem.
  • 15. THE MUSCULARSYSTEMThere are 639muscles in an adultmuscular systemdivided into skeletal,cardiac & smoothmuscles.
  • 16. DEFINITION Neurological examination is a method ofobtaining specific data in relation to thefunction of a patient’s nervous system.
  • 17. INDICATION Neurological observations are required tomonitor and evaluate changes in the nervoussystem by indicating trends, thus aidingdiagnosis and treatment which in turn mayaffect prognosis and rehabilitation. Thefrequency of neurological observations willdepend on the patient’s condition and therapidity with which changes are occurring orexpected to occur.
  • 18. Level of consciousness - Alertness or state ofawareness of the environmentAttention -The ability to focus or concentrateover time on one task or activity—an inattentiveor distractible person with impaired consciousnesshas difficulty giving a history or responding toquestions.
  • 19. Memory - The process of registering or recordinginformation, tested by asking for immediaterepetition of material, followed by storage orretention of information. Recent or short-termmemory covers minutes, hours, or days; remote orlong-term memory refers to intervals of years.Orientation - Awareness of personal identity,place, and time; requires both memory andattention
  • 20. Perceptions - Sensory awareness of objects in theenvironment and their interrelationships (externalstimuli); also refers to internal stimuli such asdreams or hallucinationsThought processes - The logic, coherence, andrelevance of the patient’s thought as it leads toselected goals, or how people thinks
  • 21. Thought content - What the patient thinksabout, including level of insight and judgmentInsight - Awareness that symptoms ordisturbed behaviors are normal or abnormal;for example, distinguishing betweendaydreams and hallucinations that seem real
  • 22. Judgment - Process of comparing and evaluatingalternatives when deciding on a course of action;reflects values that may or may not be based onreality and social conventions or normsAffect - An observable, usually episodic, feeling toneexpressed through voice, facial expression, anddemeanorMood - A more sustained emotion that may color aperson’s view of the world (mood is to affect asclimate is to weather)
  • 23. Language - A complex symbolic system forexpressing, receiving,and comprehending words; as with consciousness,attention, and memory, language is essential forassessing other mental functionsHigher cognitive functions - Assessed byvocabulary, fund of information,abstract thinking, calculations, construction ofobjects that have two or three dimensions
  • 24. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 25. 1. Cotton applicator 5. Vials containing coffeeAssesses patient’s or vanilla Assessesresponse to light touch. olfactory nerve extract,2. Needle Assesses sugar salt.patient’s response to pain 6. Tongue blade3. Test tube containing hot 7. Penlight& cold water Assesses 8. Snellen charttemperature sensation. 9. Tuning fork4. Reflex hammer 10. Thermometer 11. BP apparatus 12. Stethoscope
  • 26. PHYSICAL EXAMINATION5 categories:1. Cerebral function- LOC, mental status2. Cranial nerves3. Motor function4. Sensory function5. Reflexes
  • 27. PREPARED BY: RUSSEL DE LARA, R.N. & JOHN FRANCIS FAUSTORILLA, R.N., R.M.
  • 28. LEVEL OFCONSCIOUSNESS • TECHNIQUE • SPEAK TO THE PATIENT IN A NORMAL TONE OF VOICE. AN ALERT PATIENT OPENS THE EYES, LOOKS AT YOU, AND ALERT RESPONDS FULLY AND APPROPRIATELY TO STIMULI (AROUSAL INTACT). • SPEAK TO THE PATIENT IN A LOUD VOICE. FOR EXAMPLE, CALL LETHARGIC THE PATIENT’S NAME OR ASK “HOW ARE YOU?” OBTUNTED • SHAKE THE PATIENT GENTLY AS IF AWAKENING A SLEEPER. • APPLY A PAINFUL STIMULUS. FOR EXAMPLE, PINCH A TENDON, STUPOROUS RUB THE STERNUM, OR ROLL A PENCIL ACROSS A NAIL BED. (NO STRONGER STIMULI NEEDED!) COMATOSE • APPLY REPEATED PAINFUL STIMULI.
  • 29. THE GLASGOW COMA SCALEACTION RESPONSE SCOREBEST EYE OPENING (E) • SPONTANEOUSLY 4 • TO SPEECH 3 • TO PAIN 2 • NONE 1BEST VERBAL RESPONSE (V) • ORIENTED 5 • CONFUSED 4 • INAPPROPRIATE WORDS 3 • INCOMPREHENSIVE SOUNDS 2 • NO VERAL RESPONSE 1BEST MOTOR RESPONSE (M) • OBEYS COMMANDS 6 • LOCALIZES PAIN 5 • FLEXION WITH WITHDRAWAL 4 • ABNORMAL FLEXION 3 • ABNORMAL EXTENSION 2 • FLACCID 1TOTAL SCORE 15
  • 30. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 31. Determine the client’s orientation to time, placeand person.Ask the client to state his name (general data),time of the day, date, day of the week correctly
  • 32. 1.Assess and listen for lapses in memory.2.Assess immediate recall Ask the client to repeat a series of three digits spoken slowly. Gradually increase the number of digits. Start again to ask a series of three digits but this time ask the patient to state it backwards
  • 33. 3. Assess recent memory Ask the client to recall recent events of the day. Ask the client to recall information given early in the interview Provide the client with three facts to recall4.Assess remote memory Ask the client to describe a previous illness or event
  • 34. Apply theGlascow ComaScale.
  • 35. Test the ability to concentrate or attention spanof the client.Ask the client to recite the alphabet or countbackwards from 100.
  • 36. Assess any defects in or loss of the power to expressoneself by speech, writing or signs or to comprehendor written language. If with difficulty speaking: Point to common objects and ask client to name them. Ask client to read some words and to match the printed and written words with pictures Ask the client to respond to simple verbal and written commands.
  • 37. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 38. Nerve Function How to test I olfaction with an odorous substance II vision vision chart III most eye muscles "follow the moving finger" IV superior oblique look down at the nose V facial sensation touch the face muscles of mastication clench the teeth VI lateral rectus look to the side VII facial expression smile, raise the eyebrows taste sugar or salt VIII hearing a tuning fork balance look for vertigo IX pharynx sensation gag reflex muscles of larynx and check for hoarseness, open X pharynx, parasymp. wide and say "AH" trapezius and test shoulder raise or XI sternocleidomastoid turning the head XII tongue muscles stick out the tongue
  • 39. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 40. FINGER-TO-NOSE TEST: ask the client to abductand extend the arms at shoulder height and rapidlytouch the nose alternatively with one index fingerand then the other. The client repeats the test withthe eyes closed if the test is performed easy.FINGER TO NOSE AND TO THE NURSE’SFINGERS: Ask the client to touch the nose and thenyour index finger held at a distance at about 45 cm atrapid and increasing rate.
  • 41. FINGERS TO FINGERS: ask the client to spread thearms broadly at shoulder height and then bring thefingers together at the midline, first with eyes openand then closed, first slowly and then rapidly.FINGERS TO THUMB (SAME HAND): Ask the clientto touch each finger of one hand to the thumb of thesame hand as rapidly as possible.
  • 42. ALTERNATING PRONATION AND SUPINATIONOF HANDS ON KNEES: Ask the client to pat bothknees with the palms of both hands and then withthe back of the hands alternately at ever increasingrate.
  • 43. HEEL DOWN OPPOSITE SHIN: ask the client toplace the heel of one foot just below the oppositeknee and run the heel down the shin to the foot.Repeat with the other foot.TOE OR BALL OF FOOT TO THE NURSE’SFINGER: Ask the client to touch your finger with thelarge toe of each foot.
  • 44. WALKING GAIT: Ask the client to walk across theroom and back and assess the client’s gait.ROMBERG’S TEST: ask the client to stand withfeet together and arms resting at the sides, firstwith eyes open and then closed. Stand closeduring this test to prevent the client from falling.
  • 45. STANDING ON ONE FOOT WITH EYES CLOSED:Ask the client to close the eyes and stands on onefoot and then the other. Stand close to the clientduring this test.HEEL-TOE WALKING: Ask the client to walk astraight line, placing the heel of one foot directlyin front of the toes of the other foot.TOE OR HEEL WALKING: Ask the client to walkseveral steps on the toes and then on the heels.
  • 46. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 47. 1. Ask the patient to identify the “sharp” or “dull” or “don’t know” sensation when the sharp or dull end of the safety pin or needle is felt on the symmetrical areas of the body.2. Points on the spot where the sensation was felt.
  • 48. 1. Ask the client to tell when vibrations are first felt by indicating “Yes” and when the vibrations stop by stating “gone”.2. Compare the vibratory sensations felt on symmetrical sides of the body.
  • 49. 1. Ask the client to identify the position of the big toe while moving it.2. Use familiar small object to test stereognosis with client’s are eyes closed.
  • 50. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 51.  Biceps reflex  Cremasteric reflex Triceps reflex  Patellar reflex Brachioradiallis reflex  Achilles reflex Abdominal reflex  Plantar reflex
  • 52. PREPARED BY: RUSSEL DE LARA, R.N. | JOHN FRANCIS FAUSTORILLA, R.N., R.M. | FUR SERQUINIA,
  • 53. ELECTROENCEPHA-LOGRAPHYWithholdmedicationsthat mayinterfere withthe results:anti-convulsants,sedatives andstimulantsWash hairthoroughlybeforeprocedure
  • 54. COMPUTEDTOMOGRAPHYSCANSWith radiationriskIf contrastmedium will beused- ensureconsent, assessfor allergies todyes and iodineor seafood,flushing andmetallic tasteare expected asthe dye isinjected
  • 55. MAGNETICRESONANCEIMAGINGUses magneticwavesPatients withpacemakers,orthopedicmetalprosthesis andimplantedmetal devicescannot undergothis procedure
  • 56. CEREBRALANGIOGRAPHYNote allergiesto dyes, iodineand seafoodEnsureconsentKeep patientat rest afterprocedureMaintainpressuredressing orsandbag overpunctured site
  • 57. LUMBARPUNCTUREEnsure consent,determine ability tolie stillContraindicated inpatients withincreased ICPKeep flat on bedafter procedureIncrease fluidintake afterprocedure

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