Neurologic Exam

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Neurologic Exam

  1. 1. ASSESSMENT: Neurologic Examination<br />Ma. Tosca Cybil A. Torres, RN, MAN<br />
  2. 2. AN IMPORTANT ASPECT OF THE NEUROLOGIC ASSESSMENT IS THE HISTORY OF THE PRESENT ILLNESS<br />
  3. 3. HEALTH HISTORY<br />Should include: <br />Onset<br />Character<br />Severity<br />Location <br />Duration <br />Frequency of s/sx<br />Associated complaints<br />Precipitating and aggravating factors<br />Progression, remission, and exacerbation<br />Presence and absence of similar symptoms among family members<br />Review of medical history <br />History of falls or trauma<br />Use of alcohol, medications and illicit drugs <br />
  4. 4. Common Clinical Manifestations<br />Pain (chronic or acute) <br />Seizures<br />Dizziness and vertigo <br />Visual disturbances <br />Weakness<br />Abnormal sensation <br />
  5. 5. Physical Examination <br />A neurological assessment is divided into five components: <br />Cerebral function <br />Cranial nerves<br />Motor system <br />Sensory system <br />Reflexes <br />Follows a logical sequence and progresses from higher levels of cortical function (ex: abstract thinking) to lower levels of function (ex: determination of the integrity of the peripheral nerves)<br />
  6. 6. I. Assessing cerebral function <br />Interpretation and documentation of neurologic abnormalities, particularly mental status abnormalities, should be SPECIFICandNONJUDGMENTAL.<br />
  7. 7. Mental Status<br />Assessment begins by observing client’s appearance and behavior<br />Posture<br />Gestures<br />Movements<br />Facial expressions<br />Motor activity <br />Manner of speech <br />LOC<br />Orientation <br />
  8. 8. State of Awareness<br />
  9. 9. Intellectual function <br />Serial 7s<br />Interpretation of well-known proverbs/idioms<br />Capacity to recognize similarities<br />Judgement<br />
  10. 10. Though Content <br /><ul><li>Is the patient’s thoughts:
  11. 11. Spontaneous
  12. 12. Natural
  13. 13. Clear
  14. 14. Relevant
  15. 15. Coherent
  16. 16. Check: </li></ul>Illusions<br />Hallucinations<br />preoccupations <br />
  17. 17. Emotional Status <br />Assess:<br /><ul><li>Affect
  18. 18. Mood
  19. 19. Consistency of verbal communication to non verbal cues </li></li></ul><li>Perception <br />Agnosia- inability to interpret or recognize objects seen through the special senses. <br /><ul><li>Visual
  20. 20. Auditory
  21. 21. Tactile
  22. 22. Body parts and relationships </li></li></ul><li>Motor Ability <br />Ask client to perform a skilled act<br />Successful performance requires the ability to understand the activity desired and normal motor strength<br />
  23. 23. Language Ability <br />Aphasia- deficiency in language function<br />Broca’s Aphasia (non-fluent aphasia)- speech output is severely reduced and is limited mainly to short utterances of less than four words.<br />Wernicke’s Aphasia (fluent aphasia) -ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected.<br />Global aphasia- most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Global aphasics can neither read nor write.<br />
  24. 24. Broca’s Aphasia<br />
  25. 25. Wernicke’s Aphasia<br />Ex: <br />I called my mother on the television and did not understand the door. <br />It was too breakfast, but they came from far to near. <br />My mother is not too old for me to be young.<br />
  26. 26. II. Examining the Cranial Nerves <br />
  27. 27.
  28. 28. III. Examining the Motor System<br />Assess muscle size, tone, and strength, coordination, and balance<br />Note for rigidity, spasticity and flaccidity<br />
  29. 29. Muscle Strength Grading<br /> 0 – No contraction1 – Slight contraction, no movement2 – Full range of motion without gravity3 – Full range of motion with gravity4 – Full range of motion , some resistance5 – Full range of motion, full resistance<br />
  30. 30. Balance and Coordination<br />Rapid, alternating movements<br />Point-to-point testing <br />Ataxia- incoordination of voluntary muscle action <br />Romberg test<br />
  31. 31. IV. Examining the Reflexes<br />Stretch or Deep Tendon Reflexes A brisk tap to the muscle tendon using a reflex hammer produces a stretch to the muscle that results in a reflex contraction of the muscle. The muscles tested, segmental level, and grading of DTR's is listed below.<br />Grading DTR's<br /> 0 – Absent1 – Decreased but present2 – Normal3 – Brisk and excessive4 – With clonus<br />
  32. 32. Reflexes <br />Biceps reflex<br />Triceps reflex<br />Brachioradialis reflex<br />Patellar reflex<br />Ankle reflex<br />Superficial reflexes<br />Corneal <br />Abdominal reflexes<br />Gag<br />Cremasteric<br />Plantar<br />perianal<br />
  33. 33. V. Sensory Examination<br />The sensory examination is largely subjective and requires the cooperation of the patient. <br />
  34. 34. Assessment of the sensory system involves: <br />Tactile sensation <br />Superficial pain <br />Vibration <br />Integration of sensation <br />Proprioception<br />Stereognosis<br />
  35. 35. Diagnostic Evaluation<br />CT scan <br />
  36. 36. CT scan<br />
  37. 37. MRI <br />
  38. 38. Cerebral angiography <br />
  39. 39. Myelography<br />An x-ray of the spinal subarachnoid space after injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture <br />
  40. 40. Post myelography care<br />Head elevated to 30-45 degrees for 3H or as prescribed by the AP<br />Encouraged to increase OFI <br />Assess VS and ability to void <br />Untoward signs------headache, fever, stiff neck, photophobia, and seizures<br />
  41. 41. Electroencephalography (EEG)<br />
  42. 42. Electromyography (EMG)<br />
  43. 43. Lumbar Puncture <br />
  44. 44. CSF analysis<br />Queckenstedt’s test <br />
  45. 45. End of discussion <br />

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