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Neurologic Exam
 

Neurologic Exam

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    Neurologic Exam Neurologic Exam Presentation Transcript

    • ASSESSMENT: Neurologic Examination
      Ma. Tosca Cybil A. Torres, RN, MAN
    • AN IMPORTANT ASPECT OF THE NEUROLOGIC ASSESSMENT IS THE HISTORY OF THE PRESENT ILLNESS
    • HEALTH HISTORY
      Should include:
      Onset
      Character
      Severity
      Location
      Duration
      Frequency of s/sx
      Associated complaints
      Precipitating and aggravating factors
      Progression, remission, and exacerbation
      Presence and absence of similar symptoms among family members
      Review of medical history
      History of falls or trauma
      Use of alcohol, medications and illicit drugs
    • Common Clinical Manifestations
      Pain (chronic or acute)
      Seizures
      Dizziness and vertigo
      Visual disturbances
      Weakness
      Abnormal sensation
    • Physical Examination
      A neurological assessment is divided into five components:
      Cerebral function
      Cranial nerves
      Motor system
      Sensory system
      Reflexes
      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)
    • I. Assessing cerebral function
      Interpretation and documentation of neurologic abnormalities, particularly mental status abnormalities, should be SPECIFICandNONJUDGMENTAL.
    • Mental Status
      Assessment begins by observing client’s appearance and behavior
      Posture
      Gestures
      Movements
      Facial expressions
      Motor activity
      Manner of speech
      LOC
      Orientation
    • State of Awareness
    • Intellectual function
      Serial 7s
      Interpretation of well-known proverbs/idioms
      Capacity to recognize similarities
      Judgement
    • Though Content
      • Is the patient’s thoughts:
      • Spontaneous
      • Natural
      • Clear
      • Relevant
      • Coherent
      • Check:
      Illusions
      Hallucinations
      preoccupations
    • Emotional Status
      Assess:
      • Affect
      • Mood
      • Consistency of verbal communication to non verbal cues
    • Perception
      Agnosia- inability to interpret or recognize objects seen through the special senses.
      • Visual
      • Auditory
      • Tactile
      • Body parts and relationships
    • Motor Ability
      Ask client to perform a skilled act
      Successful performance requires the ability to understand the activity desired and normal motor strength
    • Language Ability
      Aphasia- deficiency in language function
      Broca’s Aphasia (non-fluent aphasia)- speech output is severely reduced and is limited mainly to short utterances of less than four words.
      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.
      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.
    • Broca’s Aphasia
    • Wernicke’s Aphasia
      Ex:
      I called my mother on the television and did not understand the door.
      It was too breakfast, but they came from far to near.
      My mother is not too old for me to be young.
    • II. Examining the Cranial Nerves
    • III. Examining the Motor System
      Assess muscle size, tone, and strength, coordination, and balance
      Note for rigidity, spasticity and flaccidity
    • Muscle Strength Grading
      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
    • Balance and Coordination
      Rapid, alternating movements
      Point-to-point testing
      Ataxia- incoordination of voluntary muscle action
      Romberg test
    • IV. Examining the Reflexes
      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.
      Grading DTR's
      0 – Absent1 – Decreased but present2 – Normal3 – Brisk and excessive4 – With clonus
    • Reflexes
      Biceps reflex
      Triceps reflex
      Brachioradialis reflex
      Patellar reflex
      Ankle reflex
      Superficial reflexes
      Corneal
      Abdominal reflexes
      Gag
      Cremasteric
      Plantar
      perianal
    • V. Sensory Examination
      The sensory examination is largely subjective and requires the cooperation of the patient.
    • Assessment of the sensory system involves:
      Tactile sensation
      Superficial pain
      Vibration
      Integration of sensation
      Proprioception
      Stereognosis
    • Diagnostic Evaluation
      CT scan
    • CT scan
    • MRI
    • Cerebral angiography
    • Myelography
      An x-ray of the spinal subarachnoid space after injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture
    • Post myelography care
      Head elevated to 30-45 degrees for 3H or as prescribed by the AP
      Encouraged to increase OFI
      Assess VS and ability to void
      Untoward signs------headache, fever, stiff neck, photophobia, and seizures
    • Electroencephalography (EEG)
    • Electromyography (EMG)
    • Lumbar Puncture
    • CSF analysis
      Queckenstedt’s test
    • End of discussion