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Neurological assessment sp07 webversion

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Neurological assessment sp07 webversion

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