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N 295 lecture 14 neurological student copy

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N 295 lecture 14 neurological student copy

  1. 1. Neurological Assessment <ul><li>Central Nervous System </li></ul><ul><ul><li>Brain </li></ul></ul><ul><ul><li>Spinal Cord </li></ul></ul><ul><li>Peripheral Nervous System </li></ul><ul><ul><li>12 pairs of Cranial Nerves </li></ul></ul><ul><ul><li>31 pairs of Spinal Nerves & Branches </li></ul></ul>http://www.bbc.co.uk/science/humanbody/index.shtml?game spring 2012
  2. 2. spring 2012
  3. 3. Spinal Nerves * spring 2012
  4. 4. Health History <ul><li>Headaches </li></ul><ul><li>Head Injury </li></ul><ul><li>Dizziness/ Vertigo/ Paresthesia </li></ul><ul><li>Seizures </li></ul><ul><li>Tremors, Weakness </li></ul><ul><li>Incoordination </li></ul><ul><li>Difficulty Swallowing and Speaking </li></ul><ul><li>Past History, Medications </li></ul><ul><li>Environmental Occupational Hazards </li></ul>spring 2012
  5. 5. Neuro Exam Equipment <ul><li>Penlight </li></ul><ul><li>Tongue Blade </li></ul><ul><li>Cotton Ball </li></ul><ul><li>Tuning Fork </li></ul><ul><li>Percussion Hammer </li></ul><ul><li>Tube of Hot & Cold Water </li></ul>spring 2012
  6. 6. Components of Mental Status Examination * <ul><li>Consciousness </li></ul><ul><li>Orientation </li></ul><ul><li>Language </li></ul><ul><li>Mood and Affect </li></ul><ul><li>Memory </li></ul><ul><li>Calculation Skills </li></ul><ul><li>Abstract Reasoning </li></ul><ul><li>Judgment </li></ul><ul><li>Thought Process & Perceptions </li></ul>spring 2012
  7. 7. Mental Examination Tools <ul><li>Mini-Mental Status Exam </li></ul><ul><li>Denver II Screening Test </li></ul><ul><li>Behavioral Checklist </li></ul><ul><li>Glasgow Coma Scale </li></ul>spring 2012
  8. 8. MMSE maximum score = 30 <ul><li>24 - 30   normal, depending on age, education, complaints 20 - 23   mild 10 - 19   moderate 1   -   9   severe 0             profound </li></ul>spring 2012
  9. 9. Glasgow Coma Scale * spring 2012
  10. 10. Neuro Recheck <ul><li>Pupillary Response? </li></ul><ul><li>Strength of extremities? </li></ul><ul><li>LOC? </li></ul><ul><li>Orientation? </li></ul>spring 2012
  11. 11. Increased Intracranial Pressure* <ul><li>Cushings Triad: </li></ul><ul><ul><ul><li>Sudden Elevation of SBP </li></ul></ul></ul><ul><ul><ul><li>Widening Pulse Pressure </li></ul></ul></ul><ul><ul><ul><li>Slow Bounding Pulse </li></ul></ul></ul>spring 2012
  12. 12. Cranial Nerves spring 2012
  13. 13. Sensory Assessment * <ul><li>ASSESSMENT: </li></ul><ul><ul><li>Compare Distal to Proximal </li></ul></ul><ul><ul><li>Client’s Eyes are Closed </li></ul></ul><ul><ul><li>Explain Tests </li></ul></ul><ul><ul><li>Can Be Fatiguing </li></ul></ul><ul><li>Pain and Temperature </li></ul><ul><li>Position and Vibration </li></ul><ul><li>Light Touch </li></ul><ul><li>Discriminative Sensations </li></ul>spring 2012
  14. 14. Motor Assessment <ul><li>Assessment </li></ul><ul><ul><li>Muscle size </li></ul></ul><ul><ul><li>Strength and Mobility </li></ul></ul><ul><ul><li>Tone </li></ul></ul><ul><ul><li>Involuntary Movements </li></ul></ul><ul><li>Cerebellar Function Assessment </li></ul><ul><ul><ul><li>Observe Gait, Balance, Coordination </li></ul></ul></ul><ul><ul><ul><li>Perform Romberg Test </li></ul></ul></ul><ul><ul><ul><li>Finger to Nose Test </li></ul></ul></ul><ul><ul><ul><li>Rapid Alternate Movements </li></ul></ul></ul><ul><ul><ul><li>Heel to Shin Test </li></ul></ul></ul>spring 2012
  15. 15. Motor Assessment <ul><li>Abnormal Gaits: </li></ul><ul><ul><li>Ataxic (Cerebellar) </li></ul></ul><ul><ul><li>Hemiplegic </li></ul></ul><ul><ul><li>Parkinsonian </li></ul></ul><ul><ul><li>Scissors </li></ul></ul><ul><ul><li>Steppage (Foot Drop) </li></ul></ul><ul><ul><li>Waddling </li></ul></ul>spring 2012
  16. 16. Abnormal Muscle Movements <ul><li>Paralysis </li></ul><ul><li>Fasciculation's </li></ul><ul><li>Tic </li></ul><ul><li>Myoclonus </li></ul>spring 2012
  17. 17. Reflexes <ul><li>DTRs </li></ul><ul><li>Superficial Reflexes: </li></ul><ul><ul><li>Abdominal Reflex </li></ul></ul><ul><ul><li>Cremasteric Reflex </li></ul></ul>spring 2012
  18. 18. Speech Problems (APHASIAs ) <ul><li>Global Aphasia </li></ul><ul><li>Wernicke’s Aphasia </li></ul><ul><li>Broca’s Aphasia </li></ul>spring 2012
  19. 19. Health Promotion <ul><li>Identify Risk Factors for CVA </li></ul><ul><li>Safe Travel </li></ul><ul><li>Safe Recreation </li></ul>spring 2012
  20. 20. Nursing Diagnoses <ul><li>Decreased Cerebral Perfusion </li></ul><ul><li>Impaired Verbal Communication </li></ul><ul><li>Unilateral Neglect </li></ul>spring 2012

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