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Neurological assessment dr nahla shaaban khalil 2018
1.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Neurological assessment By Dr .Nahla Shaaban Khalil Assist professor critical care &Emergency Nursing Cairo University 2018
2.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Nervous SystemNervous System Central Nervous System •Brain •Spinal cord Peripheral Nervous System •Cranial nerves •Spinal nerves
3.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Central Nervous System-BrainCentral Nervous System-Brain
4.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Central Nervous System-Spinal CordCentral Nervous System-Spinal Cord
5.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Peripheral Nervous System-12 Pairs of Cranial NervesPeripheral Nervous System-12 Pairs of Cranial Nerves • Originate in the brain • Control many activities in the body • Take impulses to and from the brain
6.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Figure 24.4 Cranial nerves and their target regions. (Sensory nerves are shown in blue; motor nerves, in red.)
7.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Table 24.1 Cranial Nerves
8.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Peripheral Nervous System-Spinal nervesPeripheral Nervous System-Spinal nerves • 31 pairs of spinal nerves – 8 pairs of cervical nerves – 12 pairs of thoracic nerves – 5 pairs of lumbar nerves – 5 pairs of sacral nerves – 1 pair of coccygeal nerves
9.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Dermatome: band of skin innervated by the sensory root of a single spinal nerve SPINAL NERVESSPINAL NERVES
10.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Common or Concerning SymptomsCommon or Concerning Symptoms of the Nervous Systemof the Nervous System • Observing mental status, speech, and language • Observing sensorium, memory, abstract thinking ability, speech, mood, emotional state, perceptions, thought processes, ability to make judgments • Headache • Dizziness or vertigo • Weakness • Numbness • Loss of sensations • Loss of consciousness • Seizures • Tremors or involuntary movements
11.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Physical Assessment of thePhysical Assessment of the Neurologic SystemNeurologic System • Testing cranial nerves • Testing Motor function • Testing Sensory function • Testing Reflexes (Always consider left to right symmetry)
12.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Areas of the Neurologic SystemAreas of the Neurologic System AssessmentAssessment • Testing cranial nerves – I – II – III – IV – V – VI – VII – VIII – IX – X – XI – XII
13.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito l. Olfactory: smelll. Olfactory: smell • Client both eyes and one naris are closed • Place a strong smelling item under each nostril individually and ask the person to identify it.
14.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito ll. Optic: visionll. Optic: vision • Visual acuity -Distance/Central vision: Snellen eye chart -Near vision (hand-held card) • Examine the Optic Fundi by using the Ophthalmoscope
15.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito • Visual acuity – Distance/Central vision: Snellen eye chart; position patient 20 feet (6 meters) from the chart o Patients should wear glasses if needed o Test one eye at a time Eyes – Techniques of ExaminationEyes – Techniques of Examination
16.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Eyes – Techniques of ExaminationEyes – Techniques of Examination • Visual acuity – Near vision: use (Jaeger or Rosenbaum chart (hand-held card) – can also use to test visual acuity at the bedside – hold 14 inches (about 30 cm) from patient’s eyes Rosenbaum chartJaeger chart
17.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito lll. Oculomotorlll. Oculomotor lV. TrochlearlV. Trochlear Vl. AbducensVl. Abducens • Test Extraocular Movements • Test direct and consensual pupillary reaction to light • Accommodation
18.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito • Extraocular movements/six cardinal directions of gaze/wagon wheel method • The client must keep the head still while following a pen that you will move in several directions to form a star in front of the client’s eyes. • Always return the pen to the center before changing direction. Eyes – Techniques of ExaminationEyes – Techniques of Examination
19.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito • Accommodation An object held about 10 cm from the client’s nose Eyes – Techniques of ExaminationEyes – Techniques of Examination
20.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito V. TrigeminalV. Trigeminal • Bilaterally palpate temporal and masseter muscles while patient clenches teeth • (Sensation) Ask client to closed his eyes and test forehead, each cheek, and jaw on each side for sharp or dull (use a cotton swab) sensation. Direct the client to say ‘now’ every time the cotton is felt. • (Reflex) With the individual's eyes open and looking upward, the practitioner takes a strand of cotton, approaches the cornea from the side, and touches it with the cotton. This should initiate a blink response. Both eyes should be tested independently.
21.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Vll. FacialVll. Facial • Ask the client to close both eyes and keep them closed. Try to open them by retracting the upper and lower lids simultaneously and bilaterally. • Ask patient to raise eyebrows, show teeth, grimace, smile, puff both cheeks (Assess face for asymmetry, abnormal movements) • Use the sweet, salty, sour and bitter items to test taste (Between each solution the mouth needs to be rinsed with water)
22.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Vlll. AcousticVlll. Acoustic • Weber Test (by using a tuning fork). • Rinne test: to compares air and bone conduction • Romberg test: Ask the patient to remain still and close their eyes (for about 20 seconds).
23.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Ears – Hearing acuityEars – Hearing acuity – Rinne o Compare time of air vs. bone conduction o Place the base of the tuning fork on the client’s mastoid process- and note the number of seconds. o Then move the fork in front the external auditory meatus (1-2 cm) Air and bone conduction (AC and BC)
24.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito lX. GlossopharyngeallX. Glossopharyngeal X. VagusX. Vagus • Ask the client to open the mouth, depress the client’s tongue with the tongue blade, ask the client to say ”ah” . Usually, the soft palate raises and the uvula remains in the midline • Observe the individual swallowing. • Test gag reflex, warning patient first.
25.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito LX. GLOSSOPHARYNGEALLX. GLOSSOPHARYNGEAL X. VAGUSX. VAGUS Ask the client to open the mouth, depress the client’s tongue with the tongue blade, ask the client to say ”ah” . Usually, the soft palate raises and the uvula remains in the midline
26.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Xl. Spinal AccessoryXl. Spinal Accessory • Test the Trapezius muscle: have the client shrug the shoulders while you resist with your hands • Ask the client to try to touch the right ear to the right shoulder without raising the shoulder. Repeat with the left shoulder
27.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Xll. HypoglossalXll. Hypoglossal • Ask patient to protrude tongue and move it side to side. Assess for symmetry, atrophy.
28.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Areas of the Neurologic SystemAreas of the Neurologic System AssessmentAssessment • Motor function – Observation of gait and balance – demonstration of the Romberg test – demonstration of the finger-to-nose test – Observation of rapid alternating action movements
29.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Observation of gait and balance Ask the client to walk across the room and return
30.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Rombergism test for balance. Ask the patient to remain still and close their eyes (for about 20 seconds).
31.
Copyright ©2012 by
Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Romberg sign Ability to maintain upright position with feet together and eyes open •Sway/fall when eyes closed •Indicates impaired proprioception or vestibular dysfunction
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Finger-to-nose test. -Ask the client to extend both arms from the sides of the body -ask the client to keep both eyes open -ask the client to touch the tip of the nose with right index finger, and then return the right arm to an extended position. -ask the client to touch the tip of the nose with left index finger, and then return the left arm to an extended position. -Repeat the procedure several times. -Ask the client to close both eyes and repeat the alternating movements
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Observation of rapid alternating action movements -Ask the client to sit with the hands placed palms down on the thighs. -Ask the client to return the hands palms up. -Ask the client to return the hands to a palms-down position. -Ask the client to alternate the movements at a faster pace. Testing rapid alternating movement, palms up. Testing rapid alternating movement, palms down. Testing rapid alternating movement, palms up. Testing rapid alternating movement, palms down.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Areas of the Neurologic SystemAreas of the Neurologic System AssessmentAssessment • Sensory function – Observation of light touch identification – Sharp, dull determination – Stereognosis – Graphesthesia (Number identification)
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito -Evaluation of light touch. -Use wisp of cotton to touch the skin lightly on both sides simultaneously. -Test several areas on both the upper and lower extremities. -Ask the patient to tell you if there is difference from side to side or other "strange" sensations.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the client’s ability to identify sharp sensations. -Ask the client to say “sharp” or “dull” when something sharp or dull is felt on the skin. -Touch the client using random locations. Testing the client’s ability to identify dull sensations Testing the client’s ability to identify sharp sensationsTesting the client’s ability to identify dull sensations Testing the client’s ability to identify sharp sensations
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito -Testing stereognosis using a coin -Use as an alternative to graphesthesia. -Place a familiar object in the patient's hand (coin, paper, pencil, etc.). -Ask the patient to tell you what it is.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito -Testing graphesthesia (Number identification) -With the blunt end of a pen or pencil, draw a large number in the patient's palm. -Ask the patient to identify the number.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Definition of reflex: The reflex is then an automatic response to a stimulus that does not receive or need conscious thought.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Deep tendon reflexes A deep tendon reflex is often associated with muscle stretching. Tendon reflex tests are used to determine the integrity of the spinal cord and peripheral nervous system, and they can be used to detect the presence of a neuromuscular disease.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Areas of the Neurologic SystemAreas of the Neurologic System AssessmentAssessment • Reflexes (Stimulus-response activities of the body.( – Biceps (C5 / C6) – Triceps C7 – Brachioradialsis C5 / C6) – Patellar (knee) L2-L4 – Achilles S1 – Plantar (Babinski). – Abdominal
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the biceps reflex. -The patient's arm should be partially flexed at the elbow with the palm down. -Place your thumb or finger firmly on the biceps tendon. -Strike your finger with the reflex hammer. -look for contraction of the biceps muscle and slight flexion of the forearm.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the triceps reflex. -Support the upper arm and let the patient's forearm hang free. -Strike the triceps tendon above the elbow with the broad side of the hammer. -observe contraction of the triceps muscle with extension of the lower arm.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the brachioradialis reflex. -Have the patient rest the forearm on the abdomen or lap. -Strike the radius about 1-2 inches above the wrist. -Watch for flexion and supination of the forearm.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito supination of the forearm response in brachioradialis reflex.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing patellar (knee) reflex, client in a sitting position. -Have the patient sit with the knee flexed. -Strike the patellar tendon just below the patella. -Note contraction of the quadraceps muscle and extension of the knee.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the Achilles tendon reflex with client in a sitting position. -Dorsiflex the foot at the ankle. -Strike the Achilles tendon. -Watch and feel for plantar flexion at the ankle deep tendon reflex consisting of plantar flexion of the foot when a sharp tap is givdeep tendon reflex consisting of plantar flexion of the foot when a sharp tap is giv en directly to the tendon at the back of the ankle.en directly to the tendon at the back of the ankle. This reflex is often absent in people with peripheral neuropathies orThis reflex is often absent in people with peripheral neuropathies or diabetes. A sluggish return of the flexed foot maydiabetes. A sluggish return of the flexed foot may occuroccur in patients within patients with hypothyroidism and lower motor neuron diseases.hypothyroidism and lower motor neuron diseases. A hyperactive reflex may be caused by hyperthyroidismA hyperactive reflex may be caused by hyperthyroidism .
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Reflexes: Reinforcement -Isometric contraction of other muscles (Jendrassik maneuver, teeth clenching) • Distraction • Slight tension in muscle group being tested
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Jendrassik maneuver,
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Testing the plantar reflex (Babinski). -Scratch the lateral aspect of the sole of each foot with the end of a reflex hammer or key. -Observe for planter flexion of the foot .
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Abdominal reflex testing pattern. -Use a blunt object such as a key or tongue blade. -Stroke the abdomen lightly on each side in an inward and downward direction. -Note the contraction of the abdominal muscles and deviation of the umbilicus towards the stimulus.
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito REFLEXES: SCALE FOR GRADINGREFLEXES: SCALE FOR GRADING Reflexes are usually graded on a 0 to 4+ scale 4+ Very brisk, hyperactive, with clonus (rhythmic oscillations between flexion and extension) 3+ Brisker than average; possibly but not necessarily indicative of disease 2+ Average; normal 1+ Somewhat diminished; low normal 0 No response
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Pearson Education, Inc. All rights reserved. Health & Physical Assessment in Nursing, Second Edition Donita D’Amico • Colleen Barbarito Areas of the Neurologic SystemAreas of the Neurologic System Assessment-Additional assessmentsAssessment-Additional assessments
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