Advanced Nursing of Spinal Patient 1 Flashcards
Why do we do a neurlogical exam?
- clinical signs can be spectacular, distressing and confusing
- breaks down complex presentations downs into manageable steps
What are the aims for a neurological exam?
- whether it is neurological
- where it is localised
- what is causing it
Where can neurlogical problems be localised?
brain, spinal cord, peripheralnerves, neuromuscular
What is the brain broken down into?
forebrain, cerebellum and brain stem
What is within the spinal cord?
c1-c5, c6-t2, t3-l3, l4-s2/3
What is the five finger rule?
signalment
onset
progression
symmetry
pain
What are you asking yourself when observaing mentation of a neurological patient?
are they alert?
are they obtunded?
are they stuporous?
are they comatosed?
are they reacting to their environment?
are they just old and relaxing or young and investigating?
What are you looking at when observing their gait and posutre?
head tilt or flexion of the spine
What is important to take into account when doing a neurological exam?
signalment, what is normal for the patient and what isn’t, breed predispositions
What are you looking for when observing postural reactions?
proprioception
can the patient place their feet appropriately when moved around the room
can they feel
What cranial nerve reflexes can you perform?
menace
pupillary light reflex
gag reflex
palpebral reflex
What are you looking at when doing a sensory evaluation?
panniculus and deep pain perception
What is one of the most common neurlogical presentations?
gait abnormalities
What is a head tilt?
one ear is below the other
What is a head turn?
nose is turned towards the body
What is ventrofelxion of the neck?
a low head carriage
What are the 3 types of cruvature of the spine?
scoliosis
lordosis
kyphotic
What is decerebrate rigidity?
extension of all limbs, head and neck
What is decerebellate rigidity?
extension of the thoracic limbs, head and neck
What is lordosis?
arching upward of the spine
What is scoliosis?
curving of the spine
What is kyphotic?
arching downward ofthe spine
What are postural reactions?
proprioceptive positioning
hopping
visual placing
tactile placing
hemi-walking
wheelbarrowing
What is visual placing?
when picking patient up and moving them towards a table would expect them to place their paws down on the table as they can see where this is
What is tactile placing?
similar to visual placing but patients eyes are covered, when front of paws touch the table expecting them to place their paws down
What is hemi-walking?
lifting thoracic and pelvic limbs on one side either left or right and getting patient to walk one way then the other
What is wheelbarrowing?
lifting up both legs and getting them to walk forward or backward
Where are upper motor neurons located?
between the cerebral cortdex and spinal cord
What do lower motor neurons do?
connect to the CNS to the effector organand send a signal to make them connect
What would happen if the lower motor neurons were effected?
any existing reflexes that the patient still has will be weaker or absent, msucle tone reduced, decreased muscle mass and severe muscle atrophy
What does flaccid paresis or paralysis mean?
limbs are completely flaccids, no muscle tones, reduced reflexes
What would happen if upper motor neurons were effected?
reflexes will be stronger than normal,more exaggerated and easier to elict, some normally inhibited reflexes may become apparent, increase in muscle tone, chronic muscle atrophy
What does chronic muscle atrophy mean?
muscle atrophy that occurs over a longer period
What is a panniculus reflex?
testing skin reaction when pinched, going along the back as well
What are the spinal reflexes of the thoracic limbs?
- withdrawal reflex
- extensor carpi radialis reflex
- biceps brachii and triceps reflex
What are the pelvic limb reflexes?
- patella reflex
- cranial tibial and gastrocnemius
What other spinal reflexes are there that don’t affect the limbs?
- perineal
- panniculus
What is the cutaneous trunci reflex?
panniculus relfex, testing segmental nerves, spinal cord up to T1 and the lateral thoracic nerve
What is the cutaneous trunci reflex for?
localisation of a spinal lesion
What is deep pain?
when a aptient can feela noxious stimuli on their toes
What is deep pain negative?
patient cannot feel any pain at all within their toes (no reaction or withdrawal reflex with no additional reaction)
What are we looking for when performing a pain assessment?
reaction from the patient e.g turning, vocalising and trying to bite
What is occulcephalic reflex?
when you move the patients head and they track the correct way
What is miosis/miotic?
constricted pupils
What is mydriasis/mydratic?
dilated pupils
What is anasocoria?
asymmetric pupils
What does it mean if a patients pupil goes from miotic to mydriatic?
they are neurologically deteriorating
What does a mid-size fixed pupil that is unresponsive to light indicate?
grave prognsosis
What is paraparetic?
weak with some movement
What is non-ambulatory paraparesis?
cannot use their legs much but has good movement when supported
