Ch 25. Neurological Flashcards
Nervous system 2 parts
Central nervous system (CNS)
Peripheral nervous system (PNS)
Cerebral cortex lobes
Frontal lobe
Parietal lobe
Occipital lobe
Temporal lobe
Ex of Sensory receptors:
Skin Mucous membranes Muscles Tendons Viscera
sensory receptors monitor
Conscious sensations
Internal organ functions
Body positions
Reflexes
4 types of reflexes
deep tendon
superficial
visceral
pathological
Cranial Nerve #
Spinal nerves #
12 pairs of cranial nerves
31 pairs of spinal nerves: 8 cervical, 12 thoracis 5 lumbal, 5 sacral, 1 coccyx
Developmental Considerations: Older Adults
- General atrophy and loss of neurons in brain and spinal cord
- Decrease in weight and volume of brain
- Decreased muscle strength and impaired fine coordination – sensations may be diminished.
- Slowed reaction time
- Dizziness and loss of balance
- Decrease in muscle bulk seen in hand
- Benign tremors (senile tremors)
- Dyskinesias
- Difference in gait
- Loss of ankle jerk
- DTRs less brisk
Subjective Data: Health History
Headache Head injury Dizziness or vertigo Seizures Tremors Weakness Incoordination Numbness or tingling Difficulty swallowing Difficulty speaking Significant past history
Older adults Risk for falls Cognitive function Tremor Vision
Stroke Prevention: common symptoms
Most common symptoms
- Sudden weakness or numbness in face, arms, or legs, especially on one side of the body
- Sudden confusion, trouble speaking or understanding speech
- Sudden changes in vision
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no reason or explanation
Less common symptoms
- Sudden nausea or vomiting
- Brief loss of consciousness, including fainting
Modifiable risk factors for stroke
Cardiovascular disease (CHD, HF, PAD) Hypertension Smoking/second-hand exposure Diabetes Atrial fibrillation Other cardiac conditions Dyslipidemia Asymptomatic carotid stenosis Sickle cell disease Postmenopausal hormone therapy Diet and nutrition Inactivity Obesity (fat distribution) History of TIA
Stroke Prevention
Diet Limit sodium intake Moderate exercise Maintain healthy weight Smoking cessation Limit alcohol intake Manage underlying medical conditions
Objective: Test Cranial Nerve II (optic)
Visual acuity
Visual fields (confrontation, cover one eye they cover the other)
Examine ocular fundus, determine the colour, size, shape of the optic disc
Objective: Test Cranial Nerve III, IV, VI (oculomotor, trochlear, abducens)
Pupils (PERRLA) – Pupis, equal, round, reactive, light and accommodation
Assess extraocular movements (diagnostic positions test)
Are they equal strong in each side against resistance?
Objective: Test Cranial Nerve V (trigeminal)
MOTOR FUNCTION
Assess muscles of mastication with teeth clenched
Try to separate jaw by pushing down on chin
Clenth teeth and palpate the tempral and masseter muscles
SENSORY FUNCTION
Light touch
Corneal Reflex – touch coreal area with bit of cotton and it should automatically close.
Only do this if persons unconscious/make sure no contacts in eye
Distinigish between sharp and dull (on all areas of face) (sensory)
Soft touch: piece of cotton
3 points of touch: ophthalmic, maxillary, mandibular
Objective: Test Cranial Nerve VII (facial)
MOTOR FUNCTION
Mobility and symmetry
Frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth, puff cheeks- then press puffed cheeks in… note whether air escapes equally from both sides, smilling
SENSORY FUNCTION
Test Taste (not routinely tested)
Sugar, salt, lemon
Objective: Test Cranial Nerve VIII acoustic (vestibulocochlear)
Whispered voice test
Webber, rene test
Objective: Test Cranial Nerve IX, X (glossopharyngeal, vagus)
MOTOR FUNCTION Depress tongue with tongue blade, have Pt say “ahhh” Gag reflex Assess voice Get person to swallow
SENSORY FUNCTION Taste test (on posterior 1/3 of tongue, too difficult to test)
Objective: Test Cranial Nerve XI (spinal accessory)
Motor
Shrug shoulders/turn head from side to side with rististance
No shakiness, equal strength, no droopiness, good symmetry
Examine the sternomastoid and trapezius muscles for equal size
Check strength
Objective: Test Cranial Nerve XII (hypoglossal)
Inspect the tongue
Have pt. stick tongue out
Have pt. say “light, tight, dynamite”
Note the sounds of L, T, D, N
Test Cerebellar function: Balance tests
Gait
Tandem walking
Romberg test
Shallow knee bend
Test Cerebellar function: Coordination and skilled movements
Rapid alternating movements
Finger-to-finger test
Finger-to-nose test
Heel-to-shin test
Tests for Spinothalamic tract
Pain
Temperature
Light touch
Test for Posterior column tract
Vibration
Position (kinesthesia)
Tactile discrimination (fine touch)
Reflexes are graded in 5 point scale.
4+ hyperactive/very brist 3+ brisker than average 2+ normal 1+ diminished/low response 0 no response
Test the stretch (deep tendon) reflexes
Biceps reflex Triceps reflex Brachioradialis reflex Quadriceps (patellar; “knee jerk”) reflex Achilles (“ankle jerk”) reflex
Test the superficial reflexes
Abdominal reflex
Cremasteric reflex
Plantar reflex
Neurological recheck
Level of consciousness
Orientation
Motor function (are they moveing spontaneous or just to pain?)
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)/Canadian Neurological Scale (CNS)
