Exam 4 Flashcards
Cerebral cortex
- center for highest functions
- thoughts, memory, reasoning, sensation, voluntary movement
Basal ganglia
- large bands of gray matter
- initiates/coordinates movement
Thalamus
main relay station for all senses
Hypothalamus
major respiratory center with basic vital functions
Cerebellum
- coiled structure under occipital lobe
- voluntary movements, equilibrium, mm tone
Brainstem
- central core of brain made of nn fibers
Spinal cord
- nervous tissue
- tracts that connect to brain and spinal nn
ANS communicates with
internal organs and glands
PNS
all nerve fibers outside CNS
Somatic nervous system
- communicates with sense organs and voluntary mm
- sensory and motor
Cranial nerve 1
olfactory - smell
Cranial nerve 2
optic - near and distant visual acuity, visual fields
Cranial nerve 3
Oculomotor
- EOM movements (6 cardinal positions)
- palpebral fissures
- PERRLA
Cranial nerve 4
trochlear
- EOM, palpebral fissure, PERRLA
Cranial nerve 5
trigeminal
- clench teeth, light touch on cheeks, forehead, chin
Cranial nerve 6
Abducens
- EOM movements, palpebral fissures, PERRLA
Cranial nerve 7
Facial: smiling, puffed cheeks, taste
Cranial nerve 8
vestibulocochlear: hearing
Cranial nerve 9
Glossopharyngeal
- uvula movement when patient says “ahh”
- gag reflex
Cranial nerve 10
vagus
-uvula movement when patient says “ahh”
- gag reflex
Cranial nerve 11
spinal accessory - shoulder shrug
Cranial nerve 12
hypoglossal - tongue symmetry
Nerve mnemonic
our old oak table top adds fun and gaudy vibes some holidays
Cranial nn function mnemonic
some say marry money but my brother says bad bitches marry money
AAOx4
alert to person, place, time, situation
Cranial nn III, IV, VI assessment
- eye movements
- pupillary light reflex
- PERRLA
- 6 cardinal positions
Increased intracranial pressure causes
sudden, unilaterally, dilated, and nonreactive pupils
Ptosis can occur with
myasthenia gravis or dysfunction of cranial n 3
Strabismus
deviated gaze or limited movement
Nystagmus
can occur with disease of visibular system, cerebellum, or brainstem
Cranial n. VII assessment
Note mobility and facial symmetry
- smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks
Abnormal facial n findings
loss of movement or asymmetry
- can occur with stroke or bells palsy
Cranial n. VIII assessment
test hearing by ability to hear normal conversation
Cranial nn IX, X assessment
- depress tongue with blade and say “ahhh”
- uvula and soft palate should rise midline
- tonsils should move inward
- absence of symmetry could mean stroke and risk of aspiration
Cranial n XII assessment
- have patient stick out tongue
- no tremors, midline
Cranial n XI assessment
- examine sternomastoid and trapezius mm for equal size and strength
- ask patient to rotate head against resistance applied to chin
- ask patients to shrug shoulders against resistance
- mm weakness could occur from stroke or peripheral n damage
Assessing gait
should be smooth and effortless
Romberg test
- pt. stands with feet together arms at side
- have them close eyes and balance
Positive romberg test can occur with
multiple sclerosis, intoxication, loss of proprioception, poor vestibular function
Assessing pain/sensation
tested using dull and sharp side randomly on extremities x4
- patient should distinguish sharp or dull
Assessing sensation
patient identifies random object placed in hands
Astereognosis
inability to identify object correctly - can occur in stroke
Deep tendon reflex testing
- short snappy blow of hammer onto tendon
- usually patellar/quadriceps
- right and left should have equal response
DTR ranking
0 = no response
1+ = diminished
2+ = average, expected
3+ = brisker than average
4+ = very brisk, hyperactive (disease)
Plantar reflex testing
- position thigh in slight external rotation
- draw slow stork up lateral side of sole of foot and inward across the ball of foot
Plantar reflex testing: expected
plantar flexion of toes and inversion of foot
Plantar reflex testing: abnormal
babinski signs - dorsiflexion and fanning of toes
- occurs with brain injury, stroke, brain tumor, MS, spinal cord injury
Joints
- union between 2 bones
Fibrous joints
- united by fibrous tissue or cartilage
- immoveable
- skull sutures
Cartilaginous joints
- separated by fibrocartilaginous discs
- slightly moveable
- vertebrae
Synovial joints
- freely moveable
- joint cavity lined with synovial membrane
Cartilage
- avascular, tough, firm, flexible
- absorbs shock and allows for movement
Ligaments
- connect bone to bone
- stabilize bones and limits movemente
Bursae
- fluid filled sacs that cushion bones and ligaments
- located in areas of potential friction
Tendons
connect mm to bone, strong fibrous cord
MM makes up how much body weight
40-50%
Swelling in musculoskeletal indicates
joint irritation, excess joint fluid, inflammation, bony enlargement
Subluxation
two bones in joint stay in contact but misaligned
Contracture
shortening of mm leading to limited ROM
Ankylosis
stiffness or fixation in joint
Warmth + tenderness of musculoskeletal means
inflammation
5+ mm grade
full ROM against gravity, full resistance, normal
4+ mm grade
full ROm against gravity, some resistance, good
3+ mm grade
full ROM with gravity, fair
2+ mm grade
full ROM with gravity eliminated, passive motion, poor
1+ mm grade
slight contraction, trace
0 mm grade
no contraction, zero
Crepitation
audible/palpable crunching or grating accompanying movement
ROM assessment
- start with active motion
- passive motion if limitations are assessed
- should be equal bilaterally
TMJ ROM
- place fingers in front of ears and have person open and close mouth then clench jaw
- should feel smooth movement
TMJ dysfunction
crepitus and pain during movement or chewing
- tenderness with palpation
Cervical spine ROM - flexion
touch chin to chest
Cervical spine ROM - extension
lift chin to ceiling
Cervical spine ROM - lateral bending
touch ears to shoulders
Cervical spine ROM - rotation
turn chin towards shoulder
Shoulders ROM - internal rotation
rotate arms internally behind back
Shoulders ROM - external rotation
touch both hands behind head
Shoulders ROM - abduction
with arms at sides, raise both arms, touch palms together above head
Shoulders ROM - adduction
move arms back down in front of body
Elbow ROM - flexion/extension
bend and straighten elbow
Elbow ROM - pronation/supination
hold hand on table, front and back sides to table
Hands and wrist ROM - extension
bend hand up at wrist
Hands and wrist ROM - flexion
bend hand down at wrist
Hands and wrist ROM - ulnar deviation
with palms flat, turn them outward and in
Hands and wrist ROM - abduction
spread fingers apart
Hands and wrist ROM - adduction
tight fist
Hands and wrist ROM - phalen test
hold both hands back to back
- if patinet has carpal tunnel it willll cause numbness and burning
Hips ROM - flexion (90 degrees)
raise leg with knee extended
Hips ROMS: flexion 120 degrees
bend knee and raise leg while other leg remains straight
Hips ROM - internal and external rotation
flex knee and swing foot outward and inward
Hips ROM - abduction and adduction
swing leg laterally, then medially
Ankle/Foot ROM - plantar flexion
point toes to floor
Ankle/Foot ROM - dorsiflexion
point toes to nose
Ankle/Foot ROM - eversion
turn soles of feet out
Ankle/Foot ROM - inversion
turn soles of feet in
Spine ROM: flexion
bend foward and touch toes
Spine ROM: extension
bend backwards
Spine ROM: lateral bending
bend sideways
Spine ROM: rotation
twist shoulders
Mental status is
emotional and cognitive function
First sign of impending health crisis
change in mental status/LOC
Mental health
state of well-being where they realize their potential, can cope with stress, work productively, and contribute to community
Mental disorder
clinically significant syndrome associated with distress or disability
Organic disorder
caused by brain disease of known specific organ cause
Examples of organic disorders
delirium, dementia, intoxication, withdrawal
Psychiatric mental disorder
an organic etiology has not yet been established
Consciousness
awareness of one’s own existence, feelings, thoughts
Language
using voice to communicate
Mood
durable, prolonged display of feelings that color the whole emotional life
Affect
temporary expression of feelings or state of mind
Orientation
awareness of objective world in relation to self
Attention
power of concentration, ability to focus on one thing
Memory
ability to store experiences and perception for later recall
Abstract reasoning
deeper meaning beyond the literal
Perceptions
awareness of object through the 5 senses
Flat affect
lack of emotional response
Inappropriate affect
emotional reaction inappropriate for the situation
Depersonalization
loss of identity
Elation
joy and optimism, overconfidence, increased motor activity, not necessarily pathologic
Euphoria
- excessive well being
- can be inappropriate
- implies a pathologic mood
Ambivalence
opposing emotions toward something
Liability
rapid shift of emotions
Mental status is inferred by assessing…
appearance, behaviors, cognition, thoughts (ABCT)
Factors that could affect mental health interpretations
- illness
- current medications
- education and behavioral level
Components of assessing appearance
posture, body movements, dress, grooming and hygiene, pupils
Body movements that signal anxiety
restless, fidgety
Body movements that signal depression and dementia
apathy, psychomotor slowing
Body movements that signal schizophrenia
abnormal posturing, bizarre gestures
Body movements suggesting pain
facial grimacing
Body movements suggesting neurological disorders
involuntary tics
Meticulous dress may indicate
OCD
Inappropriate dress/poor hygiene may indicate
alzheimer’s
Unilateral neglect of grooming may suggest
stroke
Unexpected LOC
loses track of conversation, falls asleep, lethargic, confused
Unexpected speech findings
dysphonia, uncommunicative, dysarthria, inability to find words
Components of assessing behavior
LOC, facial expression, speech, mood and affect
Components of assessing cognition
orientation, attention span, recent memory, remote memory, new learning
Disorientation may indicate
delirium or dementia
Recent memory deficit causes
delirium, dementia, alcoholism
To test recent memory, ask the patient
what they ate in the last 24 horus
To asses remote memory, ask the person about
past birthdays, anniversaries, historical events
Remove memory loss occurs in
alzheimer’s and dementia
Test new learning by
recalling 4 words
Components of assessing thoughts
thought process, thought content, perceptions
Screening for depression
- patient health questionnaire (PHQ-2)
- 2 questions
- move to full PHQ-9 if patient answers several days
LOC: alert
- awake, readily aroused, orientated
- aware of external + internal stimuli
- respond appropriately
- meaningful itneraction
LOC: lethargic
- not fully alert
- drifts to sleep when not stimulated
- can be aroused to named when called in normal voice
- looks drowsy
- responds appropriately to questions but thinking is slow/fuzzy
- inattentive, loses train of thought, decreased spontaneous movements
LOC: obtunded
- transitional state between lethargy and stupor
- sleeps most of time
- difficult to arouse - needs loud shout or vigorous shake
- confused when aroused
- monosyllable conversation
- speech may be mumbled/incoherent
- requires constant stimulation for marginal cooperation
LOC: stupor/semi-coma
- completely unconscious
- no response to pain or stimuli
- light coma has some reflex activity
- deep coma has no motor response
LOC: delirium
- clouding of consciousness, inattentive, incoherent conversation
- impaired recent memory
- agitated, visual hallucinations, disorientated, confusion worse at night
Glascow coma scale
- accurate, reliable, quantitative tool for testing consciousness
- looks at functional state of brain as a whole
- measures eye opening, verbal response, motor response
Glascow score < 7
coma
Glascow score of 15
fully alert normal person
Galscow coma scale: eye opening response
spontaneous = 4
to speech = 3
to pain = 2
no response = 1
Glascow coma scale: motor response
obeys verbal command = 6
localizes pain = 5
flexion - withdrawal = 4
flexion - abnormal = 3
extension - abnormal = 2
no response = 1
Glascow coma scale: verbal response
oriented x 3 - appropriate = 5
conversation confused = 4
speech inappropriate = 3
speech incomprehensible = 2
no response = 1
Delirium is an
acute confusional state, potentially preventable in hospitalized persons
Delirium characteristics
disorientation, illusions, hallucinations, defective memory, agitation, inattention
Dementia definition
chronic progressive loss of cognitive and intellectual function
Dementia characteristics
- perception and consciousness are intact
- disorientation, impaired judgment, memory loss
Depression definition
long-term depressed mood > 2 weeksD
Depression characteristics
lack of pleasure, sleep and appetite disturbance, hopelessness, guilt, sadness, despair, suicidal ideation
Delirium onset
sudden, hrs to days
Dementia onset
over months
Depression onset
may be gradual with exacerbation during crisis
Delirium cause/contributing factors
hypoglycemia, fever, dehydration, hypotension, infection, adverse drug reactions, head injury, change in environment, pain, stress, substance abuse
Dementia cause/contributing factors
alzheimer’s, vascular disease, immunodeficiency, virus, neurologic disease, alcoholism, head trauma
Depression cause/contributing factor
loneliness, crises, declining health, medical conditions
Delirium cognition
impaired memory, judgment, calculations, attention span, fluctuates during the day
Dementia cognition
impaired memory, judgment, calculations, attention span, abstract thinking, agnosia
Depression cognition
difficulty concentrating, forgetfulness, inattention
Delirium LOC
altered
Dementia LOC
not altered
Depression LOC
not altered
Delirium activity levels
- increased or reduced
- sundowning
- reversed sleep/wake cycle
Dementia activity level
- not altered
- sundowning
Depression activity level
- usually decreased
- lethargy, fatigue, no motivation
- poor sleep, wake up early
Delirium emotional state
- rapid swings, fearful, anxious, suspicious, aggressive
- hallucinations, delusions
Dementia emotional state
flat, agitation
Depression emotional state
extreme sadness, apathy, irritability, anxiety, paranoid, ideation irritability
Delirium speech and language
rapid, inappropriate, incoherent, rambling
Dementia speech and language
incoherent, slow, inappropriate, rambling, repetitions
Depression speech and langauge
slow, flat, low
Delirium prognosis
reversible with proper and timely treatment
Dementia prognosis
not reversible, progressive
Depression prognosis
reversible with proper and timely treatment
The greatest influence on health status is
poverty
