FINALS NEURO Flashcards
● General behavior
● Stream of talk
● Mood
● Content of thought
● Intellectual capacity
● Sensorium
MENTAL STATUS
Visual acuity, visual confrontation test,
fundoscopy
Optic Nerve
pupils, palpebral fissures, extraocular muscles
Oculomotor nerve
trochlear nerve
abducens nerve
corneal reflex, facial sensation, muscles of mastication
Trigeminal nerve
Gross hearing, Weber’s and Rinne’s tests
Auditory nerve
phonation, swallowing/coughing
Glossopharyngeal nerve
gag reflex, palatal elevation
Vagus nerve
sternocleidomastoid and trapezius muscles
Spinal accessory nerve
Tongue protrusion, articulation
Hypoglossal
○ Posture/Gait
○ Somatotype, body symmetry
○ General activity
○ Tremors and other involuntary movements
○ Fasciculation
MOTOR SYSTEM
Muscle bulk, tone, tenderness
Palpation
○ Neck flexors, extensors
○ Shoulder flexors, extensors, abductors,
adductors
○ Elbow flexors, extensors
○ Wrist flexors, extensors
○ Finger flexors, extensors
○ Abdominal crunches
○ Hip flexors, extensor
○ Knee flexors, extensors
○ Ankle dorsiflexors, plantar flexors
Manual Muscle Strength Testing
Brain and spinal cord
CNS
A highly integrated and complex system divided into two parts:
the central nervous system (CNS)
Peripheral nervous system (PNS).
Neurologic system
Cranial nerves and spinal nerves
PNS
assessment gives the nurse a
detailed data regarding the patient’s health status
and self-care practices.
NEUROLOGIC ASSESSMENT
● Deep tendon reflex
● Physiologic reflex (as needed)
● Pathologic reflex
● Special reflexes (as needed)
REFLEXES
● Apraxias
● Agnosias
● Aphasias
HIGHER CORTICAL FUNCTION TESTS
Touch, pain, vibration, and position sense including
Romberg’s test
SENSORY
Maintains our motor equilibrium and calibration
of movements. It is an essential region of the
brain playing a central role in maintaining our
gait, stance, and balance, as well as the
coordination of goal-directed movements and
complex movements.
CEREBELLAR
Protect the brain and spinal cord.
MENINGEALS
The awareness of the person, self-awareness, as
well as awareness of his surroundings.
LEVEL OF CONSCIOUSNESS
o Mediated anatomically by ascending
reticular activating system (ARAS),
diencephalon, and the thalamus.
o is patient being aroused by a specific
stimuli
AROUSAL (Wakefulness)
o Anatomically in the cerebral hemisphere
o more concern on the function of the
cerebral hemispheres or the function of
lobes
AWARENESS (Content)
- A state of normality
- while you are listening, means you are alert;
Described qualitatively
Alert
Open eyes, answer questions and fall back
asleep.
Lethargic (Somnolent)
- Opens eyes to loud voices, responds slowly to
confusion, seems unaware of the environment. - State between wakefulness and stupor; blunted
and sleep-like, can be aroused by less vigorous
stimulation. then for stuporous patients.
Obtunded
Condition in which the patient is in a sleep-like
state but you are able to arouse the patient
using vigorous stimulation, the patient is still
able to make purposeful responses.
Stupor
- Patient may not be aroused by vigorous
stimulation
-
Sleep-wake cycle is abolished
Comatose
For clients who are at risk for rapid deterioration of
the nervous system.
GLASGOW COMA SCALE
GLASGOW COMA SCALE:
Highest grade u can give here is ____
Lowest score that you can give is ___
15
3
GLASGOW COMA SCALEL
Eye Opening -
Motor Response -
Verbal Response -
GCS =
4 points
6 points
5 points
3 - Deep coma
Reaction or posture of the patient when
pain/pressure is applied
ABNORMAL CEREBRAL RESPONSE WITH INC ICP
● Lesions in the corticospinal tract
- Hands are flexed
- Elbows are flexed
- Shoulders are adducted
- Knees are internally rotated
- Feet are plantar flexed
DECORTICATE POSTURING
● Lesions in the diencephalon, midbrain, or pons
- Adducted shoulders
- Elbows are extended
- Hands are internally rotated
- Palms are pronated
- Feet are plantar flexed
DECEREBRATE POSTURING
● Acting normally on his age, sex, or occupation?
● Dressed neatly, slovenly or appropriately for age
● and occasion?
● Immobile, catatonic, hyperactive, agitated, quiet?
● Mostly done through observations
OBSERVE FOR THE GENERAL BEHAVIOR
● Flow of speech
● Excessively talkative, frantic, anxiously speaking,
halting, forced, scarce, dysphonic, dysarthric,
aphasic, explosive, scanning?
OBSERVE STREAM OF TALK AND SPEECH
● Not directly asked, but observed.
● Observe facial expression and display of his
emotions.
OBSERVE FOR THE MOOD
Patient can shift mood from one
emotion to another
LABILITY
(Real external stimuli) Misinterpretation of
a real external stimulus (Like when there’s a rope in
the floor and the patient sees that as a snake)
Illusions
● Do you reach conversational goals when you ask
questions?
● Side-tracked or go off tangent spontaneously or
abruptly? (flight of ideas)
CONTENT OF THOUGHT
(No external stimuli) False sensory
perception, you do not have an external stimuli but
they are perceiving something (The patient is
looking at a thin air and the patient is seeing a
ghost)
Hallucinations
(A fixed false belief) You believe
someone is following him or her.
Delusions
General evaluation of patient’s intellectual capacity
from simple observation.
Note the educational level
INTELLECTUAL CAPACITY
● A function of alertness and focus
● Test: ask the patient to spell the word “world” or
“cat”. Then you may ask to spell the word
backwards. You may use the word “mundo” in
filipino
ATTENTION SPAN
● Three spheres (time, place, and person)
● “What is the complete date today?”
● “What day is today”
ORIENTATION
● Responsible Function with your hippocampus
● Test for Function of your declarative memory
MEMORY
Ask the patient to remember the
following words: “ball”, “flag”, “tree”, or “mangga”,
“mesa”, “pera”
Immediate recall
o When is your birthday/anniversary?
o Who is your grade 1 teacher
o What school did you go to in grade
school
Remote memory
Ask the patient to recall the 3
words you previously asked to remember
Short-term recall
“What did you have for breakfast
or lunch today”
Recent memory
● Involves the patient’s judgment in given critical
situation
● Refers to the patient’s recognition of his illness and
its implications
Main question: Can the patient recognize his or her
illness and its implications
INSIGHT AND JUDGEMENT
● Reflects the patient’s awareness of current events
or what is going on around him.
● “Who is the current president of the Philippines”
FUND OF INFORMATION
● Ask the client to close his/her eyes then SNIFF and
identify aromatic substances.
CN I: OLFACTORY - SMELL
o Inability to identify the correct scent
o Loss of smell because of trauma
Anosmia
● Visual Acuity
● Ask the client to read printed materials
● Visual field testing/visual confrontation test.
● Use a Snellen chart or Jaeger chart
● Check if there are any retinal pathologies
CN II: OPTIC - SIGHT
examining the eye; look for any papilledema (optic edema)
FUNDOSCOPIC EXAMINATION
your left eye is directly
inclined with your patient’s right eye. (if there are
cuts in a quadrant of your eyes)
VISUAL FIELD TESTING
pupillary light reflex
AFFERENT ARM OF THE REFLEX
● Assess the directions of gaze by asking the patient
to follow moving objects
● Pupillary light reflex and consensual light reflex
CN III: OCULOMOTOR - EYE MOVEMENT
Assess Directions of gaze by asking client to follow
moving object
CN IV & VI: TROCHLEAR AND ABDUCENS - EYE
MOVEMENT
CN V: TRIGEMINAL - SENSATION
THREE BRANCHES:
○ V1- Ophthalmic branch (Sensory)
○ V2- Maxillary Branch (Sensory)
○ V3 - Mandibular Branch (Sensory and Motor)
● Assess light touch and pain sensation across the
face
● Opening mouth against resistance and moving jaw
from side to side
CN V: TRIGEMINAL - SENSATION
Checking for symmetry, and furrows in the
nasolabial folds
Ask the client to identify a salty or sweet taste in
front of the tongue
CN VII: FACIAL - EXPRESSION AND TASTE
● Gross hearing
● Weber’s test - for lateralization of sound
● Rinne’s Test - Placing tip of the tuning fork in the
tuning fork
● Schwabach Test - Comparing the hearing of the
examiner and the hearing of the patient
● Vibratory sound laterized to good ear (sensorineural
loss)
● Air conduction longer than bone conduction
(sensorineural loss)
CN VIII: ACOUSTIC - HEARING
Observe the patient’s speech, articulation, tone
volume and quality of voice
Observe if there are any drooling of saliva
CN IX, X, AND XII:
GLOSSOPHARYNGEAL
VAGUS
HYPOGLOSSAL
Patient is able to perform sounds
which are produce by the movement of the tongue
Lingual Sounds
sounds produce with the
contraction of the throat
Glutaral sounds
● Sternocleidomastoid (Moves head from left to right)
● Trapezius muscle (ask the patient to shrug)
CN XI: ACCESSORY - MUSCLE MOVEMENT
Move the face to the opposite side (left side) -
Move the face to the right side -
Ask the patient to raise both shoulders and apply downward resistance -
STERNOCLEIDO (RIGHT)
STERNOCLEIDO (LEFT)
TEST FOR TRAPEZIUS MUSCLE (SHOULDER SHRUG)
Structures that concerns with function of the motor
system
○ Motor cortex
○ Thalamus
○ Cerebellum
○ Glacial Ganglia
You will have faulty function if the motor system has a problem most of these concerns with the function of the corticospinal
tract
Test for cerebellum function
○ Rubrospinal Tract
○ Vestibulospinal Tract
○ Reticulospinal Tract
Lower Motor Neurons
Muscles are strongest when acting from their
shortest position and weakest when acting from
their longest position
LENGTH-STRENGTH PRINCIPLE
Select movements that are neither too strong for
you to overcome nor too weak for you to judge
resistance
MATCHING PRINCIPLE
The muscle groups that supports the standing
posture, allows a person to move, walk, and leap
against gravity constitutes the antigravity muscle
system and are immensely stronger than the
antagonist
ANTIGRAVITY MUSCLE PRINCIPLE
● Have patient to cooperate
● “I’m trying to test how strong you are, Don’t let me
win”
Coordination with pt is needed to get the maximum
effort of the pt
ENGAGEMENT PRINCIPLE
Using a wisp of cotton, lightly touch alternate areas
of the arms, chest, abdomen comparing left to right
SENSORY TESTS
TEST LIGHT TOUCH
- No response/contraction areflexia
- Weak jerk/contraction hyporeflexia
- Fairly brisk jerk/contraction normoreflexia
- Excessively strong and brisk jerk
hyperreflexia - Strong jerks/contraction with rhythmic
or flapping tremors clonus
- 0
- 1+
- 2+
- 3+
- 4+
Using the blunt end of a pin, ask the patient to say
“sharp” or “dull”, depending on what he/she
perceives.
TEST FOR PAIN
● Using a test tube with warm or cold water of a
tuning fork.
TEST FOR TEMPERATURE
Ask the patient to stand with feet together EYES
CLOSE and you will be looking for any swaying or
instability with the patient’s posture. Be ready to
catch your patient if he or she falls.
ROMBERG TEST
Support the hand or foot. With the other hand grasp
the patient’s digit (fourth digit) by its side and wiggle
it up and down.
TEST FOR DIGITAL POSITION SENSE
● Using a tuning fork
● Apply the free end of the shaft to the fingernails and
toenails. Do this initially with the patient eyes open
as demonstration.
VIBRATORY SENSE
Connection of vestibular system and cochleo
modulo lobe of the cerebellum; if you have this
function this will result you as a nystagmus
VESTIBULOCEREBELLUM
Consist of connections in cutaneous and
proprioceptive information from the spinal cord to
the vermis and paravermis region of the cerebellum
SPINOCEREBELLUM
Connection between cerebral cortex and cerebral
hemisphere back to the cerebral cortex
CEREBROCEREBELLUM
Ask the patient to follow your finger directly towards
the lateral to the patient’s eye
NYSTAGMUS
Ask the patient to raise his/her arms and keep the
arms in a firm position.
REBOUND PHENOMENON
For truncal balance
Ask the patient to walk along a straight line with
steps very close to one another.
TANDEM GAIT
● Testing for signs of meningitis or inflammation
● Ability to move neck
PASSIVE MENINGEAL TESTING
● Focused more on the neck and legs
● Ask to lie down flex the hip or the knee joint around
90° angle with your one hand and lift the angle so
that the knee can be extended.
KERNIG’S MANEUVER
● Flexing the neck
● Ask the pt to lie down place your hand at the back
of the head and flex the neck forward
BRUDZINSKI’S MANEUVER
Close eye, then identify the number or letter you will
write with the back of the pen on their palm
GRAPHESTHESIA
Refers to the inability to recognize the form and
import of objects by touch.
ASTEREOGNOSIA
Ask the patient to close eyes and identify the object
you place in their hand, place a coin or pen in their
hand, repeat this with the other hand using different
objects.
STEREOGNOSIS
Is the inability to execute a previously learned skilled
movement which is not due to sensory of motor
dysfunction
APRAXIA
Loss of ability to use language or words due to
cerebral pathology.
APHASIA
Viewed as a deficit of self-awareness
ANOSOGNOSIA
