LESSON 10 NEUROLOGICAL ASSESSMENT Flashcards
2 REGION OF NERVOUS SYSTEM
Central Nervous System (CNS)
Peripheral Nervous System (PNS)
Cerebrum consist of what ?
right and left hemispheres, frontal, parietal, occipital & temporal lobes
(thalamus and hypothalamus) body temp, sleep
Diancephalon
position sense, posture & equilibrium/balance
Cerebellum
(medulla oblongata, pons & midbrain) resp. & cardiac regulation, sneezing
Brain stem
somatic sensory center
Parietal
higher intellect, speech production, personality, behavior, emotions, voluntary movement
Frontal
hearing, memory, speech perception and translation
Temporal
Vision
Occipital
Consist of Cervical, thoracic, lumbar nerves
Spinal roots
Responsible for motor roots
anterior
responsible for sensory roots
posterior
damage to posterior roots
loss of sensation
damage to anterior roots
flaccid paralysis
External environmental information received and transmitted through?
Peripheral nervous system
number of spinal nerves in
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
cervical 8 pairs C1-C8
Thoracic 12 pairs T1-T12
Lumbar 5 pairs L1-L5
Sacral 5 pairs S1-S5
Coccygeal 1 pair Coccyx
-Rapid involuntary predictable motor response to a stimulus.
-Reflex arc, is not dependent on the brain.
Reflex
Skeletal muscle contraction
Somatic
Cardiac, smooth muscle and glands
autonomic
Three basic types of neurologic examination
Screening neurologic exam
Complete neurologic exam – neurologic concerns
Neurologic recheck exam
consideration for assessment
Assess mental status first
Equipment
Eye charts, tuning fork, pen light, reflex hammer, key, buttons, coin, big safety pin
eye opening (GCS)
SPONTANEOUS 4
TO SOUND 3
TO PAIN 2
NEVER 1
motor response (GCS)
obeys command 6
localizes pain 5
normal flexion (withdrawal) 4
abnormal flexion 3
extension 2
none 1
verbal response
oriented 5
confused conversations 4
inappropriate words 3
incomprehensible sound 2
none 1
GCS is used to evaluate patients with
traumatic brain injury
altered mental status
GCS measures what categories
eye opening (e)
motor response (m)
verbal response (V)
formula for GCS score
e + v + m
GCS SCORE INTERPRETATION
13-15 MILD HEAD INJURY
12-9 MODERATE HEAD INJURY
BELOW 8 SEVERE HEAD INJURY
(mental status) Physical appearance, dress, grooming, hygiene
Appropriate for age, sex, culture, season, setting
(mental status) Behavior and affect, facial expression
Depressed, hostile, euphoric, fearful, flat/dull
third type of mental status
Assess thought content/process
speech language
Quality
Rate
Volume
Fluency – Abnormal patterns
difficulty/discomfort in talking (laryngeal disease)
aphonia/dysphonia
distorted speech sounds, may sound unintelligible, basic language intact
cerebellar dysarthria
a language disorder that affects how you communicate. It’s caused by damage in the area of the brain that controls language expression and comprehension.
Aphasia
can understand but can’t speak
Broca’s aphasia
absent/reduced speech and comprehension
global aphasia (expressive)
can’t understand but can speak
Wernicke’s aphasia (receptive)
Producing speech are of the brain (broca’s area)
frontal lobe
understanding and processing speech are of the brain (wernicke’s area)
temporal lobe
Perceptions
Illusions/delusions
Hallucinations
Ability to make a decision/judgment
Insight
Though process and perception
Ask to repeat 3-4 unrelated words (cognitivge abilities and mentation)
immediate memory
Ask who “I” am, last meal, last visitor (cognitive abilities and mentation)
recent memory
Ask the birthday, anniversary, last President, favorite President (cognitive abilities and mentation)
remote memory
Meaning of a proverb, simple math (cognitive abilities and mentation)
abstract reasoning and skills