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N143 > Module 6: Neurological > Flashcards

Module 6: Neurological Flashcards

1
Q

What are the developmental considerations for an infant assessment?

A
  • Neuro system not fully developed at birth – develops cephalocaudally, proximal to distal
  • Not yet myelinated: Don’t have full control over their motor fxn
  • Movements directed by reflexes
  • As the cerebral cortex develops during the first year, it inhibits these reflexes, and they disappear at predictable times.
  • Persistence of the primary reflexes is an indication of CNS dysfunction
  • Cranial nerves cannot be tested directly
  • The infant’s sensory and motor development proceeds along with the gradual acquisition of myelin because myelin is needed to conduct most impulses.
  • Sensation is rudimentary at birth. The newborn needs a strong stimulus and then responds by crying and with whole body movements.
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2
Q

What are the developmental considerations for an preschool and school-age assessment?

A

Observation of dress/undress/buttons
Importance of familiarity with developmental milestones
Test balance, fine motor skills
Lack of reliability in testing sensation in young children

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3
Q

What are the developmental considerations for older adults assessment?

A
  • 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
  • Decrease in sensation – touch, taste, pain, smell
  • Slowed reaction time, deep tendon reflexes less brisk
  • Loss of sense of position of big toe
  • Pupillary miosis, irregular pupil shape and decreased reflexes
  • Dizziness and loss of balance
  • Tremors, dyskinesia (abnormal involuntary movements)
  • May occur in the hands, head, and jaw with possible repetitive facial grimacing
  • Aging involves a progressive decrease in cerebral flow and oxygen consumption
  • Causes dizziness and loss of balance with position change should get up slowly
  • Difference in gait – risk for falls
  • What out for obstacle and uneven terrain
  • With memory loss in some, can be hard to diagnose an injury
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4
Q

What are the developmental considerations for a physical exam on an infant birth - 12mo

A

noting that milestones you normally would expect for each month

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5
Q

Milestones at birth:

A 
Newborn is very alert
Eyes open
Demonstrates strong, urgent sucking
Normal cry is loud and lusty
Next 2 or 3 days may be spent sleeping as the baby recovers from the birthing process
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6
Q

What would a behavioural assessment of the infant include?

A
  • spontaneous waking activity,
  • responses to environmental stimuli,
  • social interaction
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7
Q

Milestone at 2mo:

A

By 2 months: baby smiles responsively and recognizes the parents face

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8
Q

Milestone at 4mo:

A

At 4 months: babbling begins

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9
Q

Milestone at 9mo:

A

At 9 months: 1 or 2 words are used nonspecifically after 9 months

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10
Q

Can cranial nerves be tested on an infant?

A

The cranial nerves cannot be tested directly, but you can infer their proper functioning by the maneuvers shown in Table 25-1

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11
Q

What is dyskinesia?

A

abnormal involuntary movements

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12
Q

What is included in the subject data for neuro assessment?

A

1) Headache
2) Head injury
3) Dizziness/vertigo
4) Seizures
5) Tremors
6) Weakness
7) Incoordination (balance or walking)
8) Numbness or tingling
9) Difficulty swallowing
10) Difficulty speaking
11) Significant history
12) Environmental or occupational hazards

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13
Q

What is syncope?

A

is a sudden loss of strength, a temporary loss of consciousness (a faint), due to lack of cerebral blood flow, such as low blood pressure.

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14
Q

What is vertigo?

A

is a rotational spinning caused by neurological disease in the vestibular apparatus in the ear, or in the vestibular nuclei in the brain stem

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15
Q

What is Aura?

A

a subjective sensation that precedes a seizure and it could be auditory, visual, or motor.

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16
Q

Tremors?

A

Involuntary shaking, vibration, or trembling

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17
Q

Paresis?

A

is a partial or incomplete paralysis

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18
Q

Paralysis?

A

is a loss of motor function due to a lesion in the neurological or muscular system or loss of sensory innervation

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19
Q

Parethesia

A

an abnormal sensation, such as burning, tingling

Difficulty swallowing

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20
Q

Dysarthria

A

Difficulty forming words

21
Q

Dysphasia

A

difficulty with language comprehension or expression

22
Q

Dysphagia

A

difficulty swallowing

23
Q

Additional health history for infants and children:

A

1) Maternal health
2) Neonatal period
3) Reflexes
4) weakness and balance in late infancy
5) Family history
6) Seizures
7) physical development
8) Cognitive development
9) Environmental hazards

24
Q

Additional health history for older adults:

A

1) Risk for falls
2) Cognitive fxn
3) Tremor
4) Vision

25
Q

What does PERRLA stand for?

A

Pupils Equal, Round, Reactive to Light, Accommodation

- use a pen light to check

26
Q

What are the different types of neurological examinations for objective data?

A
  • Screening neuro exam,
  • complete neuro exam
  • neuro recheck exam
  • Inspect and palpate motor system
  • Cerebellar fxn
  • Sensory system
  • Assess reflexes
27
Q

What is a screening neurological examination used for?

A

an examination of seemingly healthy patient whose histories no significant subjective findings

28
Q

What is a Complete neurological examination used for?

A

an examination of patients who have neurologic concerns (e.g. heachache, weakness, loss of coordinations) or who have show signs of neurological dysfunction

29
Q

What is a neuro recheck exam used for?

A

an examination if patients demonstrate neurological deficits who require periodic assessments (e.g. hospitalized patients and in those in extended care)

30
Q

What is the sequence for neurological examination?

A

1) Mental Health Status
2) Test cranial nerves
3) Inspect and palpate motor system
4) Sensory system
5) Reflexes

31
Q

What are you inspecting and palpating all muscle groups of the motor system for?

A

Size, strength, tone, involuntary movement

32
Q

When assessing size of muscle groups…

A
  • compare bilaterally

- check for atrophy and hypertrophy

33
Q

When assessing strength of muscle groups…

A
  • test for power of muscle groups simultaneously
  • paresis: diminished strength
  • Paralysis
34
Q

When assessing tone of muscle groups…

A
  • contraction in voluntary muscle groups
  • ROM
  • pain with motion
  • Flaccidity: decreased resistance
  • Spasticity and rigidty: increased resistance
35
Q

When assessing involuntary of muscle groups…

A
  • Tic
  • tremor
  • fasciculation: flickering movement under the skin
  • myoclonus: jerky contraction
  • chorea: jerky affecting hips, shoulders, face
  • athetosis: writhering movements
36
Q

What is included in a cerebellar fxn test?

A

1) balance test
- Gait
- Romberg test
- Knee bend or hop (on both legs, one at time)
2) Coordination and skilled movements
- Rapid alternating movements (RAM)
- Finger to finger test
- Finger to nose test
- Heel to shin test

37
Q

What is Ataxia?

A

uncoordinated or unsteady gait

38
Q

Consideration when assessing sensory fxn:

A
  • Make sure patient is alert, cooperative, and comfortable and adequate attention span. Otherwise you may get inaccurate readings.
  • compare bilaterally
  • start from decreased sensation towards area of sensitivity
  • Patients eyes should be closed
39
Q

What does routine screening procedure for sensory fxn include?

A

superficial pain, light touch, and vibration in a few distal locations, and testing stereognosis.

40
Q

What assessments are included for sensory fxn?

A
  • Spinothalamic tract

-

41
Q

What does spinothalamic tract test for?

A

Pain
Temperature
Light touch

42
Q

Hypoalgesia:

A

decreased pain sensation

43
Q

Analgesia:

A

absent pain sensation

44
Q

Hyperalgesia:

A

Increased pain sensation

45
Q

Hypoaesthesia:

A

absent touch sensations

46
Q

Hyperaesthesia:

A

increased touch sensations

47
Q

What does posterior column tract tract test for?

A
  • vibration (with a tuning fork)
  • position (kinesthesia)
  • tactile discrimination
48
Q

What are the tests used for tactile discrimination? Stereognosis:

A

Stereognosis: Test the person’s ability to recognize objects by feeling their forms, sizes, and weights.

Graphesthesia: the ability to read a number by having it traced on the skin.

Two-point discrimination:

Extinction: Simultaneously touch both sides of the body at the same point. Ask the person to state how many sensations are felt and where they are

Point location:

N143 (10 decks)

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