Module 6- Neurological Assessment Flashcards
nerves carry fibres that can be separated into two parts. what are the two parts?
somatic and automatic
- somatic- innervate skeletal (voluntary) muscle
- automatic- innervate smooth (involuntary) muscle, cardiac muscle, and glands
what are the developmental considerations for infants?
- neurological system is not completely developed at birth
- motor activity in newborns is under control of spinal chord and medulla
- process of myelinization follows cephalocaudal order and proximal to distal order (head, neck, trunk and extremities)
- born with primitive reflexes
what are the developmental considerations for older adults?
- aging process causes a general atrophy with steady loss of neurons in brain and spinal chord
- causes a decrease in weight and volume with thinning of cerebral cortex, reduced subcortical brain structures, expansion of the ventricles
- neuron loss leads to many people 65+ with loss of muscle bulk, loss of muscle tone in face, decreased muscle strength etc.
- decreased muscle strength and impaired fine coordination
- slowed reaction time
- dizziness and loss of balance
list subjective data for neuro
- Headache
- Head injury
- Dizziness or vertigo
- Seizures
- Tremors
- Weakness
- Incoordination
- Numbness or tingling sensation
- Difficulty swallowing
- Difficulty speaking
- Significant past history
- Environmental and occupational hazards
what is additional history that you’d wanna know for infants and children?
- Maternal health
- Neonatal period (full term, premature? Any birth trauma?
- Reflexes
- Weakness and balance
- Seizures
- Physical development
- Environmental hazards
- Cognitive development
- Family history
what is additional history that you’d wanna know for older adults?
- Risk for falls
- Cognitive function
- Tremor
- Vision
what is normal for infants with their development?
- very alert, eyes open demonstrates strong, urgent sucking
- baby smiles responsively and recognizes the parents face
what is normal for preschool and school age children with their development?
- assess child’s general behaviour during play activities, reaction to parent, and cooperation with parent and with you
- note gait when walking and running
what is normal for older adults with their development?
- decrease in muscle bulk in hand- normal
- slower gait
what is the correct sequence for the abbreviated neurological examination?
- Level of consciousness
- Motor function
- Pupillary response
- Vital signs
describe LOC
- earliest and most sensitive index of change in neurological status
- note ease of arousal and state of awareness and orientation
describe motor function
-check voluntary movement of each extremity by giving specific commands
describe pupillary response
- note size, shape, symmetry of both pupils
- shine light into each pupil and note direct and consensual light reflex
- both should constrict
what is the glascow coma scale used for?
for patients with head trauma
- widely used scoring system for patients with altered level of consciousness in ICU
- GCS used to assess functional state of brain as a whole, not of any particular site in the brain
what are the 3 divided areas on the glascow coma scale?
- eye opening, verbal response, motor response
- each area is rated separately and patients best response is scored numerically
- 3 numbers are added; total score reflects brains functional level
what is the score of someone who is fully alert, normal patient?
15
what score reflects coma?
less than 7
what is flaccid quadriplegia?
a. Complete loss of muscle tone and paralysis in all four extremities
b. Indicating completely non functional brain stem
what is Opisthodomos
a. Prolonged arching of back with head and heels bent backward
b. Indicates meningeal irritation
what part in body regulates sensory function?
parietal lobe and spinal chord
what regulates movement?
frontal lobe (basal ganglia)
what regulates vital signs?
hypothalamus
what regulates motor coordination and equilibrium
cerebellum
what about nerve impulse and conduction?
grey matter of brain
what about motor and speech
wernickes area and brocas area
who does a initial full neuro exam?
doctor and then nurse can do the neuro re-check (LOC, motor function etc)
when the infant is lying supine and the head is turned to one side, the extremities on the same side straighten and the opposite size flex. This reflex is called?
The tonic neck
newborns are born with fontanelles, the anterior ones close at what age?
12-18 months
what does the nurse inspect for when checking pupils during this exam?
PERRLA
when administering the mini mental status exam, the nurse should consider what?
the client’s values, beliefs, cultural and educational background
whats the best way to assess for remote memory?
ask the patient about birthdays, anniversaries, social security numbers
what is the babinski reflex?
feet flare out
what is the moro reflex?
baby performs abduction as if falling
what number is the olfactory nerve and whats its function?
roman numeral 1 and sense of smell
what number is optic and whats its function?
roman numeral 2 and vision
what number is oculomotor and whats its function?
RN 3 and eyelid elevation and pupil reactions
what number is trochlear and whats its function?
4 and downward and lateral eye movements
what number is trigeminal and whats its function?
5 and facial and mouth sensation (chewing)
what number is abducens and whats its function?
6 and lateral eye movement
what number is facial and whats its function?
7 and facial expressions, taste, eyelid and lip closure
what number is vestibucochlear and whats its function?
8 and hearing and equilibrium
what number is glossopharyngeal and whats its function?
9 and gag reflex and swallowing
what number is vagus and whats its function?
10 and gag reflex, swallowing and speech sounds
what number is accesory and whats its function?
11 and shoulder movement and head rotation
what number is hypoglossal and whats its function?
12 and tongue movement
