Neuro Flashcards
What are some general questions you might want to ask your pt as part of the neuro exam?
- Have you ever had a sz, stroke, or paralysis?
- have you ever been diagnosed as having a tremor or parkinsons dx?
- have you ever had numbness, tingling, or “pins-and-needles” in your arm or leg that has lasted more than 2 hours?
- Have you ever had nerve injury, MS, or any other nervous system disease?
- Have you had migraine HAs?
- Have you been working at your usual jobs or activities?
- there are more…..also ask more clarifying questions if they answer yes
What is your goal for the pre-op neuromuscular assessment?
Why is this importnat?
- Goal to determine range of motion, any abnormalities or joint problems
- This is important b/c we will take away the normal protective pain reflexes with anesthesia
- dont want to injur them further
How do you assess the temporomandibular joint?
- Place tips of index finger just in front of the tragus of ear, ask pt to open mouth
- fingertips should drop into joint spaces as mouth opens
- check for smooth range of motion, swelling/tenderness
- snapping and clicking is normal
- ask pt to open and close mouth, protrude and retract jaw and side to side
How do you assess the cervical spine?
- Flexion- chin to chest
- extension- look up
- rotation
- lateral bending
How do you assess the shoulder girdle?
- abduct the arms to shoulder level
- raise arms vertical position above head, palms facing each other
- place both hands behind the neck with elbows out to side
- place both hands behind the small of back
What is thoracic outlet syndrome?
why do we care about this?
- compression of brachial plexus and subclavian vessels near the first rib
- be certain pt can work or sleep with arms elevated over their head before putting arms beside head
- we care because arms are better above head for prone positioning
How do you assess the pts elbow?
- ask pt to bend and straighten elbow
- with arms at sides and elbows flexed instruct pt to turn palms up (supination) and down (pronation)
How do you assess the hip?
- focus on ROM that will affect positioning
- Flexion: supine pt bends each knee to chest/abdomen
- abduction: supine pt, stabilize anterior superior iliac spine and abduct the extended leg until the iliac spine moves, this is their limit!
How can you assess the nervous system?
- mental status
- speech
- cranial nerves
- gait
- motor function
- sensory function
How do you assess cranial nerves
I
II
III
- CN I: (olfactory) have them smell something; vanilla or mint
- CN II: (optic)
- sight confrontation test- stand in front of pt, both covering mirrored eye, bring finger in from the periphery, both should see it at same time
- pupillary reaction to light
- CN III: (oculomotor) pupillary reaction to light, look for extraoccular movements
How do you assess cranial nerves
IV
V
VI
- CN IV: (trochlear) look for extraoccular movements
- CN V: (trigeminal)
- ask pt to clench teeth as you paplate temporal muscles
- check sensation (see pic)
- corneal reflex with cotton ball
- CN VI: (abducens) look for extraoccular movements
How do you assess Cranial nerve VII?
- CN VII- Facial
- have pt raise both eyebrows
- frown
- close eyes tightly so you cant open them
- show teeth
- smile
- puff out cheeks
How do you assess cranial nerves
VIII
IX & X
- CN VIII ( acoustic)- this is done by audiology
- CN IX & X ( glossopharyngeal and vagus)
- listen for voice hoarseness
- gag reflex
- say AHHH, palate should rise symmetrically
How do you assess Cranial nerve
XI
XII
- CN XI: (spinal accessory)
- have pt turn their head side to side against your hand
- ask pt to shrug both shoulders up against your hand
- CN XII: (hypoglossal)- ask them to stick out tongue
How is the assessment of muscle strength graded?
- test flexion and extension and compare symmetry
- Grade 0-5 scale
- 0- no muscle contraction detected
- 1- barely detectable
- 2- active movement with gravity eliminated
- 3- active movement against gravity
- 4- active movement against gravity with some resistance
- 5- active movement against gravity with full resistance
Weakness or change in elbow flexion would indicate an injury at ___, ___
elbow extension ___, ____, ____
flexion: C5, C6
extension: C6, C7, C8
A changed or weaked grip strength would indicate injury at ____, ____, _____
- C7, C8, T1
A change or weakness in finger abduction would indicate an injury where?
C8, T1, ulnar nerve
