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ACUTE CARE MODULE 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

what are three key things to observe about the neuro patient prior to touching/talking to the patient?

A
  1. patient movements
  2. eye opening
  3. arousal state
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2
Q

what are two considerations for vitals with regards to neuro patients?

A
  1. many have orders to keep BP below a certain level

2. monitor ICP if appropriate

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3
Q

what does lethargic mean

A

drowsy and may fall asleep without stimulation

difficulty with attention, questions, or tasks

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4
Q

what does obtunded mean

A

difficult to arouse from a somnolent state and confused when awake

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5
Q

what does stupor mean

A

response only to strong, generally noxious stimuli and returns unconscious when stimulation ends

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6
Q

what does coma mean

A

unaroused by any type of stimulation

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7
Q

how should you assess arousal state?

A

assess changes with different positions such as sidelying and sitting and with different sensory cues

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8
Q

what is selective attention

A

ability to focus on one source of input

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9
Q

what are the four categories of attention that can be used to describe mental status in patients

A

selective, divided, sustained, switching

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10
Q

what are two strategies for assessing attention

A
  1. read a list of numbers and ask them to repeat back (7 is typical)
  2. read a list of letters and every time a letter A is read then tap the table
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11
Q

what should be considered before making a judgement about a patient’s cognition?

A

assess sensory status

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12
Q

related the following words: cognition, awake, and attention

A

if the patient is not awake, they cannot give you attention. If a patient is awake but doesn’t give you attention then they have poor cognition

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13
Q

when considering mental status, what are the steps to addressing the asleep patient

A
  1. gently nudge and if they wake continue and record their quality of awake-ness
  2. if they remain asleep, provide additional stimulus
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14
Q

when considering mental status in a neuro patient, what are the steps to addressing the awake patient

A

introduce yourself and then record their quality of awake-ness throughout the session

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15
Q

what is AOx4

A

who, when, where, why

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16
Q

what is a special sensory consideration for the neuro population?

A

vision

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17
Q

what is a special motor contribution for the neuro population and how does it impact PT

A

swallowing and speech - aspiration precautions

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18
Q

where are the five major supine pressure points for ulcers?

A

occiput, shoulder, elbow, sacrum, and heel

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19
Q

where are the five major sidelying pressure points for ulcers

A

ear, shoulder, greater trochanter, outer and inner knee, ankle

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20
Q

where are the five major wheelchair pressure points for ulcers?

A

scapula, sacrum, IT, heel, and ball of foot

21
Q

T/F: we perform CN exams

A

true, but not on every patient, every time, and certainly not if its already been done

22
Q

what are the three categories of sensory integrity

A

superficial, deep, and combined cortical

23
Q

what are three superficial sensory integrity tests

A

pain, touch, and temperature

24
Q

what are three deep sensory integrity tests

A

proprioception, kinesthesia, and vibration

25
Q

what are four combined cortical sensory integrity tests

A

stereognosis, tactile localization, two-point discrimination, and graphesthesia

26
Q

what are three important pre-requisites for testing sensory integrity

A
  1. pt must be able to follow instruction
  2. pt must be able to be oriented to the procedure
  3. need to minimize leading questions
27
Q

how do you test ROM in the neuro population

A

visual estimation/gross screen for active range; AAROM usually for treatment and PROM for sensory integration

28
Q

what are the two major upper extremities DTR’s and what root levels are tested

A

biceps (C5/6) and triceps (C6/7)

29
Q

what are the two major lower extremity DTR’s and what root levels are tested

A

quads (L2-4) and achilles (S1-2)

30
Q

what are superficial cutaneous reflexes

A

brief muscle contractions at the level of stimulus

31
Q

how do you perform a babinski, what roots are involved, and what is a positive result

A
  1. stroke from lateral plantar towards the toes and then across the ball of the foot
  2. S1/2
  3. toes extend/fan
32
Q

what is a primitive/tonic reflex we can assess in the lower extremity

A

flexor withdrawl reflex

33
Q

what can brainstem reflexes tell you

A

brain death status

34
Q

what is tone

A

resistance to muscle to passive elongation or stretch when an individual attempts to relax

35
Q

what three things should you do to assess for tone

A
  1. observe resting position of the limbs
  2. palpate the muscle belly
  3. passively move the joint
36
Q

what is hypertonicity

A

increase in muscle contractility due to lesion of CNS or UMN

37
Q

what is spasticity

A

a type of hypertonicity characterized by a loss of inhibitory control on LMNs causing VELOCITY DEPENDENT resistance to passive stretch

38
Q

what is hypotonia

A

decrease in muscle contractility due to a lesion of a LMN or spinal shock from an SCI

39
Q

what is dystonia

A

hyperkinetic movement disorder characterized by disordered tone and involuntary movement

40
Q

T/F: tone is affected by comorbidities

A

true: chronic stroke patients can have tone changes if they have the flu or a UTI for example

41
Q

what are common characteristics of UMN lesions

A
  1. spasticity
  2. heightened tendon reflexes (DTRs)
  3. clonus
  4. babinski
  5. dyssynergistic movement
  6. fatigue
  7. paresis
42
Q

what are common characteristics of LMN lesions

A
  1. decreased/absent tone
  2. paralysis
  3. atrophy
  4. decreased DTR
43
Q

what are three strategies to test strength in neuro patients

A
  1. MMT
  2. ASIA tool for SCI (myotomal assessment)
  3. functional activities and reps to fatigue
44
Q

how can you describe motor control clinically

A

type and quality of movement

45
Q

how can you describe types of movement

A

local or general - spontaneous, purposeful, involuntary, reflexive

46
Q

how can you describe quality of movement

A

symmetrical, smooth, jerky, coordinated

47
Q

how is coordination achieved

A

cerebellum generates a plan, carried by the basal ganglia, and in response to the DCML

48
Q

how is coordination characterized

A

speed, distance, direction, and timing

49
Q

what are goals for neuro patients (6)

A
  1. maximize safety and function
  2. normalize tone
  3. minimize unwanted movement
  4. improve trunk control
  5. prevent loss of ROM
  6. improve arousal/attention

ACUTE CARE MODULE 2 (9 decks)

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