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Nurs 203 > Neuro Assesment > Flashcards

Neuro Assesment Flashcards

1
Q

Health History Questions

12
HHDSTWINDDSE

A 
Headache
Head injury
Dizziness / vertigo
Seizures
Tremors
weakness
incoordination
Numbness or tingling
Difficulty swallowing
Difficulty speaking
Significant past history
Environmental / occupational hazards
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2
Q

Health History Questions

Headache Questions

A

PQRSTU

Ask if normal/changing

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3
Q

Health History Questions

Head injury

A

Have you had one?
Cause?
Loss of consciousness
Location

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4
Q

Health History Questions

Dizziness / Vertigo

A

 Vertigo- sensation of rotational spinning (objective vs. subjective)

 Syncope (fainting)- sudden loss of strength and temporary loss of consciousness

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5
Q

Health History Questions

Seizures questions

  • what is aura
  • what is postictal phase
A

Aura - subjective sensation that happens before (auditory, visual or motor)

how long
how often
medication
new or different
how long to regain
what happens

Post Ictal Phase? (altered state when you wake up, 5-10 minutes (longer for bad seizures) [Drowsiness, confusion, nausea, hypertension, headache or migraine, disorientation

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6
Q

Health History Questions

Tremors

A

Shaking

involuntary movement

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7
Q

Health History Questions

Incoordination

A

Balance

Trouble walking

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8
Q

Health History Questions

Numbness or tingling

-what is paraesthesia

A

Paraesthesia- an abnormal burning or tingling sensation

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9
Q

Health History Questions

Difficulty swallowing
-what is dysphagia

A

Dysphagia - difficulty swallowing

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10
Q

Health History Questions

Difficulty Speaking

  • what is Dysphasia
  • what is dysarthria
A

Dysphasia- difficulty speaking

Dysarthria- difficulty articulating / forming words

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11
Q

Additional Health History Questions

Infants and children

A 
Maternal health and neonatal period
Reflexes
Weakness and balance
Seizures
Physical and cognitive development
Family history
Environmental hazards
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12
Q

Additional Health History Questions

Older Adults 4

A

Risk for falls
Cognitive function
Tremor
Vision

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13
Q

Objective Data

3 Types of neurological Examinations

A

Screening neurological examination
-healthy individuals whose histories reveal no significant subjective findings

Complete Neurological examination
-Neurological concerns (headache, weakness, loss of coordination) or have signs of neurological dysfunction
[Cranial, motor, sensory, reflexes]

Neurological Recheck examination

  • hospitalized patient
  • periodic assessments on people with deficits
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14
Q

Physical Exam

A

Test Cranial Nerves and Palpate the Motor System
Assess Sensation
Test Reflexes

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15
Q

Physical Exam

Test Cranial Nerves

A

Test 12 Cranial Nerves

I = Olfactory = Oh
II = Optic = Once 
III = Oculomotor = one
IV = Trochlear = Takes
V = Trigeminal = The
VI = Abducens = Anatomy
VII = Facial = Final
VIII = Acoustic = A
IX = Glossopharyngeal = Good 
X = Vagus = Vacation
XI = Spinal Accessory = Seems
XII = Hypoglossal = Heavenly
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16
Q

Olfactory = I

Function, Type, Assessment

A 
Function: Smell (Olfaction)
Type: Sensory
Assessment:
o	Assess patency of nostrils
o	Assess smell of each nostril with opposite occluded & eyes closed
o	Possible smells: coffee, cloves, peppermint
o	Asnomia: decrease or loss of smell
o	Not routinely tested
17
Q

Optic = II

Function, Type, Assessment

A
  • Function: Vision
  • Type: Sensory
  • Assessment:
    o Visual acuity (Snellen chart)
    -The lower the denominator the worse your vision
    o Test visual fields by confrontation
    o Ophthalmoscope exam
18
Q

III = Oculomotor

Function, Type, Assessment

PERRLA

Nystagmus

Ptosis

A
  • Function:
    o Motor: movement of eyeball (EOM) & upper eyelid
    o Parasympathetic: pupil constriction, lens shape
  • Type: Mixed
  • Assessment:
    Pupils equal round react to light accommodation - Cardinal positions of gaze
    o Nystagmus- back & forth oscillation of the eyes
    o Ptosis- drooping of eyelids
  • Pupils = round, reactive to light and accommodation

*CNs III, IV & VI assessed together

19
Q

IV = Trochlear

Function, Type, Assessment

A
  • Function: movement of eyeball (down & inward)
  • Type: Motor
  • Assessment:
    o Cardinal positions of gaze
    o *CNs III, IV & IV assessed together
20
Q

V = Trigeminal

Function, Type, Assessment

3 areas (FCC)

Corneal reflex

A
  • Function:
    o Motor: Mastication (chewing)
    o Sensory: Sensations from face, scalp, cornea, nasal & oral mucosa
  • Type: Mixed
  • Assessment:
    o Motor:
     Palpate muscles of mastication (temporal & masseter) while pt clenches teeth
     Try to separate jaws by pushing on chin
    o Sensory:
     Test skin on 3 areas of face with cotton wisp (tests 3 divisions)
    • Forehead (ophthalmic)
    • Cheeks (maxillary)
    • Chin (mandibular)

Corneal reflex- omit unless abnormalities present (Do you close eyes when wisp touches it)

21
Q

VI = Abducens

Function, Type, Motor

A
  • Function: movement of eyeball (lateral)
  • Type: Motor
    o Assessment:
     Cardinal positions of gaze (6 lines, diagonal, and horizontal)
  • *CNs III, IV & VI assessed together
22
Q

VII = Facial

Function, type, assessment

A 
-	Function:
o	Motor: 
	Facial expression
o	Parasympathetic:
	Secretion of tears & saliva
o	Sensory: 
	Taste (ant. 2/3 of tongue)
-	Type: Mixed
-	Assessment:
o	Motor:
	Note mobility & facial symmetry:
•	Have pt raise eyebrows, show teeth, smile, puff out cheeks 
•	Press on puffed out cheeks (air escaping?)
o	Sensory:
	To test taste apply sugar, salt or lemon juice on tongue & ask pt to identify it
o	Not routinely tested
23
Q

VIII = Acoustic

Function, type, assessment

A
  • Function: Hearing and equilibrium
  • Type: Sensory
  • Assessment:
    o Whispered voice test
    o Tuning fork tests
    o Romberg
24
Q

IX = Glossopharyngeal

Function, type, assessment

A 
-	Function:
o	Motor: 
	Assists with swallowing & phonation
o	Parasympathetic: 
	Salvia secretion 
o	Sensory:
	Taste (post. 1/3 of tongue); gag reflex
-	Type: Mixed
-	Assessment:
o	Motor:
	Inspect pharynx- “Ahh” Observe uvula, soft palate, & tonsillar pillars
o	Gag reflex 
o	Voice
-	Sensory:
o	Too difficult to test

*CN IX & X are tested together

25
Q

X = Vagus

Function, Type, Assessment

Carotid Relfex

A 
-	Functions:
o	Motor: 
	Talking and swallowing
o	Sensory: 
	Sensations from pharynx
	Monitors BP, O2 & CO2 levels (carotid sinus & carotid body)
	Sensations from thoracic & abdominal organs
o	Parasympathetic: 
	Motility & secretion of GI organs
	Constrict lung passages
	Slows HR (carotid reflex)
-	Type: Mixed
-	Assessment:
o	Same as Glossopharyngeal (*CN IX & X are tested together)
26
Q

XI = Spinal Accessory

Function Type Assessment

A 
-	Function: 
o	Movement of head & shoulders (trapezius & sternomastoid muscles)
-	Type: Motor
-	Assessment:
o	Examine for equal size
o	Against resistance:
o	Rotate head
o	Shoulder shrug
27
Q

XII = Hypoglossal

Function, type, assessment

A 
-	Function: 
o	Movement of tongue 
-	Type: Motor
-	Assessment
o	Inspect tongue
o	Have pt stick out tongue
o	Ask pt to say: “light, tight, dynamite”
28
Q

Inspect and Palpate the Motor System

A

Muscles
Cerebellar Function
Coordinated and Skilled movements

29
Q

Inspect and Palpate the Motor System

Muscles 4

A

Size, strength, tone, involuntary movements

30
Q

Inspect and Palpate the Motor System

Cerebellar Function

Balance Test 4

A
  • Gait
  • Tandem walking (heal-to-toe)
  • Romberg test (Eyes closed, do you sway? Positive sign indicates cerebral Ataxia)
  • Shallow knee bend or hop in place
31
Q

Inspect and Palpate the Motor System

Coordinated and Skilled movements 4

A

Rapid alternating movements (knee tapping or touch fingers together

Finger-to-Finger test (nose to my finger)

Finger-to-Nose test (eyes closed, arms stretched, touch your index finger to nose)

Heel-to-Shin test (move your shin to ankle)

Failure = Cerebellar dysfunction

32
Q

Sensory System

o Ensure pt is alert, cooperative, comfortable, with adequate attention span
o Compare sensations bilaterally
o Avoid asking leading questions

Spinothalamic tract

Posterior column tract 3
(T is 5 tests)

A

Spinothalamic tract
 Pain, temperature, light touch
 Only assess temperature when pain is abnormal

Posterior column tract

Vibration
Position (kinesthesia)
Tactile discrimination

  • Stereognosis (3d objects)
  • Graphaesthesia (spelling letters in hand)

Two-point discrimination
o NR: 2-8 mm
• Extinction (touch two point on their body and say where it is)
• Point localization (touch them and say where it is)

33
Q

Test Reflexes 3

A

Deep Tendon Reflexes
- Clonus
Superficial Reflexes

34
Q

Test Reflexes

Graded on 5 point Scale (0-4)

A

4+: Very brisk, hyperactive with clonus, indicative of disease
3+: Brisker than average, may indicate disease
2+: Average, normal
1+: Diminished, low normal
0: No response

35
Q

Test Reflexes

Deep tendon Reflexes (5)
And what parts of spine do they test (cervical, Thoracic, Lumbar, Sacrum)

Abnormal:
Hyperflexia
Hypoflexia
Clonus

A

Biceps (c5 to c6) (blow to thumb on bicep)

Triceps (c7 to c8)

Brachioradialisis (forearm C5 to C6)

Quadriceps (patellar) (knee jerk L2 to L4)

Achilles (L5 to S2) (should plantar flex)

Hyperreflexia- an exaggerated reflex
Hyporeflexia- a reduced reflex
Clonus- a set of rapid, rhythmic contractions of the same muscle

36
Q

Test Reflexes

Superficial Reflexes 3
(normal/ abnormal for P)

Babinski Sign

A

Abdominal (Stroke upper[T8 to T10] and lower [T10 to T12], abs contract and belly button moves the way of stroke)

Cremasteric (L1 to L2, Stroke inner thigh, balls elevate)

Plantar (L4 to S2, Rub L from ankle up)

-Normal response
• = plantar flexion of the toes + inversion and flexion of the forefoot
 Abnormal response
• = dorsiflexion of the big toe + fanning of all the toes (a positive Babinski sign)
o This is normal only in infancy
o Past infancy indicates upper motor disease of the corticospinal tract

37
Q

Test Reflexes

Neurological Recheck (5 parts)

Deficit Patients

A

 Level of consciousness (LOC)
• Person, place, time
• A change in LOC is the most important factor
• If pt difficult to rouse, use progressive stimuli
 Motor function
• Check voluntary movement of each limb by giving specific commands
 Pupillary response
• Size shape, symmetry, reaction to light
 Vital signs

Glasgow Coma Scale

38
Q

Glasgow Coma Scale

3 areas and scale

A 
	Mostly widely used scoring system for altered level of consciousness
	Divided into 3 areas:
•	Eye opening
•	Verbal response
•	Motor response
	Numbers added with total score reflecting brain’s functional level
	Issues:
•	Can be subjective 
•	Patient that is non-verbal can not use this test
	Scoring: 
•	15 is normal
•	<7 = coma
•	<8 = intubate
39
Q

Abnormal Postures

Decorticate Rigidity
Flaccid Quadriplegia
Decerebrate Rigidity
Opisthotonos

A

Decorticate Rigidity
-Hemispheric lesion of cerebral cortex

Flaccid Quadriplegia
-Complete loss of muscle tone and paralysis of 4 limbs
Non-functional Brain stem

Decerebrate Rigidity

  • Lesion in brain stem at midbrain/upper pons
  • Worse than decorticate rigidity

Opisthotonos

  • Prolonged arching of back, with head and heels bent backward
  • meningeal irritation

Nurs 203 (15 decks)

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