Neuro Assessment Flashcards
1
Q
Primary sensory area
A
Post central gyrus
2
Q
Personality behavior Emotion Intellectual function Abstract thought Motor, attention, concentration Brocas- expressive motor aphasia Impulse control, social & sexual behavior
A
Frontal lobe
3
Q
Motor speech
A
Broca area
4
Q
Hearing Taste Smell Wernicke understanding speech Deja vu memory
A
Temporal lobe
5
Q
Sensation
Differentiation of size, shape, color
Visual and spatial perception
Integration of different concepts that allows for understanding of single concept
A
Parietal lobe
6
Q
Speech comprehension
They do word salad
For pt w/ Wernicke’s aphasia – ACT OUT WORDS – DRAW WORDS
•Individuals with Wernicke’s aphasia speak in long, uninterrupted sentences
• Reading ability is diminished, and although writing ability is retained, what is written may be abnormal
• Speech is preserved but language content is incorrect
o This may vary from the insertion of a few incorrect or nonexistent words to a profuse outpouring of jargon.
A
Wernickes aphasia
7
Q
Visual reception
A
Occipital lobe
8
Q
Motor coordination
Equilibrium balance
A
Cerebellum
9
Q
Mood changes Inability to plan sequence of complex moves changes in social behavior Difficulty with problem solving Loss of thought flexibility
A
Injury to frontal lobe
10
Q
Inability to express language
Motor speech
A
Broca’s aphasia
11
Q
Gyrus
Primary motor area
A
Pre central
12
Q
Inability to attend more than one object at a time, name an object or locate the words for writing
• problems reading
• difficulty distinguishing from left and right
• lack of awareness of certain body parts that can lead to self care difficulties
• difficulties with eye/hand coordination
A
Injury to parietal lobe
13
Q
- difficulty recognizing faces/ppl
- wernikes aphasia
- short term memory loss
- interfere with long term memory
- increased aggressive behavior
- Selective in what we see and hear
A
Injury to temporal lobe
14
Q
- people with the condition are unable to understand language in its written or spoken form, and even though they can speak with normal grammar, syntax, rate, and intonation, they cannot express themselves meaningfully using language.
- ability to grasp the meaning of spoken words is chiefly impaired
A
Wernikes aphasia
Receptive aphasia
15
Q
- have trouble speaking fluently but their comprehension can be relatively preserved.
- difficulty producing grammatical sentences and their speech is limited mainly to short utterances of less than four word
- understand speech relatively well, particularly when the grammatical structure of the spoken language is simple. However they may have harder times understanding sentences with more complex grammatical construction
A
Broca’s aphasia
Expressive aphasia
16
Q
- defects in vision
- Production of hallucinations
- inaccurately seeing objects
- inability to recognize the movement of an object
- difficulties reading and writing
A
Injury to occipital lobe
17
Q
- balance/ equilibrium
- coordination
- skilled motor activity
A
Cerebellum
18
Q
- loss of ability to walk
- tremors
- vertigo
- slurred speech
- lack of coordination
- no rapid movements
A
Injury to cerebellum
19
Q
- Glucose normal and small amount WBC
* abnormal- lactate, protein, RBC
A
Cerebral spinal fluid
20
Q
- LOC
- vitals signs
- pupillary reaction
- motor function
A
Neuro check
21
Q
Olfactory
Sensory
Smell
A
Cranial nerve 1
22
Q
Optic
Sensory
Vision- acuity and field of vision
Snellen chart
pupil reactivity to light and accommodation
Have patient read from a card or newspaper, one eye at a time. Test visual fields by having patient cover one eye, focus on your nose, and identify the number of fingers you’re holding up in each of four visual quadrants.
A
Cranial nerve 2
23
Q
Occulomotor Mixed Motor- opening of eye lids Pupil constriction, lens shape Check pupillary responses by shining a bright light on one pupil; both pupils should constrict. Do the same for the other eye. To check accommodation, move your finger toward the patient’s nose; the pupils should constrict and converge. Check EOMs by having patient look up, down, laterally, and diagonally.
A
Cranial nerve 3
24
Q
Trochlear
Motor
Downward/ inward eye movement
Have patient look down and in
A
Cranial nerve 4
25
Trigeminal
Mixed
Motor- muscle of mastication
Sensory- sensation of face, scalp, cornea, mucous membranes of mouth and nose
• Ask patient to hold the mouth open while you try to close it and to move the jaw laterally against your hand. With patient’s eyes closed, touch her face with cotton and have her identify the area touched. In comatose patients, brush the cornea with a wisp of cotton; the patient should blink.
Cranial Nerve 5
26
Abducens
Motor
Lateral movement of the eye
•Have patient move the eyes from side to side.
Cranial nerve 6
27
Facial
Mixed
Motor- facial muscles, close eyes, labial speech, close mouth
Sensory- taste
Cranial nerve 7
28
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Regulates activities of internal organs
• heart
• lung
• digestive organs
- Sympathetic
- Parasympathetic
```
Autonomic nervous system
29
* pupils dilate
* bronchodilation
* increase RR, HR, BP
* sphincter contracts
Sympathetic
30
* pupils constrict
* decease HR, BP, RR
* bronchoconstriction
* sphincter relaxes
Parasympathetic
31
* Mental status
* cranial nerves
* motor system
* sensory system
* reflexes
Neuro exam
32
Measures peripheral vision
Stand 2 ft away
Bring finger from periphery
Confrontation test
33
* clench teeth palpating muscle above mandible
* lightly touch forehand, cheek, and lower jaw
* corneal reflex
Testing cranial nerve 5
34
Abducens
Lateral eye movement
Motor
Cranial nerve 6
35
Regulates activities of internal organs, homeostasis
Autonomic nervous system
36
Pupil constriction
Decreased HR,BP,RR,
Bronchoconstriction
Sphincter relaxed
Parasympathetic
37
Pupil dilated
Increased HR, BP, RR,
Sphincter contracted
Sympathetic
38
Responsible for interpretation of all sensory input:
o Sense of smell is interpreted in parietal lobe
o Vision goes through the parietal lobe
o Touch goes through the parietal lobe
o Taste goes through the parietal lobe
o The ability to an feel an item and recognize it for what it is
o Feeling is sensory
o Differentiation of size, shape, color
o Visual and spatial perception
o Goal directed voluntary movements.
o Manipulation of objects.
o Integration of different senses that allows for understanding a single concept.
Parietal
39
Inhibits pt from understanding sensory input
o Being unable to attend to more than one object at a time.
o Anomia – Can’t name an object
o Agraphia – Can’t locate the words for writing
• Alexia - Problems with reading and writing
• Difficulty with:
o Drawing objects.
o Distinguishing left from right
o Dyscalculia – Difficulty doing mathematics
Injury to parietal lobe
40
leads to difficulties in self-care.
• Inability to focus visual attention
• Inability to manipulate objects
Injury to parietal lobe
41
teach pt to ID objects in the hand with eyes closed
o It takes pt a long time to handle an object and remember what it is
o Patient has no memory of object
Stereognosis
42
• – The lack of awareness of certain body parts and/or surrounding space that
o Considered to be worse than stereognosis
People w/ apraxia can’t recognize parts of their own body, not even their own arm
o They don’t want to do anything w/ it
o They do not feel any pain or sensation in the arm: it is not connected to them anymore
▪ AKA unilateral neglect
Apraxia
43
* Difficulty in recognizing faces
* Wernicke's Aphasia
* Disturbance with selective attention to what we see and hear.
* Difficulty with identification and verbalization about objects.
* Short-term memory loss.
* Interference with long-term memory
* Increased or decreased interest in sexual behavior.
* Inability to categorize objects
* Right lobe damage can cause persistent talking.
* Increased aggressive behavior.
Injury to Temporal Lobe
44
blindness on one side
• The world is seen only through one side
o Pt will only eat on one side of plate
o Plate will be divided in the middle
▪ NI – to teach pt to scan by turning their face
• To them, one side of world does not exist
hemianopsia
45
* Defects in vision
* Difficulty with locating objects in environment.
* Difficulty with identifying colors
* Production of hallucinations
* Visual illusions -inaccurately seeing objects.
* Word blindness -inability to recognize words.
* Difficulty in recognizing drawn objects.
* Inability to recognize the movement of an object
* Difficulties with reading and writing.
Injury to Occipital Lobe
46
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7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
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32 spinal nerves
Spinal cord
47
Sensory
Hearing and equilibrium
• Weber test, Rinne test, Whisper test
Cranial nerve 8
| Acoustic
48
Touch back of throat with sterile tongue depressor or cotton-tipped applicator. Have patient swallow.
Motor- pharynx phonation and swallowing
Sensory- taste on posterior one they'd if tongue and gag reflex
Cranial nerve 9
| Glossopharyneal
49
Mixed
Motor- pharynx and larynx talking and swallowing.
Sensory- general sensation from carotid body, carotid sinus, pharynx, viscera
Carotid reflex
Vagus
| Cranial nerve 10
50
Shoulder movement; head rotation
| • Have patient shrug shoulders and turn head from side to side
Cranial nerve 11
| Spinal accessory
51
Motor
Movement of tongue
speech (articulation)
•Have patient stick out tongue and move it internally from cheek to cheek. Assess articulation.
Cranial nerve 12
| Hypoglossal
52
LOC
Vital signs
Pupillary reaction
Motor function
Neuro check
53
Conscious -
Drowsy
Stuporous -
Coma
Level of consciousness
54
quadriceps (L2 - L4) let leg dangle. Strike patellar. You can palpate quadricep
Patellar
55
(Babinski: L4--S2) - draw a light stroke up the lateral side of the sole of the foot. Normal response flexion of toes.
Plantar
56
* Level of consciousness
* Attention span
* Memory
* Perception
* Cognitive
* General knowledge
* Speech
* Sensory perception
* Emotional status
Mentation
57
```
+5 - full ROM, full strength
+4 - full ROM, less than normal strength
+3 - can raise extremity but not against resistance
+2 - can move extremity but not lift it
+1 - slight movement
0 - no movement
```
Motor function
58
Measures blood flow
Tissue composition
Brain metabolism
Excellent for picking up lesions and brain tumors.
Radioactive tracer injected or inhaled which crosses blood brain barrier, and combines with electrons in the brain.
Patient teaching:
o No ETOH, no smoking, no caffeine prior to test.
o Pt may get dizzy or light headed
o Headaches when inhaling isotope
o After test is complete be sure pt voids to get rid of radioactive substance in body.
PET SCAN
59
Used to pick up soft tissue abnormalities such as changes within the cells, tumors, and necrotic tissue, degenerative changes w/in brain.
o Patient teaching:
o Pt. may experience claustrophobia,
o Remove anything metal than may be on or in person, such as IUD’s, hearing aids.(pt’s w/ metal prostesis such as hip or shoulder replacements are not candidates for this test.) Mri tech needs to know if pt has pacemaker, artifical heart valve.
▪ Empty bladder before test
MRI
60
• For pt who have stroke
• Tia – transient ischemic attack
• What angina is to a heart attack, TIA is to stroke
• We will study the blood flow going to the brain
• Estimated that when PP (pulse pressure) get to 60 – 70 their arteries are 50% blocked by 80: 60 to 70% blocked
• It is risk for stroke
• In this case we will monitor blood going into the brain which can ID stroke
Doppler – non-invasive – used to detect arterial stenosis, occlusion or plaque.
o Ultrasound waves are used to evaluate carotid artery blood flow.
Carotid Doppler
61
o Malformation in the connection between arteries and veins
o Is congenital/birth defect and run in families
o 2-3 out of 10 are AV malformation and Aneurism
o Usually asymptomatic
o If BP is kept within healthy range Av malformation will not cause any trouble at all for duration of life span.
AV malformation:
62
• Inject dye
• Look at blood circulation of blood In brain
o Patient needs to be hydrated
o Empty bladder
o A lot of swelling and discomfort – use ice bags
o Check pulses frequently –ESP DISTAL – check for adequate circulation to extremities
Cerebral angiography
63
very invasive
o Pt is in a side lying fetal position
o Insert long needle in between L3 & L4 or L4 & L5 – subarachnoid space
o DO NOT DO with ICP – can cause herniation of brain into brain stem
o Takes out CSF to be evaluated (CSF should be clear and colorless, if bloody can be contusion or hemorrhage in brain or spinal cord.)
o To administer medication, anesthesia
o Strict aseptic technique
o Pt teaching:
May develop a spinal headache and may last for several days, so patient should lie flat as much as possible
Spinal tap
64
The lumbar puncture needle is a very long needle
• It is possible that CSF will continue to drain out through opening of syringe
• We will do what is called epidural patch – take pt blood and inject it into hole to seal it off.
• It is not a foreign object - it is their own blood - it will seal off puncture so CSF will not leak out.
Spinal tap complications
65
Lay pt in flat position – which prevents spinal headache
• Give lots of fluids since pt needs to rebuild CSF
• Check epidural patch dressing to make sure its not draining
o Examine carefully
• Treat spinal headache
o Usually top of forehead will be throbbing when sitting or standing
• Remind Dr. not to remove too much fluid.
• Pt with increase ICP CAN’T get a lumbar puncture
Most important NI is to assess pt for s/s of increased ICP prior to lumbar puncture
Nursing interventions for spinal tap
66
• Use it with pt who has spinal cord tumor (MRI would give better view)
• Inject Pt with dye
o Water soluble dye
o Hydrate pt to get dye out of body
• Most procedures with punctures cause impaired skin integrity b/c pt received injection
o There is also a risk for meningitis
Myelography
