Neuro specific Flashcards
possible further assessment
cerebellar, proprioception, deep tendon reflexes
cerebellar
finger to nose
heel to shin
gait evaluation (ataxia?)
ataxia
indicates loss of muscle coordination, affects:
balance
speech
eye movement
proprioception
being able to know where your body parts are in space without having to see them
Romberg test (balance) – CN VII
bad deep tendon reflexes
hyperactive: problem w upper motor neurons
clonus: dorsiflexion and count oscillations
CVA
cerebrovascular accident (stroke)
hemorrhagic stroke
caused by bleeding in the brain
ischemic stroke
caused by blood clot in the brain
thrombolytic t-PA
alteplase– breaks down clot in ischemic stroke
chronic deficits caused by stroke
hemiplegia
hemianopsia
aphasia
dysarthria
dysphagia
hemiplegia
paralysis on one side of the body
hemiparesis
weakness in half of the body
hemianopsia
loss of 1/2 vision in each eye
aphasia
language difficulty
expressive aphasia
Broca’s: word finding
receptive aphasia
Wernicke’s: understanding
global
total= both
dysarthria
loss of speech articulation
dysphasia
loss of ability to swallow (no gag reflex)
cincinnati prehospital stoke scale components
droop, drift, speech
cincinnati prehospital stroke scale assesses…
balance, eyes, face, arms, speech, tongue/time
NIH stroke scale
done daily on all stroke pt’s, not memorized
transient ischemic attack (TIA)
temporary neuro deficits d/t impaired circulation to the brain (mini stroke)
TIA S/S
same as acute CVA
length of TIA
resolves in less than 24 hours
TIA indicates…
impending major CVA
meningitis
an infection of the meninges caused by bacteria, virus, or fungus (less common)
7 PA findings indicating meningitis (due to ⬆ ICP)
- HA and fever
- altered metal status (AMS)
- photophobia
- dizziness
- projectile vomiting
- nuchal rigidity and pain
- petechiae
kernigs’s sign
laying flat on back, bent leg and hip 90 degrees, resisting and in a lot of pain
Brudzinski’s sign
forcefully bend head own to chest, checking for rigidity and pain. pt will bend knees to relieve pain
cerebral palsy
disorder of movement, muscle tone, or posture caused by injury to or abnormal development of the brain (anoxia or motor brain area– not progressive)
classifications of CP
spastic
dyskinetic
ataxic
spastic
hyeprtonicity, stiffness, rigidity, contractures
dyskinetic CP
involuntary writhing movements of extremities
ataxic CP
abnormalities of balance and coordination of trunk/extremities (least common)
parkinsons disease (PD)
lack of domapine in the brain = movement disorder
S/S of Parkinsons Disease (PD)
tremors at rest and fatigue
pin rolling of fingers
interia when starting movement
shuffling, hunched gait
mask like facies w/ drooling
2 classifications of spinal cord injury
cerivical and thoracic
spinal cord injury (SCI) PA findings
impaired sensation and movement
quadriplegia (cervical spine)
- above C2-3, ventilator dependent
paraplegia (thoracic spine)
acute care for SCI
immobilize neck, assess for respiratory compromise
head injury with internal bleeding or swelling can cause
intracranial pressure (ICP)
cerebral herniation
ICP pushes brainstem downward thru opening in skull where spinal cord exits
abnormal levels of consciousness
lethargic
obtunded
stuporous
coma
obtunded
falling asleep if not continually kept awake, when awakened typically confused
stuporous
significantly out of it, difficult to keep awake
coma (comatose)
will not wakeup even if inflicting pain (finger pressed underneath fingernail, or press knuckles against sternum)
glasgow coma scale (GCS) tests what three things
eye opening response
verbal response
motor response
GCS score
from 3-15
anything less than 8 is a coma and requires intubation
TBI
traumatic brain injury
signs of TBI
projectile vomiting
altered CN 6
pupils
posturing
TBI pupils
pinpoint (commonly seen in drug abuse)
oval shape (ICP affecting CN3)
dilated and fixed
if unconscious -> dolls eyes
decorticate
arms flexed and fists clenched
legs extended and internally rotated
toes pointed
decerebrate
arms stiffly extended with pronated forearms and flexed wrists
head and neck extended
legs and toes extended, internally rotated
(indicates increased severity)
flaccid
limp without movement
worst sign
indicates damage to lower brain stem
neuro specific assessment
5 upper
7 lower
* weakness numbness or tingling?
* recent severe unexplained HA
* recent falls/altered balance
* look for facial droop or slurred speech
