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NURS 307 > Neurologic System > Flashcards

Neurologic System Flashcards

1
Q

History (Subjective)

A

A. Headache
B. Head injury - hx trauma, hx MVA, hx concussions
C. Dizziness/Vertigo, syncope, fainting
D. Seizures/Convulsions
E. Tremors, shaking in the hands or face
F. Weakness or paralysis, any problem moving any body part
G. Incoordination, problems with balance, gait
H. Numbness or tingling in any body part
I. Difficulty swallowing, drooling
J. Difficulty speaking
K. Significant past history - CVA (stroke), spinal cord injury, meningitis, encephalitis, congenital defect or alcoholism
L. Environmental hazards - insecticides, lead, organic solvents
M. Medications

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2
Q

Physical Exam/Assessment (Objective)

A

use the sequence - mental status, cranial nerves, motor system, sensory system, reflexes

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3
Q

Cranial Nerve I

A

olfactory nerve

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4
Q

Assessing: Cranial Nerve I

A

assess nasal patency, then with patient’s eyes closed present an aromatic substance

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5
Q

Cranial Nerve II

A

optic nerve

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6
Q

Assessing: Cranial II

A

test visual acuity and visual fields by confrontation

then examine the ocular fundus to determine color, size and shape of optic disc

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7
Q

Cranial Nerve III

A

oculomotor

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8
Q

Cranial Nerve IV

A

trochlear

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9
Q

Cranial Nerve VI

A

abducens

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10
Q

Assessing: Cranial Nerves III, IV, VI

A

assess consensual light reaction and accommodation
assess extraocular movements (H)
assess for nystagmus

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11
Q

Cranial Nerve V

A

trigeminal nerve

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12
Q

Cranial Nerve V: Motor function

A

assess the muscles of the jaw by palpating the temporal and masseter muscles as the pt clenches their teeth - muscles should feel equally strong

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13
Q

Cranial Nerve V: Sensory function

A
  • with patient’s eyes closed, test light touch sensation by touching a cotton swab to forehead, cheeks and chin
  • corneal reflex - NOT routinely done, pt looking forward lightly touch cornea with cotton swab
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14
Q

Cranial Nerve VII

A

facial nerve

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15
Q

Cranial Nerve VII: Motor Function

A

note symmetry, mobility of facial structures with the following - smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks out.

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16
Q

Cranial Nerve VII: Sensory Function

A

apply to tongue solution of sugar, salt or lemon - ask patient to identify

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17
Q

Cranial Nerve VIII

A

acoustic/vestibulocochlear

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18
Q

Cranial Nerve VIII

A

test hearing acuity by normal conversation, whispered voice test, Weber and Rinne

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19
Q

Cranial Nerve IX & X

A

glossopharyngeal and vagus

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20
Q

Cranial Nerve IX & X: Motor Function

A

depress the tongue with tongue blade - note pharyngeal movement as pt says “aahh”
the uvula should rise in the midline, tonsillar pillars should move medially - note gag reflex and that voice sounds smooth

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21
Q

Cranial Nerve XI

A

spinal accessory nerve

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22
Q

Assessing: Cranial Nerve XI

A
  • examine the sternomastoid and trapezius muscles for symmetry and equal size
  • assess strength by resistant ROM - movements should feel equally strong bilaterally
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23
Q

Cranial Nerve XII

A

hypoglossal nerve

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24
Q

Assessing: Cranial Nerve XII

A

inspect the tongue, ask the pt to protrude tongue, then ask pt to say “light, tight, dynamite” - note than lingual speech sounds are clear and distinct

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25
Q

Cranial Nerve IX and X: Sensory Function

A

mediates taste on the posterior 1/3 of the tongue, too difficult to test

26
Q

Assessing Motor System

A
  1. Inspect and palpate all muscle groups, noting symmetry and size, test muscle groups of the extremities, neck and trunk for strength and tone
  2. Involuntary Movement
27
Q

Involuntary Movements normally do not occur, if present note

A

location, frequency, rate and amplitude

28
Q

Gait

A
  • observe pt walking 10-20 feet, turn and return to starting point, note smooth, steady, rhythmic effortless gait with opposing arm swing coordinated
  • then ask pt to do a heel-to-toe walk, note balance and coordination
29
Q

Romberg Test

A

ask pt to stand with feet together, arms at side, then eyes closed x 20 seconds, note balance

30
Q

Pronator Drift

A

with palms down and arms extended out, have pt close eyes and observe for drifting of arms

31
Q

Have patient Hop or stand on one foot, repeat with other foot and note

A

note balance and coordination

32
Q

Rapid alternating movements

A

ask pt to pat their knees with both hands, lift up, turn hands over and repeat - movement should be quick rhythmic/coordinated pace; ask pt to touch thumb to each finger repeat and reverse direction - movement should be accurate and quick

33
Q

Finger to Finger Test

A

ask pt to use their index finger to touch their nose then examiner’s finger, repeating with examiner moving their finger, pt’s movement should be smooth and accurate

34
Q

Finger to Nose Test

A

ask pt to close eyes, stretch out arms, then touch tip of nose with each index finger alternating hands and increased speed

35
Q

Heel to Shin Test

A

supine position, heel on opposite knee and run it down the skin to ankle without sliding off shin

36
Q

Sensory System

A

compare sensations on symmetric parts of the body

37
Q

Assess: Pain

A

lightly apply sharp point of dull end to pt’s body in a random, unpredictable order, ask pt to distinguish between “sharp” or “dull”

38
Q

Assess: Temperature

A

pt to differentiate between hot and cold

39
Q

Assess: Light Touch

A

use cotton swab and lightly touch pt in a random order, ask pt to identify when the touch (cotton) is noted

40
Q

Assess: Vibration

A

test the pt’s ability to feel vibrations over bony prominences by using a tuning fork

41
Q

Assess: Positions Test

A

(Kinesthesia) test the pt’s ability to perceive passive movement of extremities, hold body part on the sides and move up or down and ask pt which way it was moved

42
Q

Tactile Discrimination

A

Fine touch. Also measures discrimination ability of sensory cortex.
Stereognosis and Graphesthesia

43
Q

Stereognosis

A

with eyes closed, place a familiar object in the pt’s hand and ask them to identify object

44
Q

Graphesthesia

A

with eyes closed, trace a single digit number or letter on the palm, ask pt to identify

45
Q

Two Point Discrimination

A

using paper clip note the distance at which the pt no longer perceives 2 separate points

46
Q

Extinction

A

simultaneously touch both sides of the body at the same time, ask pt to state how many and where the sensations were felt

47
Q

Point Location

A

touch pt skin, withdraw quickly, then ask pt to put finger where they were touched

48
Q

Reflexes (Deep Tendon Reflexes) - Grading

A 
4+ - very brisk, hyperactive with clonus, indicative of disease
3+ - brisker than average 
2+ - average, normal
1+ - diminished, low normal
0 - no response
49
Q

Reflexes (Deep Tendon Reflexes) include

A
  1. Biceps Reflex
  2. Triceps Reflex
  3. Brachioradialis Reflex
  4. Quadriceps Reflex
  5. Achilles Reflex
  6. Clonus
  7. Abdominal Reflex
  8. Cremasteric Reflex (not tested in lab)
  9. Plantar Reflex
50
Q

Nystagmus

A

Back-and-forth oscillation of eyes

51
Q

Biceps reflex

A

C5 to C6
Support the patient’s forearm on yours; place your thumb on biceps tendon and strike a blow on your thumb
Normal response is contraction of biceps muscle and flexion of forearm

52
Q

Triceps Reflex

A

C7 to C8
Tell person to let arm “just go dead” as you strike triceps tendon directly just above the elbow
Normal response is extension of forearm

53
Q

Brachioradialis reflex

A

C5 to C6
Hold person’s thumbs to suspend forearms in relaxation and strike forearm directly, about 2-3 cm above radial sty loud process
Normal response is flexion and supination of forearm

54
Q

Quadriceps reflex

A

L2 - L4 “knee jerk”

Let lower legs dangle freely to flex knee and stretch tendons: strike directly below the patella… Check book

55
Q

Achilles Reflex

A

Check book

56
Q

Clonus

A

Test when reflexes are hyperactive.

Support lower leg in one hand and with other hand… Check book

57
Q

Plantar Reflex

58
Q

Neurologic Recheck I

59
Q

Signs of increasing intracranial pressure signals

A

Impending cerebral disaster and death and require early and prompt intervention

60
Q

Neurologic Recheck II

A 
LOC
Motor Function
Pupillary Response
Vital Signs
Glasgow Coma Scale

NURS 307 (29 decks)

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