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neurologic system assessment Flashcards

1
Q

somatic nervous system

A

transfer impulses from CNS to skeletal muscles (voluntary)

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2
Q

autonomic nervous system

A
  • relays impulses from CNS to involuntary organs, smooth muscles, cardiac muscles, glands (involuntary)
  • SNS (stim by adrenaline)
  • PNS (rest + relax)
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3
Q

peripheral nervous system

A
  • sensory (afferent) messages to CNS from sensory receptors
  • motor (efferent) messages from CNS out to muscles + glands
  • autonomic messages that govern internal organs + blood vessels
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4
Q

aging adult: ____ w/ _____ of neuron structure in brain + spinal cord

A
  • atrophy
  • steady loss
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5
Q

age-related changes: ____ of nerve conduction ______ making rxn time ______

A
  • velocity
  • decreases
  • slower
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6
Q

age-related changes: ____ delay at synapse results in _____ sensation of touch, pain, taste, smell

A
  • increased
  • diminished
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7
Q

age-related changes: motor system may show general _____ of movement, muscle strength, and agility _______

A
  • slowing down
  • decrease
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8
Q

age-related changes: progressive ______ in cerebral blood flow + oxygen consumption may cause _________.

A
  • decrease
  • dizziness + loss of balance
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9
Q

subjective data examples

A
  • HA
  • head injury
  • dizziness/vertigo
  • seizures
  • tremors
  • weakness
  • incoordination
  • numbness/tingling
  • difficulty swallowing
  • difficulty speaking
  • pt-centered care
  • env/job hazards
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10
Q

subjective data: HA.. ask about?

A
  • onset, freq, severity
  • location, quality description, associated factors
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11
Q

subjective data: head injury… ask about?

A
  • event hist, type, description
  • loss of consciousness + recall of event
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12
Q

subjective data: dizziness/vertigo… ask about?

A
  • onset, duration, description, frequency
  • associated w/ change in position
  • vertigo characteristics: objective/subjective vertigo
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13
Q

subjective data: seizures… ask about?

A
  • course + duration
  • motor activity in body
  • associated clin presentations
  • postictal phase
  • precipitating factors
  • med therapy
  • coping strategies
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14
Q

subjective data: tremors… ask about?

A
  • onset, type, duration, freq
  • precipitating + alleviating factors
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15
Q

subjective data: weakness… ask about?

A
  • localized/generalized, distal/proximal
  • impact on mobility or ADLs
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16
Q

subjective data: incoordination… ask about?

A
  • probs w/ balance while standing/ambulating.
  • lateral drifting, stumbling, falling
  • legs giving way and/or clumsy movements
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17
Q

subjective data: numbness/tingling… ask about?

A
  • onset, duration, location
  • whether it occurs w/ activity
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18
Q

subjective data: difficulty swallowing… ask about?

A
  • w/ solids/liquids
  • drooling
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19
Q

subjective data: difficulty speaking… ask about?

A
  • onset, pattern, duration
  • forming words or saying what you want to say
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20
Q

subjective data: pt-centered care… ask about?

A

info regarding past pertinent med hist

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21
Q

subjective data: env/job hazards… ask about?

A
  • exposure hist
  • med hist: Rx + OTC
  • alc hist
  • substance abuse/drug hist
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22
Q

subjective data: dizziness… ask about?

A
  • association w/ positional change/activity/medication
  • impact on ADLs
  • safety mods
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23
Q

subjective data: memory… ask about?

A
  • decrease in mental fxn/confusion
  • onset, duration, freq
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24
Q

subjective data: tremor… ask about?

A
  • location
  • precipitating + alleviating factors
  • impact on ADLs
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25
Q

subjective data: sudden vision change… ask about?

A
  • onset, duration, freq
  • loss of consciousness/safety
  • impact on ADLs
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26
Q

perform ____ neurologic exam on well persons w/ no significant findings from hist

A

screening

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27
Q

perform ____ neurologic exam on persons w/ neurologic concerns

A

complete

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28
Q

perform ______ exam on persons w/ demonstrated neurologic deficits who require periodic assessments

A

neurologic recheck

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29
Q

sequence for complete neurologic examination

A
  • mental status
  • cranial nerves
  • motor system
  • sensory system
  • reflexes
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30
Q

objective data equipment

A
  • penlight
  • tongue blade
  • cotton swab
  • cotton ball
  • tuning form: 128 or 256 Hz
  • percussion hammer
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31
Q

ooo two titties and fat vagina glazed vaguely ah!

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal
  6. abducens
  7. facial
  8. vestibulocochlear (auditory/acoustic)
  9. glossopharyngeal
  10. vagus
  11. accessory
  12. hypoglossal
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32
Q

CN1

A
  • olfactory
  • smell
  • sensory
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33
Q

CN2

A
  • optic
  • visual acuity
  • sensory
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34
Q

CN3

A
  • oculomotor
  • opening of eyelids, eye movement (upward/medial, upward/lateral, medial, downward/lateral), pupil constriction, lens shape
  • mixed
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35
Q

CN4

A
  • trochlear
  • eye movement (downward/medial)
  • motor
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36
Q

CN5

A
  • trigeminal
  • facial and scalp sensation, chewing movements
  • mixed
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37
Q

CN6

A
  • abducens
  • eye movement (lateral)
  • motor
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38
Q

CN7

A
  • facial
  • motor: facial muscles, close eye, labial speech, close mouth
  • sensory: taste sweet/salty/sour/bitter on anterior two thirds of tongue
  • PNS: saliva + tear secretion
  • mixed
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39
Q

CN8

A
  • vestibulocochlear/auditory/acoustic
  • hearing & balance
  • sensory
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40
Q

CN9

A
  • glossopharyngeal
  • sensory: taste on the posterior third of tongue
    motor: talking and swallowing
  • mixed
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41
Q

CN10

A
  • vagus
  • uvula (palate muscles) & swallowing
  • mixed
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42
Q

CN11

A
  • accessory
  • shoulder shrug (movement of trapezius + sternomastoid muscles)
  • motor
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43
Q

CN12

A
  • hypoglossal
  • tongue movement
  • motor
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44
Q

CN1: olfactory nerve test

A
  • sense of smell in ppl who report smell loss, head trauma, abnorm mental status
  • presence of intracranial lesion suspected
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45
Q

CN2: optic nerve test

A
  • visual acuity + visual fields by confrontation
  • use ophthalmoscope to examine ocular fundus to determine color, size, shape of optic disc
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46
Q

CN 3/4/6: oculomotor, trochlear, abducens test

A
  • check pupils for size, regularity, equality, direct/consensual light rxn, accommodation
  • assess extraocular movements by cardinal positions of gaze
  • assess nystagmus
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47
Q

CN III/IV/VI test for _______.

A

ocular rotations, conjugate movements, nystagmus

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48
Q

CN4/trochlear nerve specifically tests for ____, using _____.

A
  • pupillary light reflex + ptosis
  • direct + light consensual pupillary rxn to light
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49
Q

severe nystagmus in both eyes occurs w/?

A

dz of vestibular systems, cerebellum, or brainstem

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50
Q

CNV/trigeminal nerve assess motor fxn in what?

A

muscles of mastication by palpating temporal + masseter muscles as a person clenches their teeth

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51
Q

CNV/trigeminal nerve assess sensory fxn by?

A

w/ person’s eye closed, test light touch sensation by touching a cotton wisp to designated areas on a person’s face: forehead, cheeks, chin

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52
Q

assess WHAT associated w/ CNV/trigeminal nerve if person has abnormal facial sensations/abnormalities of facial movement?

A

corneal reflex

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53
Q

cotton wisp to the designated areas of the face test what divisions of CNV?

A
  • ophthalmic
  • maxillary
  • mandibular
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54
Q

CNVII/facial nerve motor fxn

A
  • note mobility + facial symmetry as a person responds to selected movements
  • have person puff cheeks, then press puffed cheeks in to see that air escapes equally from both sides
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55
Q

CNVII/facial nerve sensory fxn test

A
  • test only if suspect facial nerve injury
  • test sense of taste by applying cotton applicator covered w/ solution of sugar, salt, lemon juice and ask person to identify taste
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56
Q

CNVIII/acoustic/vestibulocochlear test

A
  • hearing acuity by ability to hear norm convos + by whispered voice test
  • tuning fork tests
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57
Q

CN IX & X/glossopharyngeal + vagus nerves motor fxn test

A
  • depress tongue w/ tongue blade + note pharyngeal movement as person says ahhh or yawns
  • uvula + soft palate should rise in midline
  • tonsillar pillars should move medially
  • touch posterior pharyngeal wall w/ tongue blade, note gag reflex
  • voice should sound smooth, not strained
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58
Q

CN IX & X/glossopharyngeal + vagus nerves sensory fxn test

A

CNIX does mediate test on posterior one thrid of tongue, but technically too difficult to test

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59
Q

CNXI/spinal accessory nerve examine?

A
  • sternomastoid + trapezius muscles for equal size
  • check equal strength by asking person to rotate head against resistance applied to side of chin
  • ask person to shrug shoulders against resistance
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60
Q

CNXII/hypoglossal nerve inspects?

A
  • tongue, no wasting or tremors should be present
  • note forward thrust in midline as person protrudes tongue
  • ask person to say “light, tight, dynamite” and note that lingual speech (sounds of letters l, t, d, n) is clear + distinct
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61
Q

motor system assess: inspect all muscle groups for?

A

size, note bilateral comparison

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62
Q

atrophy

A
  • abnormally small muscle w/ wasted appearance
  • occurs w/ disuse, injury, LMN dz like polio, diabetic neuropathy
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63
Q

hypertrophy

A
  • increased size + strength
  • occurs w/ isometric exercise
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64
Q

motor system assess: test what muscle grps for strength?

A
  • extremities
  • neck
  • trunk
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65
Q

paresis

A
  • weakness
  • diminished strength
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66
Q

paralysis

A
  • plegia
  • absence of strength
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67
Q

tone

A

normal tension in relaxed muscles

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68
Q

how to test tone during motor system assessment

A
  • persuade person to relax completely + move each extremity smoothly thru full ROM
  • normally note mild, even resistance to movement
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69
Q

what to check for during tone motor system assessment

A
  • limited ROM
  • pain w/ motion
  • flaccidity
  • spasticity + rigidity
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70
Q

flaccidity

A
  • decreased resistance
  • hypotonia occur w/ peripheral weakness
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71
Q

spasticity + rigidity

A

types of increased resistance that occur w/ central weakness

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72
Q

involuntary movements

A
  • norm none occur
  • if present, note location, freq, rate, amp
  • note movements can be controlled at will
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73
Q

tic

A
  • involuntary, compulsive, repetitive twitching of muscle group
  • EX: wink, grimace, head movement, shoulder shrug
  • due to neruo cause, EX: tardive dyskinesia, Tourette syndrome, or psychogenic cause (habit tic)
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74
Q

fasciculation

A
  • rapid, sudden jerk or short series of jerks at fairly reg intervals
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75
Q

hiccup

A

myoclonus of diaphragm

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76
Q

single myoclonic arm/leg jerk is _______ when person is falling asleep

A

normal

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77
Q

myoclonic jerks are severe w/?

A
  • grand mal seizures
  • rapid, continuous twitching of resting muscle or part of muscle w/o movement of limb
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78
Q

fine fasciculation

A
  • occurs w/ LMN dz
  • associated w/ atrophy + weakness
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79
Q

coarse fasciculation

A
  • occurs w/ cold exposure
  • not significant
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80
Q

athetosis

A
  • sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
  • occurs at irregular intervals
  • not rhythmic or repetitive
  • more convulsive than a tic
81
Q

sudden/jerky/rapid athetosis: some are _______, some are _______, all are accentuated by _______.

A
  • spontaneous
  • initiated
  • voluntary acts
82
Q

athetosis disappears with?

A

sleep

83
Q

sudden/jerky/rapid athetosis is common with?

A
  • Sydenham chorea
  • Huntington dz
84
Q

athetosis can also look like?

A
  • slow, twisting, writhing, continuous movement, resembling a snake or worm
  • involves distal more than proximal part of limb
85
Q

slow/twist/writhing athetosis occurs w/?

A

cerebral palsy

86
Q

athetoid hand

A

some fingers flexed, some extended

87
Q

tremor

A
  • involuntary contraction of opposing muscle grps
  • results in rhythmic, back-and-forth movement of one or more joints
88
Q

tremors may occur ____ or with _____.

A
  • at rest
  • voluntary movement
89
Q

all tremors disappear while?

A

sleeping

90
Q

tremors may be slow (____ per sec) or rapid (______ per sec)

A
  • 3 to 6
  • 10 to 20
91
Q

how to test rapid alternating movements (RAM) with hands and knees

A
  • ask person to pat knees w/ both hands, lift up, turn hands over, and pat knees w/ backs of hands
  • ask person to do this faster
  • norm done w/ equal turning + quick rhythmic pace
92
Q

what to check for when testing RAM

A
  • lack of coordination
  • slow, clumsy, sloppy response = dysdiadochokinesia; occurs w/ cerebellar dz
93
Q

alternative test to RAM

A
  • ask person to touch thumb to each finer on same hand, starting w/ index finger, then reverse direction (finger-to-finger test)
  • finger-to-nose and heel-to-shin
94
Q

balance test: gait

A

observe as person walks 10-20 ft, turns, and returns to starting point

95
Q

normal gait during balance tests

A
  • person moves w/ sense of freedom
  • smooth, rhythmic, effortless
  • opposing arm swing coordinated
  • person turns smooth
  • step length is about 15 inches from heel to heel
96
Q

balance tests: tandem walking

A
  • ask person to walk straight line in heel-to-toe fashion
  • check ataxia (uncoordinated/unsteady gait)
97
Q

tandem walking checks for?

A
  • upper motor neuron lesion
  • multiple sclerosis
  • acute cerebellar dysfxn
  • alc intoxication
98
Q

how to test for Romberg sign

A
  • ask person to stand up w/ feet together + arms at sides
  • when in stable position, ask person to close eyes + to hold position about 20 secs
99
Q

norm finding during test for Romberg sign

A

person can maintain posture + balance even w/ visual orienting info blocked

100
Q

positive Romberg sign means?

A

loss of balance that occurs when closing the eyes

101
Q

a (+) Romberg sign occurs w/?

A
  • cerebellar ataxia (multiple sclerosis, alc intox)
  • loss of proprioception
  • loss of vestibular fxn
102
Q

cerebellar fxn: asking a person to perform shallow knee bend or hop in place (first on one leg, then other)

A
  • demos normal position sense, muscle strength, cerebellar fxn
  • some individuals cannot hop bc aging/obesity
  • unable to perform knee bend bc weakness in quadriceps muscle or hip extensors
103
Q

ask the person to identify various sensory stimuli in order to test?

A

intactness of peripheral nerve fibers, sensory tracts, higher cortical discrimination

104
Q

when testing the sensory system, the person’s eyes should be?

A

closed

105
Q

sensory tests order

A
  • light touch: cotton ball
  • superficial pain: pinprick (split tongue blade w/ pointy end or dull end)
  • touch person’s body in random, unpredictable order
  • vibration w/ tuning fork in few distal locations
106
Q

complete testing of sensory system warranted in who?

A
  • those w/ neurologic symptoms, EX: localized pain, numbness, tingling
  • discover abnormalities
107
Q

compare sensations on?

A

symmetric parts of body

108
Q

what to do when you find definite decrease in sensation?

A

map it by systematic testing in that area

109
Q

proceed from point of decreased sensation toward ___. ask the person to tell you _________. you can map ______.

A
  • sensitive area
  • where sensation changes
  • exact borders of deficient area
110
Q

upper extremities dermatomes

A
  • shoulder: C4
  • lateral inner bicep: C5
  • thumb: C6
  • middle finger: C7
  • pinky/5th finger: C8
111
Q

lower extremities dermatomes

A
  • groin: L1
  • anterior thigh: L2
  • above knee: L3
  • medial area at knee level: L4
  • on top of foot: L5
  • lateral side of foot: S1
112
Q

anterolateral (spinothalamic) tract

A

sensory tract that carries pain, temp, crude touch, and pressure from our skin to the somatosensory area of the thalamus

113
Q

pain is tested by?

A

person’s ability to perceive pinprick

114
Q

temperature is tested?

A
  • only when pain sensation is abnorm
  • can omit bc fiber tracts are pretty much the same
115
Q

light touch is tested by?

A
  • applying wisp of cotton to skin in random order of sites + at irregular intervals
  • include arms, forearms, hands, chest, thighs, legs
  • ask person to say now or yes when touch is felt
  • compare symmetric points
116
Q

dorsal column-medial lemniscus pathway (DCML) or posterior column-medial lemniscus pathway (PCML)

A

sensory pathway of the CNS that conveys sensations of fine touch, vibration, 2-point discrimination, proprioception (body position) from skin + joints

117
Q

test vibration by?

A

test person’s ability to feel vibrations of tuning fork over bony prominences

118
Q

position (kinesthesia) tests?

A

person’s ability to perceive passive movements of extremities

119
Q

loss of vibration sense occurs w/______. often, this is the ____ sensation lost.

A
  • peripheral neuropathy (ex: diabetes + alcoholism)
  • first
120
Q

peripheral neuropathy (a complication of severe, uncontrolled _____) is worse at the _____. it gradually improves as you move ______, as opposed to a specific nerve lesion, which as a _________.

A
  • diabetes
  • feet
  • up the leg
  • clear zone of deficit for its dermatome
121
Q

how to test position (kinesthesia)

A
  • move finger or big toe up/down + ask person to tell you which way it is moved
  • test done w/ eyes closed
  • loss of position sense occurs w/ peripheral neuropathy (DM), multiple sclerosis, spinal cord lesions
122
Q

tactile discrimination (fine touch) tests also?

A

measure discrimination ability of sensory cortex/stroke

123
Q

stereognosis

A

test the person’s ability to recognize objects such as coins/keys by feeling their forms, sizes, weights

124
Q

astereognosis

A
  • inability to identify object correctly
  • occurs in sensory cortex lesions
125
Q

graphesthesia

A
  • ability to read a number by having it traced on skin
  • use blunt instrument to trace single digit number or letter on palm
126
Q

two-point discrimination

A

test ability to distinguish separation of two simultaneous pin points on skin

127
Q

extinction

A
  • simultaneously touch both sides of body at same point
  • norm both sensations felt
128
Q

point location

A

touch skin + w/draw stimulus promptly; ask person to put finger where you touched

129
Q

measurement of the ____ or _____ reveals an involuntary muscle contraction. it reveals _____ of reflex arc at specific _____ and normal override on reflex of ______.

A
  • stretch reflexed (DTRs: deep tendon reflexes)
  • myotatic reflex
  • intactness
  • spinal levels
  • higher cortical levels
130
Q

for an adequate response for DTRs:

A
  • limb should be relaxed + muscle partially stretched
  • stim reflex by directing short, snappy blow of reflex hammer onto muscle’s insertion tendon
  • bilateral comparison: responses should be equal
131
Q

use of reflex hammer for DTRS

A
  • action takes place at wrist
  • strike brief, well-aimed blow + bounce up promptly; do not let hammer rest on tendon
132
Q

it is the ___ of the hammer, not the _____ of the strike that get the best results

A
  • swing
  • strength
133
Q

use the pointed end of the reflex hammer when aiming at a _____ such as _____ use the flat end when the target is ____ or to ____ the impact and prevent ____.

A
  • smaller target
  • thumb on the tendon site
  • wider
  • diffuse
  • pain
134
Q

4-point scale of reflex response

A
  1. no response
  2. diminished, low norm, or occurs w/ reinforcement
  3. avg, norm
  4. brisker than avg, may indicate dz
  5. very brisk, hyperactive w/ clonus, indicative of dz
135
Q

subjective scale of DTRs require?

A
  • clinical practice
  • scale not completely reliable
  • wide range of norm exists in reflex responses
136
Q

reinforcement

A
  • sometimes reflex response fails to appear
  • try further encouragement of relaxation, varying positions, or increasing strength of blow
137
Q

alternate techniques when doing DTRs testing to help?

A

elicit reflexes by performing an isometric exercise in a diff muscle grp

138
Q

EX of isometric exercise in diff muscle grp when performing DTRs

A
  • person lock fingers together + pull as hard as they can, and then strike tendon in knee
  • person clench teeth or grasp thigh when doing biceps
139
Q

biceps reflex

A
  • C5-C6
  • support person’s forearm on yours, place thumb on biceps tendon, strike blow on thumb
  • norm response: contract of biceps muscle + flexion of forearm
140
Q

triceps reflex

A
  • C7-C8
  • tell person to let arm go dead as you strike triceps tendon directly just above elbow
  • norm response: extension of forearm
141
Q

brachioradialis reflex

A
  • C5-C6
  • hold person’s thumb to suspend forearms in relaxation + strike forearm directly, about 2-3 cm above radial styloid process
  • norm response: flexion + supination of forearm
142
Q

quadriceps reflex

A
  • L2-L4
  • patellar/knee reflex
  • let lower legs dangle freely to flex knee + stretch tendons, strike tendon directly just below patella
  • norm response: extension of lower leg
143
Q

Achilles reflex

A
  • L5-S2
  • ankle jerk
  • position person w/ knee flexed, hold foot in dorsiflexion + strike Achilles tendon directly
  • norm response: foot plantar flexes against examiner’s hand
144
Q

clonus

A
  • set of rapid, rhythmic contractions of same muscle
  • very sudden, jerky movements mainly in hands + arms
  • may not present during sleep
145
Q

hyperreflexia

A
  • exaggerated reflex
  • occurs w/ upper motor neuron (UMN) lesions (ex: stroke)
146
Q

hyporeflexia

A
  • absence of reflex
  • lower motor neuron prob
  • occurs w/ interruption of sensory afferents or destruction of motor efferents + anterior horn cells (ex: spinal cord injury)
147
Q

plantar reflex

A
  • L4-S2
  • Babinski’s reflex
  • apply pressure to outer/lateral bottom of for moving toward + across base of toes
148
Q

norm response to plantar reflex test

A
  • toes move downward
  • plantar flexion of toes + inversion & flexion of forefoot
149
Q

abnormal response of plantar reflex

A
  • toes fan outward + move toward ceiling
  • dorsiflexion of big toe + fanning of all toes
  • (+) Babinski’s sign (normal for infants)
  • upper motor neuron dz (EX: stoke, CNS dz like meningitis)
150
Q

neuro exam for head trauma/increase ICP or neuro deficit caused by systemic dz

A
  • change in LOC: perform relative assessments
  • motor fxn: check voluntary movement of each extremity by giving specific commands
  • pupillary response: check PERLA, note size in mm
  • VS: measure + motor, Glasgow + diabetic neuropathy screening
151
Q

Glasgow coma scale

A
  • eye-opening, motor, verbal response
  • quantitative measurement tool to assess LOC/measure decreases in consciousness
  • 15: best response
  • 8 or less: comatose client
  • 3: totally unresponsive
152
Q

Diabetic neuropathy screening

A
  • monofilament test
  • standardized measurement tool to detect peripheral neuropathy
153
Q

motor fxn check - pronator drift

A
  • ask person to extend both arms forward/halfway up, palms up, eyes closed, and hold for 10-20 secs
  • pronator drift: downward unilateral drift + turning in of forearm that occurs w/ mild hemiparesis or stroke
154
Q

Glasgow eye response

A
  • how awake + alert you are
  • 4: spontaneously
  • 3: to speech
  • 2: to pain
  • 1: no response
155
Q

Glasgow motor response

A
  • how well brain can control muscle movement
  • show if there are any issues w/ connections btw brain + rest of body
  • 6: obeys commands
  • 5: moves to localized pain
  • 4: flexion w/drawl from pain
  • 3: abnorm flexion (decorticate)
  • 2: abnorm extension (decerebrate)
  • 1: no response
156
Q

Glasgow verbal response

A
  • how well certain brain abilities work (thinking, memory, attention span, awareness of surroundings)
  • 5: oriented to time, place, person
  • 4: confused
  • 3: inappropriate words
  • 2: inappropriate sounds
  • 1: no response
157
Q

GCS ranges for head injuries

A
  • 13-15: mild TBI/concussion
  • 9-12: moderate TBI
  • 3-8: severe TBI
158
Q

pupillary response in a brain injured person:

A

sudden unilateral dilated + nonreactive pupil is ominous

159
Q

cranial nerve ___ runs parallel to the brainstem. when increasing _____ pushes the brainstem down (_______), it puts pressure on CN ____, causing _______.

A
  • III
  • ICP
  • herniation
  • III
  • pupil dilation
160
Q

aging adult: CN mediating ____ and ____ not usually tested, may show some ___ in fxn

A
  • taste
  • smell
  • decline
161
Q

aging adult: _____ in muscle bulk apparent in ___. ____ muscles often look wasted, even w/ no apparent ____. grip strength is relatively ____.

A
  • decrease
  • hand
  • dorsal hand
  • arthropathy
  • good
162
Q

aging adult: _______ occasionally occurs.

A
  • senile tremors
  • benign tremors: intention tremor of hands, head nodding, tongue protrusion
163
Q

aging adult: dyskinesias

A
  • repeated stereotyped movement in jaw, lips, or tongue may accompany senile tremors
  • no associated rigidity present
164
Q

aging adult: gait

A
  • may be slower + more deliberate than in younger person
  • may deviate from midline path
165
Q

aging adult: RAMs

A

rapid alternating movements may be difficult to perform

166
Q

aging adult: ____ of sensation and ____ stimulus needed to elicit a response.

A
  • loss
  • increased
167
Q

after 65 years of age, loss of sensation of ______ at ______ common; loss of ______; tactile sensation may be ______; may need ____ stimuli for light touch; and especially for _____

A
  • vibration
  • ankle malleolus
  • ankle jerk
  • impaired
  • stronger
  • pain
168
Q

aging adult: plantar reflex

A
  • may be absent/difficult to interpret
  • often not see definite norm flexor response
  • still should consider definite extensor response abnorm
168
Q

aging adult: superficial abdominal reflexes

A
  • may be absent
  • prob bc stretching of musculature thru pregnancy or obesity
168
Q

aging adult: DTRs _____; those in upper extremities usually _____, but ankle jerk commonly _____; knee jerks may be ____; bc aging ppl find it difficult to relax limbs, always use _____ when eliciting DTRs.

A
  • less brisk
  • present
  • lost
  • lost
  • reinforcement
169
Q

health promo: FAST plan

A
  • by american heart association-stroke
  • F: face drooping
  • A: arm weakness
  • S: speech difficulty
  • T: time to call 911
170
Q

health promo: review risk factors

A
  • HTN
  • cigarette smoking
  • heart dz
171
Q

health promo: vaccination to reduce risk for?

A

herpes zoster (shingles) in older adult

172
Q

warning signs of Alzheimer’s

A
  • memory loss
  • losing track
  • forgetting words
  • getting lost
  • poor judgment
  • abstract failing
  • losing things
  • mood swings
  • personality change
  • growing passive
173
Q

abnormalities in CN I, olfactory nerve

A

anosmia

174
Q

abnormalities in CN II, optic nerve

A
  • defect or abstract central vision
  • defect in peripheral vision, hemianopsia
  • absent light reflex
  • papilledema
  • optic atrophy
  • retinal lesions
175
Q

abnormalities in CN III, oculomotor nerve

A
  • dilated pupil, ptosis, eye turns out + slightly down
  • failure to move eye up, in, down
  • absent light reflex
176
Q

abnormalities in CN IV, trochlear nerve

A

failure to turn eye down or out

177
Q

abnormalities in CN V, trigeminal nerve

A
  • absent touch + pain, paresthesias
  • no blink
    -weakness of masseter or temporalis muscles
178
Q

abnormalities in CN VI, abducens nerve

A

failure to move laterally, diplopia on lateral gaze

179
Q

abnormalities in CN VII, facial nerve

A
  • absent or asymmetric facial movement
  • loss of taste
180
Q

abnormalities in CN VIII, acoustic nerve

A

decrease or loss of hearing

181
Q

abnormalities in CN IX, glossopharyngeal nerve

A

no gag reflex

182
Q

abnormalities in CN X, vagus nerve

A
  • uvula deviates to side
  • no gag reflex
  • voice quality: hoarse/brassy, nasal twang/husky
  • dysphagia, fluids regurgitate thru nose
183
Q

abnormalities in CN XI, spinal accessory nerve

A

absent movement of sternomastoid or trapezius muscles

184
Q

abnormalities in CN XII, hypoglossal nerve

A
  • tongue deviates to side
  • slowed rate of tongue movement
185
Q

abnormalities in muscle tone

A
  • flaccidity
  • spasticity
  • rigidity
  • cogwheel rigidity
186
Q

cogwheel rigidity

A
  • ratchet-like movement
  • common sign of Parkinson’s dz
  • moving limb feels similar to bending a lead pipe
187
Q

Parkinson’s dz

A
  • stooped posture
  • shuffling walk w/ short steps
  • flat facial expression
  • pill-rolling finger movements
188
Q

diabetes pts: test?

A
  • skin sensation on soles of feet
  • hold filament by paper handle + touch filament to skin at each site (10 total) for only 1-2 secs
  • push filament to make it bend and ask person to say now/yes at each site
189
Q

decorticate rigidity upper extremities

A
  • flexion of arm, wrist, fingers
  • adduction of arm, tight around thorax
190
Q

decorticate rigidity lower extremities

A
  • extended + rigid legs
  • internal rotation
  • plantar flexion
  • indicated hemispheric lesion of cerebral cortex
191
Q

decerebrate rigidity upper extremities

A
  • stiffly extended
  • abducted
  • internal rotation
  • palms pronated
192
Q

decerebrate rigidity lower extremities

A
  • stiffly extended
  • plantar flexion
  • teeth clenched
  • hyperextended back
  • more ominous than decorticate rigidity
  • indicates lesion in brainstem at midbrain or upper pons
193
Q

flaccid quadriplegia

A
  • complete loss of muscle tone + paralysis of all 4 extremities
  • indicate nonfxnal brainstem
194
Q

opisthotonos

A
  • prolonged arching of back, w/ head + heels bent backward
  • indicates meningeal irritation
195
Q

Kernig’s sign

A
  • person ly on back w/ hips + knees flexed & bent at 90-degrees, extend + straighten one knee at a time
  • (+) Kernig’s sign: resistance, pain (lower back) or inability to extend knee
  • (+) sign raise sus for meningitis
196
Q

Brudzinski’s sign

A
  • forced flexion of neck elicits reflex flexion of hips
  • severe neck stiffness cause pt’s hips + knees to flex when neck is flex
  • indicates meningitis, subarachnoid hemorrhage, possible encephalitis

health assess (3 decks)

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