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Exam 4 | Health Assessment > Neurological > Flashcards

Neurological Flashcards

1
Q

Neurological Evaluation: Inspection

A
  • Respirations: bc it’s driven by brain
    • Observe rate, rhythm, pattern
    • You’ll see changes in ^ if brain affected even if lungs are fine
  • Pupils: presence/absence of PEERLA gives insight to CN II, III, IV, VI
    • Observe size, quality, rxn to light
  • Ocular movement
    • Observe position of eyes/eyelids at rest
    • Check for horizontal deviation of eye
  • Posture and Muscle Tone
    • Observe gait, ambulation, etc.
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2
Q

LOC Grading (LOC, Technique, Pt Response)

A
  • Alert: Speak in norm voice tone
    • Spontaneously opens eyes
    • Looks at you
    • Responds appropriately
  • Lethargic: Speak in loud voice
    • Opens eyes but appears drowsy
    • Looks at you
    • Responds
    • Returns to sleep
  • Obtundation: Gently wake as if waking someone who’s asleep
    • Opens eyes
    • Looks at you
    • Responds slowly
    • Somewhat confused
    • Decreased alertness and interest in environment
    • Goes back to sleep after conversing
  • Stupor: Apply painful stimuli (sternal rub, tendon pinch, etc.)
    • Arouses during painful stimuli
    • Verbal response slow or absent
    • Returns to unresponsive state when stimuli ceases
  • Comatose: Apply repeated painful stimuli
    • Remains unarousable
    • Eyes closed
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3
Q

Assessing Brain Damage w/ Glasgow Coma Scale (What, Highest/Lowest Scores, Used for, Based on)

A
  • What: initial GCS used as baseline to compare w/ future follow-up GCS score
  • Highest: 15 & Lowest: 3
  • Used for traumatic situations where there’s some type of brain insult
  • Based on…
    • Eye-opening response
    • Verbal response
    • Motor response (to verbal command and/or painful stimulus)
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4
Q

Abnormal Flexion ⇒

A
  • Decorticate
  • Indicates damage to cerebral cortex or areas above brainstem
  • Corticospinal tract damage
  • Rigid flexion
  • Upper arms held tightly to sides of body
  • Elbows, wrists, fingers flexed
  • Feet plantar flexed
  • Legs extended and internally rotated
  • Tremors or intense stiffness
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5
Q

Abnormal Extension ⇒

A
  • Decerebrate
  • Indicates damage to midbrain or upper pons within brainstem
  • Brainstem damage
  • Rigid extension
  • Arms fully extended
  • Forearms pronated
  • Wrists and fingers flexed
  • Jaws clenched
  • Neck extended
  • Back may be arched
  • Feet plantar flexed
  • Occurs spontaneously, intermittently, or in response to stimuli
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6
Q

Overview of Assessing Coordination (Testing Systems of…)

A
  • Motor: muscle strength
  • Cerebellar: rhythmic movement and steady posture
    • Rapid alternating movements
    • Point-to-Point movements
    • Gait and other related body movements
    • Posture
  • Vestibular: balance and coordination of eye, head, body movement
  • Sensory: positional senses
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7
Q

Cerebellar Function Testing Techniques (Cerebellum Definition, Techniques + Steps)

A
  • Cerebellum: processes input from other areas of brain, spinal cord, sensory receptors to provide precise timing for coordinated, smooth movements of skeletal muscular system
    • Stroke affecting cerebellum ⇒ may cause dizziness, nausea, balance and coordination problems
  • Rapidly Alternating Movements
    • Steps: Hands on lap, face down first + Flip hands up and down as fast as possible
  • Fine Motor Coordination: Upper Extremities
    • Finger to nose + Touch that finger from nose to nurse’s finger by fully extending arm & Touch thumb to rest of fingers as fast as possible
  • Fine Motor Coordination: Lower Extremities
    • Steps: Put heel to shin + Slide heel from shin and down to leg
  • Romberg Test
    • Steps: Standing eyes closed + Feet together + Stay in that steady position for 30 secs + Nurse needs hands around pt in case they fall
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8
Q

Overview of Assessing Sensory System Functioning (assessing & testing for)

A
  • Pain & Temp controlled by → Spinothalamic Tracts
    • Spinothalamic Tracts: sensory pathway originating in spinal cord that transmits info to thalamus abt pain, temp, itch, and crude touch
  • Position & Vibration controlled by → Posterior Columns/Dorsal Column
    • Posterior Columns/Dorsal Column: area of white matter in dorsomedial side of spinal cord, part of dorsal funiculus, made up of fasciculus gracilis and fasciculus cuneatus + part of ascending posterior column-medial lemniscus pathway important for well-localized fine touch and conscious proprioception
  • Light Touch controlled by → Spinothalamic & Posterior Columns
  • Comparing…
    • Symmetrical areas
    • Distal and proximal ends of body parts
  • When testing vibration and position sensation → test fingers and toes first
    • Distal → proximal bc if they have distal intact then they’ll have proximal intact
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9
Q

Peripheral Nerve Sensory Testing Lower Extremities (Sensation Type + Description)

A
  • tactile: light touch using cotton
  • pain: using stick to press and slide down
  • vibratory: instrument on malleoli and hit it to feel vibration
  • positional: rubbing toes and asking if it’s going up or down
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10
Q

Cortical Sensory Function in Upper Extremities (Technique + Description)

A
  • Stereognosis:
    • Eyes closed
    • Give pt common object (coin)
    • They feel it and tell you what it is
  • Two Point Discrimination:
    • Eyes closed
    • Poke their palms w/ one point first then two points at same time
    • Ask if they’re being poked w/ one or two points
  • Graphesthesia:
    • Eyes closed
    • Using end of Q-tip, write letter or number
    • Ask them what you wrote
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11
Q

Reflexes Testing (DTR Definition, Hyperactive & Diminished Reflexes Suggests ___, Notes)

A
  • Deep Tendon Reflexes (DTR): means of assessing spinal nerves so make sure you have pt’s baseline on hand
  • Hyperactive reflexes → suggests CNS disease
  • Diminished reflexes → suggests ↓ sensation due to damaged spinal segments
  • Note that diseases of muscles may also diminish DTRs
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12
Q

DTR Reflex Testing Grading Scale

A
  • 0: no response
  • 1: somewhat diminished (low norm)
  • 2: av, norm
  • 3: brisker than av, may indicate disease
  • 4: very brisk, hyperactive
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13
Q

Superficial Reflexes (Present or Absent) (Reflex + Spinal Level)

A
  • Upper Abdominal → T7, T8, T9
    • Abdominal reflexes can be lost w/ age and/or abdominal surgeries
  • Lower Abdominal → T10, T11
    • Abdominal reflexes can be lost w/ age and/or abdominal surgeries
  • Cremasteric → T12, L1, L2
    • What: stroking inner thigh of male pt proximal to distal to elicit cremasteric reflex
      • Testicle and scrotum should rise on stroke side
        • Absent w/ upper and lower motor disorders, testicular torsion, L1 and L2 spinal injury
      • Helps in recognizing testicular emergencies!!!
  • Plantar → L4, L5, S1, S3
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14
Q

Deep Reflexes (Present or Absent) (Reflex + Spinal Level)

A
  • Biceps → C5, C6
  • Brachioradial → C5, C6
  • Triceps → C6, C7, C8
  • Patellar → L2, L3, L4
    • If someone has herniation or herniated disc from back injury (common place to have injury is in lumbar region so herniations in lumbar regions L2, L3, L4) ⇒ means they have absent patellar reflex
  • Achilles → S1, S2
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15
Q

Dizziness & Vertigo (Causes)

A
  • Palpitations → may cause lightheadedness
  • Vasovagal stimulation, low BP, febrile (fever-like Sxs) illnesses, excessive HTN med dosage → may cause near-syncope
  • Inner ear conditions or Brainstem conditions like tumors → may cause vertigo (environment around is spinning) accompanied by other neurological S&S
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16
Q

Vertigo: Peripheral

A
  • Far less concerning/dangerous
  • Usually concerns inner ear
  • Treatable
  • Onset: Sudden
  • Causes less severe
  • Duration: intermittent w/ severe Sxs
  • Affected by head position and movement
  • Motor function, coordination, gait intact
  • NV more frequent
  • Benign Positional Vertigo (BPV)
    • Onset: sudden, often when rolling onto affected side or tilting head up
    • Duration: few seconds – <1 min
    • Hearing: unaffected (tinnitus absent)
    • Additional features: sometimes nausea, vomiting, nystagmus
  • Meniere’s Disease
    • Onset: sudden
    • Duration: several hrs – ≥1 day
    • Hearing: sensorineural hearing loss– recurs, eventually progresses
    • Tinnitus: present, fluctuating
    • Additional features: pressure or fullness in affected ear, NV, nystagmus
17
Q

Vertigo: Central

A
  • Dangerous/Quality of life affected
  • Usually concerns brainstem deficits
  • Onset: sudden
  • Causes: more severe
  • Duration: variable but rarely continuous
  • Hearing: unaffected (tinnitus absent)
  • Additional features: usually w/ other brainstem deficits– dysarthria, ataxia, crossed motor and sensory deficits
18
Q

Weakness or Paralysis (Causes)

A
  • Transient Ischemic Attack: temporary and all Sxs resolve in 24 hrs
  • Cerebrovascular Accident: stroke that needs CT scan before any Tx
    • Ischemic: due to emboli that prevented blood flow to brain
      • Treated w/ meds to dissolve clots
    • Hemorrhagic: massive bleed in brain → blood has nowhere to go → buildup of pressure → causes damage fast
      • If ischemic-clot-dissolving meds used as Tx ⇒ kills pt
  • CNS lesions: causes focal weakness (specific body part weakened/affected depends on where in brain lesion is)
  • Myopathy: when muscle fibers don’t function normally → causes bilateral proximal muscle weakness like muscular dystrophy
  • Polyneuropathy: causes bilateral distal muscle weakness
  • Myasthenia Gravis: autoimmune disorder
    • ↑ muscle weakness w/ repeated effort
    • ↓ muscle weakness w/ rest
19
Q

Myasthenia Gravis (what, associated with, S&S, incidence)

A
  • What: when IS mistakes healthy tissue → produces antibodies that block muscle cells from receiving neurotransmitters from nerve cells
  • Associated w/: tumors of thymus (organ of IS)
  • S&S: Weakness of voluntary (skeletal) muscles ⇒ ↑ muscle weakness w/ repeated effort
  • Incidence: affect ppl of any age but common in young women and older men
20
Q

Infections: Meningitis (what, causes, S&S, seen more in)

A
  • What: inflammation of meninges (membrane around brain/spinal cord)
  • Causes: bacteria, virus, fungi, parasite, other toxin
  • S&S:
    • Nuchal rigidity/stiff neck
      • If pt unable to touch chin to chest or if painful → think meningitis
    • Severe headache
    • Fever
    • Malaise
    • ↓ LOC
    • Stupor
    • Coma
    • NV
  • Seen more in pts who have severe deficits in IS
21
Q

Infections: Encephalitis (what, causes, S&S)

A
  • What: inflammation of brain itself
  • Causes: bacteria, virus, fungi, parasite, mosquito bite, etc.
  • S&S:
    • Photophobia
    • Lethargy
    • Muscle weakness
    • Fever
    • Irritability
    • Nuchal rigidity/stiff neck
    • Other neurological Sxs
22
Q

CVA & TIA Same S&S

A
  • Sudden onset of 1 or more of following:
    • Unilateral numbness/weakness of face, arm, or leg
    • Confusion
    • Difficulty speaking or understanding
    • Changes in vision, unilateral or bilateral
    • Loss of balance, difficulty w/ ambulation
    • Severe headache w/ unknown etiology
23
Q

CVA (what + other notes)

A
  • What: hemorrhagic (massive brain bleed where blood has nowhere to go ⇒ pressure causes damage) OR ischemic (emboli prevents blood flow to brain)
  • Ischemic med Tx will kill hemorrhagic pt bc it’s clot dissolving and hemorrhagic is alrdy excessively bleeding !!! ⇒ CT scan first before any Tx !!!
  • Needs Tx within 3 hrs of S&S onset
24
Q

TIA (what + other notes)

A
  • What: narrowing of blood vessels in brain ⇒ decrease in blood flow and oxygen supply
  • S&S fully resolves within 24 hrs
25
Q

CVA & TIA Same Risk Factors

A
  • Age:
    • Older >
    • Women taking birth control pills or pregnant >
      bc of clotting side effects
  • A-fib
  • ↑ lipids
  • Hx of HTN, DM, CAD, surgery
26
Q

CVA & TIA Same Detection

A
  • BE FAST
    • Balance changes
    • Eyesight changes
    • Facial drooping
    • Arm weakness
    • Slurred speech
    • Time to call 911
27
Q

Parkinson’s Disease (what, S&S, risk factors)

A
  • What: slow, progressive disease where there’s damage to dopamine-producing nerve cells in striatum nigra ⇒ results in poor communication between parts of brain that coordinate and control movement and balance
  • S&S:
    • Insidious/Slow onset
    • Bradykinesia: slowing or freezing of movement
    • Tremor of hands, arms, legs, jaw, face
    • Pill rolling: pill between forefinger and thumb and they keep rolling it
    • Muscle rigidity
    • Shuffled walk bc of affected coordination ⇒ ambulation affected
    • Impaired posture
    • Changes in speech
    • Falls
    • Anxiety
    • Dementia in late stage
  • Risk Factors:
    • Age
    • FHx of Parkinson’s (large role)
    • Pesticide exposure
    • Head trauma that can later result in Parkinson’s
28
Q

Multiple Sclerosis (MS) (what, S&S, diagnosed with)

A
  • What: autoimmune disorder that causes progressive demyelination of nerve fibers
    Myelination of nerve fibers ⇒ better and fast signal transmission than unmyelinated
    Demyelination affects brain and spinal cord
  • S&S: commonly remitting/relapsing
    • Paresthesia
    • Diplopia and/or Nystagmus
    • Depression
    • Impaired gait
    • Difficulties w/ bowel/bladder
    • Sexual dysfunction
    • Fatigue
  • Diagnosed w/ brain scan
29
Q

Speech Disorders (aphonia, dysphonia, dysarthria, aphasia)

A
  • Aphonia: loss of voice w/ disease that affects larynx or its nerve supply
  • Dysphonia: less severe impairment in volume, quality, or pitch of voice
    • Causes: laryngitis, laryngeal tumors, unilateral CN X paralysis
  • Dysarthria: defect in muscular control of speech apparatus ⇒ slurred/nasal speech
    • Causes: motor lesions of CNS or PNS, Parkinson’s, Cerebellar disease
  • Aphasia: disorder in producing or understanding language
    • Cause: lesions in dominant cerebral hemisphere
    • Types:
      • Wernicke’s: fluent & repetitive where rapid speech, inflection and articulation good but sentences makes no sense
      • Broca’s: nonfluent & expressive where speech is slow and laborious, inflection and articulation impaired but sentences make sense
30
Q

COVID-19 S&S

A
  • Anosmia: loss of smell
  • Ageusia: loss of taste
  • Peripheral nerve damage
  • Disorientation & Confusion
  • Psychosis
  • Post-traumatic stress
  • Memory loss
  • Altered mental status
  • Encephalitis
  • Hemorrhage
  • Dizziness
  • Agitation
  • Headache
  • Weakness
  • Stroke
31
Q

Traumatic Brain Injury (S&S: changes in…)

A
  • Physical
  • Behavioral
  • Cognitive
  • Interpersonal
  • Environmental
32
Q

Red flags

A
  • “Worst headache of my life”
  • Pt 50+ w/ no Hx of headaches recently complaining of headache → think secondary type of headache
33
Q

Age-Related Considerations: Infants & Children

A
  • Normal
    • Significant brain growth in 1st yr of life + continues to ~12-15yrs
    • Reflexes primitive in newborn (grasping, startle, stepping)
    • Motor maturation is cephalocaudal in nature (head to toe development)
  • Abnormal
    • TBIs
    • Cerebral palsy: permanent disorder of movement and posture development bc it’s a group of disorders that can involve brain and nervous system function
      • Affects: cognitive learning/thinking, vision, hearing, movement
      • Types: spastic, dyskinetic, ataxic, hypotonic, mixed, etc.
    • Myelomeningocele (Spina Bifida): congenital defect of one or more vertebrae (commonly lumbar or sacral) that permits meningeal sac filled w/ a portion of spinal cord to protrude
      • Affects (depends on severity): walking, bladder control
    • Shaken Baby Syndrome: shaking kid and brain excessively
      • Abuse bc brain is bouncing from one side of skull to other
      • S&S: if they have these and no Hx of other disease → think abuse
        • Subdural hematoma
        • Retinal hemorrhage
        • Brain swelling
34
Q

Age-Related Considerations: Pregnant Women

A
  • Normal (relieves after delivery)
    • Increase sleep in 1st trimester w/o feeling rested
    • Decrease sleep in 3rd trimester: has associated somatic Sxs like leg cramps
    • Carpal tunnel syndrome due to fluid retention
35
Q

Age-Related Considerations: Older Adults

A
  • Normal
    • ↓ # of cerebral neurons: not associated w/ deterioration in mental function
    • ↓ velocity of nerve impulse ⇒ may slow response time
36
Q

Stroke Primary & Secondary Prevention

A
  • Primary: Target modifiable risk factors of cardiovasc diseases
    • HTN
    • Smoking
    • Dyslipidemia
    • DM
    • Weight management
    • Diet & Nutrition
    • Physical activity
    • EtOH
  • Secondary Prevention: For pts who alrdy had TIA or CVA → identify underlying cause and reduce cardiovasc risk factors + interventions of antiplatelet agents, anticoagulants, carotid revascularization
37
Q

How to Document General OBJECTIVE Findings

A
  • AO x3 = alert and oriented to person, place, time
  • AO x 4 = alert and oriented to person, place, time, event
  • No apparent distress
  • Conversation clear and appropriate
  • CN II-XII grossly intact
  • Balanced gait
  • Upright posture
  • Negative Romberg test
  • Muscle Strength 5+ BUE & BLE
  • Peripheral sensations intact BIL
  • DTRs 2+ BUE & BLE

Exam 4 | Health Assessment (6 decks)

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