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.
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
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)
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
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
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
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
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
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
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
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
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
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!!!
- Testicle and scrotum should rise on stroke side
- What: stroking inner thigh of male pt proximal to distal to elicit cremasteric reflex
- Plantar → L4, L5, S1, S3
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
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
