Neurological Assessment Flashcards
State how three different types of cells can cause different nervous system illnesses and what each cause?
- infarctions (neurones which don’t received sufficient blood flow)
- Multiple sclerosis (inflammation destruction and plaque affecting nerve impulse)
- Tumours (cells of NS growth)
What are different categories of brain conditions?
- traumatic brain injury’s (focal injury)
- cerebral haemorrhage (bleed between meninges layers of brain)
- Infection (focal or global infection)
- Oedema (swelling)
- Hydrocephalus (increased cerebrospinofluid)
Which section of the A-E assessment would you do a neurological assessment?
D - disability
- AVPU or GCS
- Pupillary response
- motor assessment
- sensory assessment
- blood glucose level
What are the 5 sections of the neurological observation chart?
- GCS
- Limb movements
- Vital signs
- Pupils
- Sensations
Define conciousness
State general awareness of self and environment including ability to orientate time, place and person.
What is the reticular activating system complex?
What does the complex allow for?
Network nerves extending from brain stem to forebrain, thalamus and cerebral cortex to receive sensory information
Greater sensory stimulation = greater alertness = greater consciousness
What does AVPU stand for?
Alert
Responsive to voice
Responsive to pain
Unresponsive
Evaluate the AVPU method
Pros
- Simple, rapid and easy
- For trauma patients
Cons
- Only allows overview assessment not any causes or details
- Poor sensitivity to moderate impairment
What score on the GCS requires escalation?
Any score below 8 as airways are compromised
Escalate if GCS changes by 2 or more (any change is a change)
Evaluate the glasgow coma scale
- Most reliable
- Standardise neurological observations
- Quick, easy, objective, reliable and accurate
- Allow early changes in consciousness for treatment and management
Con
- Not as effective if symptoms like swelling to eyes that effect their ability to open
Describe the GCS scoring method
Conciousness score
- 15 point score (8 or more escalate)
- For each section give best responses and only one
- Best eye opening - Start just visually, then talk to the patient, then response to pain (assessing the central nervous system)
- Best verbal response – Levels from whole conversations and no confusion to no sounds or audible noises)
- Best motor response – purposefully obeys to no response
What can you use for a painful stimuli to assess best eye opening in a GCS?
- Trapezius squeeze – caution in spinal injuries as pressure is applied
- Supraorbital notch pressure – eyebrow/ above eyeball
- Jaw angle pressure
What circumstances should you immediately escalate in pupillary response?
Unequal in size or shape or sluggish
What does pupillary response assess?
- Assess cranial nerve 3
Explain the process of a checking a pupillary response
What is the normal response to pupillary response?
- Assess cranial nerve 3
- Each pupil must be assessed for shape, size and reaction to light
- Shape – round
- Size – equal sizes and generally 3-5mm
- Reaction – react to light quickly, abnormal reactions are slow, sluggish or non reactive.
What are some specific symptoms that should be escalated?
- Visual fields and visual acuity – CN 2 optic nerve
- Unable to open eyelid – CN 3 oculomtor nerve
- Facial weakness – CN 7 facial nerve
- Hearing loss – CN 8 – acoustic nerve
- Gag and swallow deficits - CN 9 glossophrary nerve
How would you do a motor and sensory assessment?
- Limb motor power and sensation (each assessed individuals)
- Use dermatology map to display where problems/ symptoms are in the body
- Motor power – assess power and movement of each limb
- Can differentiate between sides eg. Left severe and right normal
Categories
1. Normal 2. mild 3. severe 4. Abnormal flexion 5. Extension 6. nil movement
What are the categories of motor and sensory assessment?
- Normal (overcomes resistance applied can overcome gravity)
- Mild (difficult overcoming resistance applied)
- Severe (patient can not overcome resistance)
- Abnormal flexion (abnormal movement where wrists externally rotate and arms flex inwards towards body)
- Extension – abnormal movement where finger, wrists and arms externally rotate and straighten away from body
- Nil – no movement
What is a myoclonus?
brief involuntary twitching of muscle eg. Seizure
What is a fasciculation?
involuntary muscle contraction and relaxation
What is paralysis>
loss of motor movement
What is a tic?
involuntary twitch of muscle
What is a rest tremor?
coarse, slow movement
What is an intention tremor?
worse with voluntary movement
What is chorea?
sudden rapid jerky movements of limb
What is atherosis?
slow, twisting writhing movements
State the three different abnormal muscle tones?
Flaccidity – decreased muscle tone
Spasticity – increased tone
Rigidity – constant state of resistance eg. parkinsons
What is a flaccidity muscle tone?
Decreased muscle tone
What is spasticity muscle tone?
Increased tone
What is rigidity muscle tone?
Constant state of resistance eg. parkinsons
How would you do a sensory assessment?
Commonly associated with spinal conditions
Assess arms, trunk and legs for
- Normal sensation
- Pins and needles
- Numbness
- Hypersensitivity
- None
How would you provide escalation if you were worried following a neurological assessment?
- Increased frequency of observations to 15 minute in deteriorating patients
- Escalate changes and concerns
- Prepare for further investigations or treatments eg, CT scan, MRI or pharmacological
