neurological assessment Flashcards
what do spinal nerves innervate?
dermatomes
reasons to conduct a neuro assessment could be…
headache
head injury
dizziness/vertigo
tremors
seizures
weakness
incoordination
numbness or tingling
difficulty swallowing or talking
components of the neurological examination
vital signs
level of consciousness
communication/speech
orientation
motor
sensory pain
pupillary reaction
deep tendon reflexes
aphasia
loss of language function
babinski sign
dorsiflexion of the foot with extension and splaying of the toes in response to the plantar reflex, normally suppressed by corticospinal input (toes should bend down)
paresis
partial loss of or impaired voluntary muscle control
sensation
nervous function that recieves info from environment and translates it into electrical signals
what is a dermatome
a sensory area of skin related to the spinal cord segment and nerve
dermatome landmarks
axilla - T1
nipple - T4
umbilicus - T10
groin - L1
knee - L4
glasgow coma scale
standardized objective assessment defining LOC by giving it a numerical value
lowest and highest scores for glasgow coma scale
lowest score possible - 3
normal/highest - 15
coma - 8 or less
decerebrate and decorticate posturing are signs of…
brain death, the brain can no longer distinguish where pain is coming from
decorticate posturing
damage to corticospinal tracts, movement inward and toward the core
decerebrate posturing
damage to the brain stem results in movement outward
AVPU of mental status assessment
alert, verbal, pain, unresponsive
conscious M/S testing
direct commands
assess muscle strength against resistance
assess gait and speech
unconscious M/S testing
observe for spontaneous mvmt
assess resistance to mvmt
assess response to painful stimuli (trapezius, sternal rub)
deep tendon reflex
Romberg’s test assesses…
proprioception by having patient stand with eyes closed and maintain balance
Romberg’s test results
positive = loss of balance
negative = maintain balance
suggests ataxia (poor muscle control) is sensory in nature
what tests can assess cerebellar function
balance tests, coordination and skilled movements (RAM)
RAM test
patient pats knees with front and back of hands, finger to finger tests (tremors)
diadochokinesia
ability to perform RAM
dysdiadochokinesis
slow, irregular, clumsy movements
balance tests
test gait by having them walk and then turn the other way, tandem walk, Romberg test
stereognosis
recognize objects with eyes closed
graphesthesia
read number traced on hand
two point discriminatoin
distinguish separation of two stimuli (ex: paresthesia and diabetes will have abnormal findings)
superficial pain sensation test
assess sharp and dull pain
if pain sensation is abnormal how should you proceed?
with a temperature test
light touch test
apply wisp of cotton
motor function tests (hand and feet)
hand grips, dorsiflexion of feet against resistance
primary sensory functions
light touch, pain, temperature, vibration
sensory function procedure
observe all sensory function tests for bilateral differences
impairments can be mapped by dermatome
light touch, vibration w tuning fork, temperature, monofilamnet
monofilament test
touch to 6 random sites on sole of foot, should be able to tell when it is touching foot
deep tendon reflexes scale
0 - absent
1 - sluggish or diminished
2 - brisk, EXPECTED
3 - more brisk than expected
4 - hyperactive with clonus
babinski reflex
draw blunt object along sole of foot from heel to ball, touch should flex down
what does brudsinskis sign test for?
meningeal irritation
brudzinski’s sign test
nuchal rigidity, place hand under neck and on patient’s chest, have them point chin to chest
abnormal: resistance with pain in neck and flexion of hips
kernig’s sign
flat, supine position
raise leg straight or flex, extend knee
abnormal: resistance to straightening
PERRLA pupillary assessment
pupils, equal, round, reactive to, light, accomodation
accomodation in pupillary assessment
near and far, moving finger in and out, eyes should accomodate for the movement
consensual pupillary
light in the right and left eye responds equally
direct response pupillary
light in the right eye and the right eye responds
unequal pupil sizes could mean…
late sign of brain injury (BAD), tumor, concussion
cranial nerve 1
olfactory nerve, able to detect smell in each nostril
cranial nerve 2
optic nerve, visual acuity 20/20
cranial nerve 3
oculomotor, no drooping eyelids
cranial nerve 4
trochlear, PERRLA findings
cranial nerve 5
trigeminal, masseter strength and sensation to light touch of forehead, cheeks, jaw
cranial nerve 6
abducens, direct and consensual reaction to stimuli
cranial nerve 7
facial nerve, no facial asymmetry (close eyes, blow cheeks)
cranial nerve 8
acoustic, hearing intact, balance
cranial nerve 9
glossopharyngeal, uvula should elevate with palate
cranial nerve 10
vagus, swallows easily and speaks clearly
cranial nerve 11
spinal accessory, shoulder shrug against resistance and neck rotation
cranial nerve 12
hypoglossal, tongue strength and rest/extension
common neurological diagnostics
CT, MRI, angiography, EEG, lumbar puncture
red flags in neuro assessment
seizure in someone without seizure history
change in LOC or sensorium
sudden weakness/paralysis
sudden inability to speak
sudden inability to follow directions
sudden loss of vision
fever with stiff neck
neuro check on hospitalized patinet
LOC
pupillary check
facial symmetry
AVPU or glasgow coma scale
tongue midline
speech clear and articulate
hand grasp strength
wiggle fingers
wiggle toes
