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NSG2317 - health assessment > Neurological Assessment > Flashcards

Neurological Assessment Flashcards

1
Q

Health History Points

A
  1. Headache
  2. Head Injury
  3. Dizziness or Vertigo
  4. Seizures
  5. Tremors
  6. Weakness
  7. Incoordination
  8. Numbness or Tingling
  9. Difficulty Swallowing
  10. Difficulty Speaking
  11. Significant Past History
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2
Q

Epilepsy

A

defined as 2+ seizures within a 24h period

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3
Q

Aura

A

a subjective sensation that precedes a seizure
→ auditory, visual or motor

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4
Q

Paresis

A

weakness of voluntary movements or impaired movement

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5
Q

Paralysis

A

loss of motor function as a result of a lesions in the neurological or muscular system, or loss of sensory innervation

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6
Q

Dysmetria

A

inability to control one’s ROM of their muscles

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7
Q

Paraesthesia

A

an abnormal sensation, such as burning or tingling

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8
Q

Dysphagia

A

difficulty swallowing

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9
Q

Dysarthria

A

difficulty forming words → can still understand words

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10
Q

Aphasia

A

difficulty with language compression or expression → can still form words (unrelated to conversation)

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11
Q

CN I

A

olfactory nerve → smell
- tested only when suspected/presence of head
trauma. changes in mental status, or
intracranial lesion

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12
Q

CN II

A

optic nerve → vision
- snellen eye chart
- confrontation test (peripheral vision)

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13
Q

CN III

A

oculomotor nerves → extraocular movement (EOM)
a. Eyelid opening
b. pupil constriction
c. lens shape
- 6 cardinal planes of vision

test CN III, IV, and VI together*

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14
Q

CN IV

A

trochlear nerve → EOM downwards and inward

test CN III, IV, and VI together*

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15
Q

CN V

A

trigeminal nerve → sensation
a. sensation of the face, scalp, cornea, mucous
membranes, mouth, and nose
b. blinking reflex →corneal reflex
c. muscles of mastication → palpate, feel for
bilateral strength

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16
Q

CN VI

A

abducens nerve → lateral eye movement

test CN III, IV, and VI together*

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17
Q

CN VII

A

facial nerve → facial movement, closing of eyes and mouth
a. taste (anterior 2/3 of tongue) → taste
b. saliva and tear production
c. speech

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18
Q

CN VIII

A

Auditory → hearing + equilibrium
- whispered voice test
- Romberg test

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19
Q

CN IX

A

Glossopharyngeal → production of speech and swallowing
- taste (posterior 1/3)
- gag and carotid reflex

test CN X and IX together* (observe uvula and soft palate elevation when saying “ahhh”)

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20
Q

CN X

A

Vagus nerve → talking and swallowing
- sensation from carotid body and sinus,
pharynx, and viscera
- carotid reflex - dec in HR and BP with bilateral
palpation of arteries

**test CN X and IX together ** (observe uvula and soft palate elevation when saying “ahhh”)

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21
Q

CN XI

A

spinal accessory nerve → movement in trapezius/ sternomastoid muscles
- test with should shrug against resistance

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22
Q

CN XII

A

Hypoglossal nerve → movement of the tongue
- tongue tone/ bulk
- tongue movement
- clear speech → “light, tight, dynamite”

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23
Q

Motor System (3)

A
  1. Muscles
  2. Cerebellar Function
  3. Coordination
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24
Q

Motor System: Muscles

A
  1. Inspection -
    a. size - same bilaterally (<1cm difference)
    b. no involuntary movements (if present, note
    location, frequency, rate and amplitude)
  2. Palpation - strength and tone (ROM tests with and without resistance)
    a. strength - test power of homologous muscles
    simultaneously
    b. tone - normal degree of contraction in
    voluntarily relaxed muscles (passive
    resistance to mild stretch)
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25
Motor System: Cerebellar Function (3 tests)
a. Gait - should be smooth, rhythmic, and effortless - tandem walk (heel-to-toe walk) normally straight and balanced b. Romberg Test c. One-Leg Hop/ Shallow Knee Bend
26
Romberg test
ask the patient to stand with feet together and arms relaxed at their sides, close their eyes and stand for 20 seconds → some swaying is normal, but balance should be maintained - A positive Romberg sign is loss of balance that occurs when the eyes are closed → closed eyes eliminate the advantage of orientation by removing the compensatory response
27
One-Leg Hop/ Shallow Knee Bend
patient should perform a shallow knee bend or hop in place (depending on physical limitations/ capabilities) → Demonstrates normal position sense, muscle strength, and cerebellar function - Inability to perform knee bend because of weakness in quadriceps muscle or hip extensors is abnormal
28
Motor Function Coordination Tests
a. Rapid Alternating Movements b. Ringer-to-Finger Tests c. Fingers-to-Nose Test d. Heel-to Shin Test
29
Sensory System (2)
1. Spinothalamic Tract 2. Posterior Column Tract
30
Sensory System: Spinothalamic Tract
a. Pain b. Temperature c. Touch
31
Sensory System: Posterior Column Tract
a. Vibration b. Position (kinasthesia) c. Tactile Discrimination
32
Hypoalgesia
decreased pain sensation
33
Analgesia
absence of pain sensation
34
Hyperalgesia
increased pain sensation
35
Hypoaesthesia
decreased touch sensation
36
Anaesthesia
absent touch sensation
37
Hyperasthesia
increased touch sensation
38
Stereognosis
patient’s ability to recognize objects by feeling their forms, sizes, and weights, with the eyes closed
39
Astereognosis
inability to identify objects correctly, occurs with sensory cortex lesions
40
Graphesthesia
the patient's ability to read a number traced on skin
41
Two-point discrimination (test)
test the patient’s ability to distinguish the separation of two simultaneous pinpoints on the skin, noting the distance at which the point becomes one
42
Extinction (test)
simultaneously touch both sides of the body at the same point, asking the patient to identify how many sensations they felt and where
43
point location (test)
touch the skin and withdraw the stimulus promptly, ask the patient to identify where the sensation was
44
Reflexes (2)
1. Deep Tendon Reflexes 2. Superficial (cutaneous) Reflexes
45
Deep Tendon Reflexes
involuntary muscle contractions in response to an external stimulus (reflex hammer)
46
Grading Deep Tendon Reflexes
4+ = very brisk, hyperactive with clonus (abnormal, muscles are contracting without coordination), indicative of disease 3+ = brisker than average, may indicate disease 2+ - average, normal 1+ = diminished, low normal 0 = no response → patient might need to be repositioned or distracted to elicit reflex response (have patient perform isometric muscle contraction at a muscle group distal to the location being examined)
47
Biceps Reflex
- contraction of biceps - flexion of the forearm
48
Triceps Reflex
- extension of forearm
49
Brachioradialis Reflex
- flexion and supination of forearm
50
Achilles Reflex
- plantar flexion of the foot
51
Colonus
Tested for when reflexes examined are hyperactive - If colonus is present, rapid, rhythmic contractions of the muscle and movement of the foot is visible and palpable
52
Superficial Reflexes
sensory receptors are located in the skin rather than the muscles
53
Abdominal Reflexes
- ipsilateral contraction of the abdominal muscle with an observed deviation of the umbilicus towards the stroke
54
Plantar Reflex
- plantar flexion of the toes - inversion and flexion of the forefoot
55
Flaccidity
Decreased muscle tone (hypotonia), muscle feels limp, soft, and flappy, muscle is weak and fatigued
56
Spasticity
Increased tone (hypertonia), increased resistance to passive lengthening and then suddenly giving way
57
Rigidity
Constant state of resistance, resistance to passive movement in any direction, dystonia (constant state of involuntary muscle contraction)
58
Cogwheel Rigidity
Type of rigidity in which the increased tone lessens by degrees during passive ROM so that it feels like small, regular jerks
59
Multiple Sclerosis
Chronic, progressive, immune-mediated disease​ - Axons become inflamed, demyelinated, degenerated, and undergo sclerosis - results in uncoordinated muscle movement, muscle spasms, loss of coordination and balance
60
Paraplegia
Lower motor neuron damage caused by spinal cord injury - Initially produces “spinal shock” (no movement or reflexes below lesion) → gradual return of deep tendon reflexes (flexor spasms of legs into extensor spasms of leg - Spasms lead to extensor tone (knees don't bend easily, limited ROM)

NSG2317 - health assessment (18 decks)

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