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Health Assessment > Neurological Assessment > Flashcards

Neurological Assessment Flashcards

1
Q

What are the 2 main types of nervous systems?

A

Central and Peripheral (Peripheral is further split into somatic and autonomic).

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2
Q

What are the main structures of the CNS?

A

Cerebral Cortex, Basal Ganglia, Thalamus, Hypothalamus, Cerebellum, Brainstem, Spinal Cord.

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3
Q

What is crossed representation?

A

Feature of the nerve tracts where the left cerebral cortex receives sensory info from and controls the right cerebral cortex, and vice versa.

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4
Q

What is the spinothalamic tract?

A

Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch.

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5
Q

When asking patient history, what are some changes that are notable?

A 
Change in A&O and memory
Change in sensation
Change in performing ADL's
Change in appearance or symmetry
Changes in dizziness, fainting, insomnia, nervousness, tremors, weakness, gait, and coordination.
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6
Q

What are important aspects when gathering patient’s FAMILY history?

A

Seizure, stroke, dementia, lightheadedness/vertigo, learning, retardation, neuromuscular disorders.

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7
Q

What are some important things to know about a patient’s PAST history?

A

Birth trauma, injury, speech/hearing problem, exposure to chemicals, alcohol, coffee, drugs, medications, and allergies.

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8
Q

What is some equipment you would need for a neurological exam?

A

Flashlight, tongue blade, tuning fork, reflex hammer, sensory testing equipment.

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9
Q

What is the order of the neurological exam?

A
  1. Mental status
  2. Cranial Nerves 1-12
  3. Motor function
  4. Sensory
  5. Cerebellar
  6. Reflexes
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10
Q

Mental status

A

A person’s emotion and cognitive functioning. This cannot be scrutinized directly like skin or heart sounds. Its functioning is inferred through assessment of the individual’s behaviors.

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11
Q

Mental disorder

A

Significant behavioral or psychological pattern associated with distress, a painful symptom, disability, impaired functioning, or significant risk of pain, disability, death of loss of freedom.

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12
Q

Organic disorders

A

Due to brain disease of known specific organic cause (ex. delirium, dementia, alcohol/drug intoxication and withdrawal)

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13
Q

Psychiatric mental illness

A

Organic etiology has not yet been established (ex. anxiety disorder, schizophrenia)

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14
Q

What are some behaviors that can help you assess a person’s mental status?

A

LOC, language, mood, affect, orientation, attention, memory, abstract reasoning, thought process, thought content, perceptions.

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15
Q

What is the Glasgow coma scale (GCS)?

A

A standardized objective assessment that defines the LOC by giving it a numeric value. Divided into three areas: eye opening(4), verbal response(5), and motor response(6). Normal score is 15, 7 or less is a coma.

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16
Q

LOC

A

(Level of consciousness) Alert, awake, readily aroused

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17
Q

Lethargy

A

Responds appropriately once aroused

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18
Q

Obtunded

A

Transitional state between lethargy and stupor; difficult to arouse

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19
Q

Stupor

A

Semi-coma, arousal to stimuli(shake or pain) with simple motor or moaning responses

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20
Q

Coma

A

Completely unconscious; no pain response

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21
Q

What can grooming indicate?

A

Poor hygiene or lack of concern about appearance may indicate major depression, dementia, or psychiatric disturbance.

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22
Q

Facial expression should be consist with…

A

Emotional content of topic discussed.

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23
Q

What are some aspects of body language that may be observed?

A

Eye contact, posture, hyper vigilance

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24
Q

Affect

A

Describes emotional reaction

25
Q

What are the four different intensities/ranges of affect?

A
  • Congruents-with context and situation
  • Constricted-a reduced range and intensity
  • Blunted-more reduced
  • Flat-no expression
26
Q

Mood

A

Longer term emotion; sustained presentation

27
Q

What are different words to describe a patient’s mood?

A 
Euthynic-normal
Depressed/Dysthymic
Elevated
Irritable,
Anxious
28
Q

What are some signs of a depressed mood?

A
  • Verbalizes feeling sad, hopeless, helpless, worthless.
  • A loss of interest
  • Crying spells, hyperrsomnia, insomnia
  • Appetite change
  • Appears sad; cries easily
  • Psychomotor retardation
29
Q

Manic

A
  • Elevated, expansive, euphoric
  • Exaggerated feeling of well being
  • Not justified by objective circumstances
  • Reports feeling elated
  • Appears happy, exhibits controlling and dominant behavior
30
Q

Anxiety

A
  • Unrealistic or excessive worry
  • Apprehension about life
  • May report dizziness, palpitations, nausea, vomiting, diarrhea
31
Q

Irritable

A

Anger, animosity, contempt, belligerent, disdain for people.

32
Q

What are some signs of possible cognitive impairment?

A

Impaired communication, inappropriate affect, getting lost in a familiar place, or at night, hazardous behavior, memory loss, agitated or suspiciousness, trouble performing ADLs.

33
Q

What are some methods of cognitive testing?

A

Current events, insight/judgement(give a scenario), repetition of series of numbers, word listing.

34
Q

What would you ask a patient in order to determine short term memory?

A

Ask for a 24 hour diet recall.

35
Q

What questions would you ask to determine a persons long term history?

A

Ask person verifiable past events such a birthday, anniversary date, or relevant historical events.

36
Q

What is MMSE?

A

Mini mental status exam; a simplified scored form of the cognitive functions of the mental status exam (takes 5-10 minutes, about 11 questions)

37
Q

What are thought content abnormalities?

A

Delusions, paranoid ideation, ideas of reference, obsessions compulsions, phobias

38
Q

Delusion

A

False beliefs firmly sustained in site of what everyone else believes, or evidence to the contrary

39
Q

Paranoid Ideation

A

Not delusional but suspicious, feels harassed, persecuted or unfairly treated. Projects blame or accuses other of malicious intent.

40
Q

Ideas of Reference

A

Less firm than delusion but believes events, objects or people have unusual meaning specifically to him/her

41
Q

Obsessions

A

Recurrent, persistent senseless ideas or impulses that interfere with thought

42
Q

Compulsion

A

Irresistible urges to engage in meaningless motor acts

43
Q

Phobias

A

Strong, persistent irrational fear.

44
Q

What is judgement and how do you assess it?

A

When a person can compare and evaluate alternatives in a situation and reach and appropriate course of action. We can assess it by noting if a person’s job and future plans are realistic.

45
Q

Cranial Nerve I

A

Olfactory. Sensory-smell. Tested by choice of odors.

46
Q

Cranial Nerve II

A

Optic. Sensory- central and peripheral vision, optic disc.

47
Q

Cranial Nerve III

A

Oculomotor-mixed. Parasympathetic-PERRLA, Motor-EOMs, lids.

48
Q

Cranial Nerve IV

A

Trochlear. Motor-EOMS

49
Q

Cranial Nerve V

A

Trigeminal. Motor- muscles of mastication. Sensory-touch, sensation face, scalp, cornea, mucous membranes of mouth and nose.

50
Q

Cranial Nerve VI

A

Abducense. Motor-lateral movement of eye (EOM)

51
Q

Cranial Nerve VII

A

Facial-mixed. Sensory-taste on anterior ⅔ tongue. Parasympathetic- saliva and tear secretion.

52
Q

Cranial Nerve VIII

A

Acoustic. Sensory-hearing and equilibrium.

53
Q

Cranial Nerve IX

A

Glossopharyngeal-mixed. Motor- phonation “ash” and swallowing. Sensory- taste posterior ⅓ tongue, pharynx (gag reflex) Parasympathetic- parotid gland, carotid reflex.

54
Q

Cranial Nerve X

A

Vagus-mixed. Motor-pharynx and larynx(talking and swallowing), Sensory-General sensation from carotid body and sinus, pharynx, viscera. Parasympathetic-carotid reflex.

55
Q

Cranial Nerve XI

A

Spinal Accessory. Motor-sternomastoid and trapezius muscle movement; neck and shoulders resistance.

56
Q

Cranial Nerve XII

A

Hypoglossal. Motor- tongue “light, tight, dynamite.”

57
Q

When testing reflexes, where on the muscle would you strike the reflex hammer?

A

the insertion point of the muscle

58
Q

What is the range of reflex reactions?

A 
4+ very brisk, hyperactive with disease.
3+ Brisker than avg. Maybe disease.
2+ Average, normal.
1+ Diminished, low normal.
0+ No response.

Health Assessment (7 decks)

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