Neurological Assessment 3 Flashcards
PERL or PERRLA
pupils, equal, round, reactive to light
acute assessment
LOC (level of Consciousness); GCS (Glasgow Coma Scale); Pupillary Reaction; Extremity strength; Sensation; CN; EOM (extraocular movement), gag reflex and corneal reflex
what is the window from onset to treatment in order to reverse symptoms
3 hours
new onset could be
overdoes of medication such as aspirin causing tinnits
0-4 year olds have higher risk for
brain injury
elderly
possible slow bleed w/ falls, as we age greater the risk of strokes
men often have
thromboylitic strokes
there is a strong correlation between
a fib and stokes
spinal cord injuries are higher in
young adults
focused health history
Numbness; Seizures, tremors, fasciculations; Headaches; Dizziness, vertigo, syncope – blackout recently?; Changes in senses: smell, taste, vision, hearing (tinnitus); Changes in swallowing (dysphagia) or speech (dysphasia/dysarthria - difficulty announcing words); Mental status change; Family History - brain tumors, stokes, high bp and same risk for cardiovascular; Psychosocial—medications, alcohol, seat belts, head gear, lead exposure
level of consciousness
Degree of wakefulness or arousability
fully awake
highest LOC, respond to all sensory stimuli; may be fully awake, but still disoriented or forgetful
alert
fully awake & oriented to person, place, time, environment; responds to verbal stimuli
lethargic
drowsy or sleeps most of time; capable of spontaneous movements; gentle shaking/speaking needed; falls back to sleep easily
obtunded
sleeps most of time and makes few spontaneous body movements; more vigorous stimulation to arouse; still makes verbal response
stuporous
unconscious most of time, no spontaneous motor activity; requires strong, noxious stimuli; verbal response limited or absent
comatose
cannot be aroused even by applying “painful” stimuli
Glascow Coma Scale
Tests for basic neurological function (high score = 15, low = 3) ; Evaluates LOC; Three LOC parameters; Not always reliable(Pediatrics—uncooperative, afraid; Elderly—hearing, vision, memory loss; Paralyzed—altered motor function)
Three LOC parameters
Eye opening, Best motor response, Best verbal response
GCS- patients with scores of 3-8 are usually said to be
in a coma
extension posturing
pons and upper function loss
abnormal flexion
damage to midbrain
awareness
ability to understand, think, feel emotions and sense of environment
assessing orientation
Awareness; Oriented to time, place, person (x3) and environment (x 4); Mini-Mental State Examination (MMSE); Abstract Reasoning
