Neurological Assessment Part 2 Flashcards
Questions about the history of present illness for neurological assessment
- any numbness or tingling
- seizures
- headaches
- muscle weakness
- slurring of speech
Tingling is common as we ? and in ?
age, diabetes
seizure that is Due to high fever, can be corrected but some
prolong
infantile seizure
Questions about past health history
- head injury with or without loss of consciousness
2 ever had meningitis, encephalitis, injury to the spinal cord, stroke? - of hypertension, stroke, Alzheimer’s?
management for cranial bleeding where we put
hole in the skull to drain the excess blood
burr holing
procedure to remove a part of skull due to tumor or too big
blood clump
craniotomy
Questions about LIFESTYLE AND HEALTH PRACTICES
1.) Smoke
2.) Diet
3.) lifting heavy objects
- disorder that causes decreased blood flow
to the fingers that causes the color to change.
Raynaud’s disease
AKA thromboangiitis obliterans; affects
blood vessels in the body, most commonly in the arms and legs.
Buerger’s disease
FIVE CATEGORIES IN NEUROLOGICAL EXAMINATION
- MENTAL STATUS
2.
need to take note to the appearance of the patient for neurological assessment (4)
- Posture
- Body movements
- Dress
- Grooming and hygiene
Restlessness - may be due to ? and ?
anxiety, hypothyroidism
Level of consciousness (5)
Alert
Lethargic
Obtunded
Stuporous
Comatose
Level of consciousness; Responds fully and appropriately to stimuli, Can answer to your questions properly and accurately
Alert
indicator for stroke
F.A.S.T
meaning of F.A.S.T
F- face
A- arms
S- Slurring of the speech
T- time
Level of consciousness; Drowsy, responds to questions then fall asleep
● Example: Sa hapon inaantok antok ka na
lethargic
Level of consciousness; Open eyes, responds slowly, confused ● When you ask questions, they do not answer you appropriately
obtunded
Level of consciousness; Arouses from sleep only from painful stimuli
Stuporous
Level of consciousness; Unarousable with eyes closed even with painful
stimuli
Comatose
score for comatose
3-8
score for generally comatose
7
score for conscious; fully alert and functioning
15
A sustained state of inner feeling
mood
cognitive functions; Person, place and time
orientation
cognitive functions; Ability to concentrate
attention span
cognitive functions; past events
Remote Memory
cognitive functions; 4 unrelated word test
New Learning
cognitive functions; Job plans, social family obligations and plans for the
Judgment
THOUGHT PROCESSES AND PERCEPTION; logical, coherent, and relevant
Thought Processes
THOUGHT PROCESSES AND PERCEPTION; ideas, beliefs, use of words
○ Hallucination
○ Ako si Superman or I’m the richest person in the world ○ May mga naririnig or nakikita ako
Thought Content
THOUGHT PROCESSES AND PERCEPTION; Awareness of reality
○ Aware kung mainit, may pamaypay ka
Perceptions
THOUGHT PROCESSES AND PERCEPTION; Do not disregard when someone tells you to end their life
Screen for suicidal thoughts
Provide information regarding transmission of motor and sensory messages (head and neck)
cranial nerves
For patient with cardiac problem, we do not want them to be ?
constipated
patient with cardiac problem, we do not want them to be constipinated
bc of vagus nerves which can lead to heart
attack
cranial nerve; Sense of smell
1 - Olfactory
cranial nerve; Vision Visual acuity, visual fields, ocular fundi, test for near vision
2 - optic
cranial nerve; Pupillary constriction, opening the eye and most extraocular movements
3 - oculomotor
cranial nerve; Downward, inward movement of the eye
4 - Trochlear
cranial nerve; Corneal reflexes, facial sensation, and jaw movements
5 - Trigeminal
trigeminal; Temporalandmasseter muscles (jaw clenching), lateral movement of the jaw
motor
trigeminal; Facial3divisions(1) Ophthalmic, (2) Maxillary, (3) Mandibular
sensory
cranial nerve; Lateral deviation of theeye
6 - Abducens
cranial nerve; Motor:Facial movements, facial expressions, closing the eye, closing the mouth
7 - Facial
cranial nerve; Hearing (cochlear division) & Balance (vestibular division)
8 - Vestibulocochlear
cranial nerve; Swallowing, rise of the palate, gag reflex
9 - Glossopharyngeal
Glossopharyngeal; Pharynx (motor or sensory)
motor
Glossopharyngeal; Posteriorportionsofthe
eardrum and ear canal, the pharynx, posterior tongue including taste (motor or sensory)
sensory
cranial nerve; Motor: Palate, pharynx, larynx - Sensory: Pharynx and larynx
10 - Vagus
cranial nerve; Shoulder and neck movements
11 - Accessory
cranial nerve; Sternocleidomastoidand
upper portion of the trapezius (motor or sensory)
motor
cranial nerve; Tongue symmetry and position
12 - Hypoglossal
cranial nerve; Hypoglossal - Tongue (sensory or motor)
motor
“absence of smell”
Anosmia
If it is ? (one nostril cannot smell) : Tumor on one side of the brain
unilateral
If it is ? (both nostril cannot smell): The patient may have colds
bilateral
impaired near vision
Presbyopia
test for Distant Vision
Snellen’s Chart
Nearsightedness
myopia
Farsightedness
hyperopia
Distance from the chart (eye test)
20 meters
Blindness starts at
200
Visual Fields by Confrontation; Inferior
70 degrees
Visual Fields by Confrontation; superior
50 degrees
Visual Fields by Confrontation; Temporal
90 degrees
Visual Fields by Confrontation; Nasal
60 degrees
Inspect margins of eyelids: Eyelid covers ? mm of iris
2
Weak eye muscles
phosis
test for Six cardinal fields
G method or wheel method
Follow objects within 5-8 cm of nose
Test for convergence
Rhythmic oscillation of the eyes; involuntary jerking movement of the eyes with quick and slow components
Nystagmus
Lack of muscle coordination
Strabismus
Double vision
Diplopia
Pupil inequality of <0.5 mm
Anisocoria
Pupillary constriction in the same eye
Direct light reflex
pupillary constriction in the opposite eye
Consensual light reflex
PERRLA MEANING
P-Pupil
● E-Equal
● R-Round
● R - Reactive to
● L-Lightand
● A - Accommodation
How fast the movement of the pupil is
BRISK
How slow the movement of the pupil is
SLUGGISH
Maybe due to tumor
DILATED
Small in size
PINPOINT
abnormal for trigeminal nerve; PNS or CNS dysfunction
bilateral
abnormal for trigeminal nerve; Lesion of CN V
unilateral
3 division of sensory division of trigeminal nerve 5
ophthalmic, maxillary and mandibular
sensory function of trigeminal nerve lesion in the (3)
Trigeminal nerve, Spinothalamic tract, Posterior columns
corneal reflex lesion in the (2)
Trigeminal nerve, Motor part of CN VII
abnormal for facial nerve
Bell’s Palsy, Paralysis lower part of the face
Identify different flavors
sensory function
Reflex regulates the motor response
Corneal Reflex
test for VESTIBULOCOCHLEAR nerve
Weber’sTest
Evaluate conduction of sound waves through bones
Weber’sTest
Helps distinguish between conductive hearing and sensorineural hearing
Weber’s Test
sound waves transmitted by the external and middle ear
Conductive hearing
Sound waves transmitted by the
inner ear
Sensorineural hearing
Hangin. Kapag umiinom ng antibiotics, may something sa tenga
Tinnitus
Conduction hearing loss, Sensorineural hearing loss
Deafness
Compares air and bone conduction sound
RinnesTest
normal for rinnes test
Air conduction heard longer than bone conduction
BC> AC
Conductive hearing loss
AC > BC
Sensorineural hearing loss
Test the vestibular portion of the nerve
CaloricTest
Performed only when client is experiencing dizziness and
vertigo
Caloric Test
normal for CRANIAL NERVE IX AND X
soft palate rises, uvula remains in midline
abnormal for CRANIAL NERVE IX AND X
Soft palate does not rise- bilateral
○ Unilateral rising of soft palate and deviation of usual to the
normal side- unilateral lesion CN X
normal gag reflex
Intact gag reflex
■ Symmetrically diminished or absent in some normal
people
abnormal gag reflex
Risk for aspiration
Motor activity of pharynx
Swallow w/o difficulty
● Deafness
normal trapezius muscle
abnormal trapezius muscle
normal sternocleidomastoid muscle
Ease of movement
○ Wide range of movements
abnormal sternocleidomastoid muscle
Wide range of motion, Muscle weakness
○ Drooping of the shoulders